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. 2024 Dec 7;2(3):qyae129.
doi: 10.1093/ehjimp/qyae129. eCollection 2024 Jul.

Usefulness of dynamic perfusion SPECT with quantitative assessment of myocardial perfusion reserve for the detection of myocardial ischaemia in patients with presumed new left bundle branch block

Alain Manrique  1 , Clément Guery  1 , Damien Legallois  2 , Pascal Richard  3 , Vincent Roule  4 , Denis Agostini  1
Affiliations

Usefulness of dynamic perfusion SPECT with quantitative assessment of myocardial perfusion reserve for the detection of myocardial ischaemia in patients with presumed new left bundle branch block

Alain Manrique et al. Eur Heart J Imaging Methods Pract. .

Abstract

Aims: The aim of this retrospective study was to evaluate the ability of dynamic SPECT with quantitative analysis of myocardial blood flow (MBF) and myocardial flow reserve (MFR) for the detection of coronary artery disease (CAD) in patients with presumed new left bundle branch block (LBBB).

Methods and results: We evaluated the dynamic SPECT results from 174 consecutive patients with LBBB without a history of CAD from a single center. MBF was assessed at rest and during regadenoson (400 μg). Normal MFR was defined as ≥ 2.1. Left ventricular function and segmental perfusion were assessed from conventional gated SPECT. SPECT abnormalities were found in 17/174 (10%) patients including a reversible SPECT defect in 4 patients (2.3%), a fixed defect in 12 patients (7%), and both in 1 patient. Global left ventricular function was normal despite a significant impairment of septal wall motion. Stress and rest MBF was decreased in the septum and the inferior wall compared with other walls (P < 0.0001), resulting in similar MFR. A reduced MFR was associated with a fixed defect (P = 0.04). Only 18 patients (10%) presented with a decreased MFR. They were more often referred to subsequent coronary angiography (8/18, 44%) compared with patients with a normal MFR (9/156, 6%, χ2 = 27.382, P < 0.0001). However, significant coronary lesions were finally found in only 4/174 patients (2%).

Conclusion: Although a decreased MFR was associated with a fixed defect on conventional perfusion imaging, the low rate of CAD finally demonstrated in this study questions the relevance of routine screening for CAD in patients with presumed new LBBB.

Keywords: dynamic perfusion SPECT; left bundle branch block; myocardial blood flow; myocardial flow reserve.

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Conflict of interest statement

Conflict of interest: D.A. received consulting fees and support for attending meetings from Spectrum Dynamics and participated to an advisory board for GE Healthcare.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Illustrative case, with perfusion SPECT (left panel) showing a non-reversible perfusion defect involving the inferior myocardial wall, MBF, and MFR(middle) demonstrating a decreased global (TOT) MFR, and coronary angiogram depicting a coronary lesion in the left anterior descending artery (right) before and after percutaneous coronary intervention.
See this image and copyright information in PMC

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