BACKGROUND: The prognostic value of tomographic myocardial perfusion imaging with dipyridamole or adenosine in patients with left bundle-branch block has not been established. METHODS AND RESULTS: The study group consisted of 245 patients with left bundle-branch block who underwent tomographic (single photon emission tomography) myocardial perfusion imaging with thallium-201 (n=173) or technetium-99m sestamibi (n=72) and either dipyridamole (n=153) or adenosine (n=92) stress. Patients were prospectively classified into two groups. Patients were classified as "high risk" if they had (1) a large severe fixed defect (n=28), (2) a large reversible defect (n=36), or (3) cardiac enlargement and either increased pulmonary uptake (thallium) or a decreased resting ejection fraction (sestamibi) (n=20). The remaining 161 patients (66% of the study group) were at "low risk." Follow-up was 99% complete at 3+/-1.4 years. Three-year overall survival was 57% in the high-risk group compared with 87% in the low-risk group (P<.0001). Survival free of cardiac death/nonfatal myocardial infarction/cardiac transplantation was 55% in the high-risk group and 93% in the low-risk group (P<.0001). The presence of a high-risk scan had significant incremental prognostic value after adjustment for age, sex, diabetes, and previous myocardial infarction (P<.0001). Patients with a low-risk scan had an overall survival that was not significantly different from that of a US age-matched population (P=.86). CONCLUSIONS: Tomographic myocardial perfusion imaging with adenosine or dipyridamole stress provides important prognostic information in patients with left bundle-branch block, which is incremental to clinical assessment.
BACKGROUND: The prognostic value of tomographic myocardial perfusion imaging with dipyridamole or adenosine in patients with left bundle-branch block has not been established. METHODS AND RESULTS: The study group consisted of 245 patients with left bundle-branch block who underwent tomographic (single photon emission tomography) myocardial perfusion imaging with thallium-201 (n=173) or technetium-99m sestamibi (n=72) and either dipyridamole (n=153) or adenosine (n=92) stress. Patients were prospectively classified into two groups. Patients were classified as "high risk" if they had (1) a large severe fixed defect (n=28), (2) a large reversible defect (n=36), or (3) cardiac enlargement and either increased pulmonary uptake (thallium) or a decreased resting ejection fraction (sestamibi) (n=20). The remaining 161 patients (66% of the study group) were at "low risk." Follow-up was 99% complete at 3+/-1.4 years. Three-year overall survival was 57% in the high-risk group compared with 87% in the low-risk group (P<.0001). Survival free of cardiac death/nonfatal myocardial infarction/cardiac transplantation was 55% in the high-risk group and 93% in the low-risk group (P<.0001). The presence of a high-risk scan had significant incremental prognostic value after adjustment for age, sex, diabetes, and previous myocardial infarction (P<.0001). Patients with a low-risk scan had an overall survival that was not significantly different from that of a US age-matched population (P=.86). CONCLUSIONS: Tomographic myocardial perfusion imaging with adenosine or dipyridamole stress provides important prognostic information in patients with left bundle-branch block, which is incremental to clinical assessment.
Authors: Yuan Xu; Ryo Nakazato; Sean Hayes; Rory Hachamovitch; Victor Y Cheng; Heidi Gransar; Romalisa Miranda-Peats; Mark Hyun; Leslee J Shaw; John Friedman; Guido Germano; Daniel S Berman; Piotr J Slomka Journal: J Nucl Cardiol Date: 2011-09-20 Impact factor: 5.952
Authors: Leslee J Shaw; Daniel S Berman; Roger S Blumenthal; Matthew J Budoff; Tracy L Faber; Tauqir Goraya; Sandra S Halliburton; Harvey Hecht; Hosen Kiat; Wolfgang Koenig; Shaista Malik; Michael Merhige; Khurram Nasir; James K Min; James O'Keefe; Donna M Polk; Paolo Raggi; Jeffrey A Rosenblatt; Ronald G Schwartz; Allen J Taylor; Gregory S Thomas; William Wijns Journal: J Nucl Cardiol Date: 2008 Jan-Feb Impact factor: 5.952
Authors: André C Lapeyre; Indu G Poornima; Todd D Miller; David O Hodge; Timothy F Christian; Raymond J Gibbons Journal: J Nucl Cardiol Date: 2005 Jan-Feb Impact factor: 5.952
Authors: Tim J F ten Cate; Johannes C Kelder; Herbert W M Plokker; J Fred Verzijlbergen; Norbert M van Hemel Journal: J Nucl Cardiol Date: 2009-12-24 Impact factor: 5.952
Authors: S R Underwood; C Anagnostopoulos; M Cerqueira; P J Ell; E J Flint; M Harbinson; A D Kelion; A Al-Mohammad; E M Prvulovich; L J Shaw; A C Tweddel Journal: Eur J Nucl Med Mol Imaging Date: 2004-02 Impact factor: 9.236