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Initial experience with regadenoson stress positron emission tomography in patients with left bundle branch block: Low prevalence of septal defects and high accuracy for obstructive coronary artery disease

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Assessing for coronary artery disease (CAD) in patients with left bundle branch block (LBBB) is difficult with noninvasive cardiac imaging. Few studies report the prevalence of LBBB associated septal-apical perfusion defects using regadenoson stress on Positron Electron Tomography (PET) imaging.

Methods and Results

We identified 101 consecutive patients with baseline LBBB, and without known CAD, who underwent rest-stress regadenoson PET. Investigators have the ability to prospectively identify studies, whose quality is limited by LBBB artifact. With the infusion of regadenoson, resting to peak stress heart rate rose from a median of 78 to 93 BPM. Despite this, LBBB perfusion artifacts were not identified in any studies. 10 individuals had both regadenoson SPECT and PET within 1 year. 3 of the 10 SPECT studies had LBBB artifacts, all of which were not seen on subsequent PET. 21 patients with PET had subsequent coronary angiography. Of these, 9 PETs were without significant inducible ischemia, and angiogram was without flow-limiting disease. 3 PETs identified inducible ischemia, but did not have flow-limiting disease on angiogram. 9 PETs identified inducible ischemia and had flow-limiting disease on angiogram.

Conclusions

In patients with LBBB undergoing regadenoson PET stress imaging, artifactual septal perfusion defects are rare.

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Abbreviations

CAD:

Coronary artery disease

IRB:

Institutional review board

LAD:

Left anterior descending

LBBB:

Left bundle branch block

LCx:

Left circumflex

MPI:

Myocardial perfusion imaging

PET:

Positron emission tomography

Rb-82:

Rubidium-82

RCA:

Right coronary artery

SPECT:

Single-photon emission computed tomography

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Disclosure

Dane Meredith, Paul Cremer, Serge Harb, Bo Xu, Amgad Mentias, and Wael Jaber have no relationships relevant to the contents of this paper to disclose.

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Authors and Affiliations

  1. Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA

    Dane Meredith MD, MPH, Paul C. Cremer MD, Serge C. Harb MD, Bo Xu MD & Wael A. Jaber MD

  2. Department of Cardiovascular Medicine, University of Iowa, Iowa City, IA, USA

    Amgad Mentias MD

Authors
  1. Dane Meredith MD, MPH
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  2. Paul C. Cremer MD
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  3. Serge C. Harb MD
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  4. Bo Xu MD
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  5. Amgad Mentias MD
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  6. Wael A. Jaber MD
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Correspondence to Dane Meredith MD, MPH.

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Meredith, D., Cremer, P.C., Harb, S.C. et al. Initial experience with regadenoson stress positron emission tomography in patients with left bundle branch block: Low prevalence of septal defects and high accuracy for obstructive coronary artery disease. J. Nucl. Cardiol. 28, 536–542 (2021). https://doi.org/10.1007/s12350-019-01681-4

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  • DOI: https://doi.org/10.1007/s12350-019-01681-4

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