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Gepubliceerd in: Netherlands Heart Journal 3/2013

01-03-2013 | Review Article

Patients with left bundle branch block pattern and high cardiac risk myocardial SPECT: does the current management suffice?

Auteurs: T. J. F. ten Cate, J. C. Kelder, H. W. M. Plokker, J. F. Verzijlbergen, N. M. van Hemel

Gepubliceerd in: Netherlands Heart Journal | Uitgave 3/2013

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Abstract

Introduction

Myocardial perfusion SPECT (MPS) is frequently used for cardiovascular risk stratification. The significance of MPS in patients with abnormal electrical ventricular activation is often questionable. This review assesses the value of MPS for risk stratification of patients with intrinsic left bundle branch block or that due to right ventricular apical pacing.

Methods

We reviewed the literature by a search of the MEDLINE database (January 1980 to September 2010). The terms prognosis or prognostic value were combined with SPECT and LBBB or pacing or pacemakers. MPS was categorised as low and high risk according to the original definitions.

Results

We identified 11 studies suitable for review. A low-risk MPS is associated with a low risk of cardiac events whereas high-risk MPS carries a 4.8-fold increased risk, 95% CI [3.2 – 7.2] (p < 0.0001). Despite secondary prevention and an improved medical and interventional care, these figures have hardly changed over time.

Conclusion and clinical implications

A low-risk MPS permits a policy of watchful waiting whereas a high-risk MPS requires further analysis and treatment. The persistent high cardiac death and acute myocardial infarction rate after a high-risk MPS suggest that the current management of these patients does not suffice and needs reconsideration.
Literatuur
1.
go back to reference Gibbons RJ, Abrams J, Chatterjee K, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina–summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina). J Am Coll Cardiol. 2003;41:159–68.PubMedCrossRef Gibbons RJ, Abrams J, Chatterjee K, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina–summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina). J Am Coll Cardiol. 2003;41:159–68.PubMedCrossRef
2.
go back to reference Groutars RG, Verzijlbergen JF, Tiel-van Buul MM, et al. The accuracy of 1-day dual-isotope myocardial SPECT in a population with high prevalence of coronary artery disease. Int J Cardiovasc Imaging. 2003;19:229–38.PubMedCrossRef Groutars RG, Verzijlbergen JF, Tiel-van Buul MM, et al. The accuracy of 1-day dual-isotope myocardial SPECT in a population with high prevalence of coronary artery disease. Int J Cardiovasc Imaging. 2003;19:229–38.PubMedCrossRef
3.
go back to reference Sharir T, Bacher-Stier C, Dhar S, et al. Identification of severe and extensive coronary artery disease by postexercise regional wall motion abnormalities in Tc-99m sestamibi gated single-photon emission computed tomography. Am J Cardiol. 2000;86:1171–5.PubMedCrossRef Sharir T, Bacher-Stier C, Dhar S, et al. Identification of severe and extensive coronary artery disease by postexercise regional wall motion abnormalities in Tc-99m sestamibi gated single-photon emission computed tomography. Am J Cardiol. 2000;86:1171–5.PubMedCrossRef
4.
go back to reference Elhendy A, Sozzi FB, van Domburg RT, et al. Accuracy of exercise stress technetium 99m sestamibi SPECT imaging in the evaluation of the extent and location of coronary artery disease in patients with an earlier myocardial infarction. J Nucl Cardiol. 2000;7:432–8.PubMedCrossRef Elhendy A, Sozzi FB, van Domburg RT, et al. Accuracy of exercise stress technetium 99m sestamibi SPECT imaging in the evaluation of the extent and location of coronary artery disease in patients with an earlier myocardial infarction. J Nucl Cardiol. 2000;7:432–8.PubMedCrossRef
5.
go back to reference Elhendy A, Schinkel A, Bax JJ, et al. Long-term prognosis after a normal exercise stress Tc-99m sestamibi SPECT study. J Nucl Cardiol. 2003;10:261–6.PubMedCrossRef Elhendy A, Schinkel A, Bax JJ, et al. Long-term prognosis after a normal exercise stress Tc-99m sestamibi SPECT study. J Nucl Cardiol. 2003;10:261–6.PubMedCrossRef
6.
go back to reference Hachamovitch R, Berman DS, Kiat H, et al. Value of stress myocardial perfusion single photon emission computed tomography in patients with normal resting electrocardiograms: an evaluation of incremental prognostic value and cost-effectiveness. Circulation. 2002;105:823–9.PubMedCrossRef Hachamovitch R, Berman DS, Kiat H, et al. Value of stress myocardial perfusion single photon emission computed tomography in patients with normal resting electrocardiograms: an evaluation of incremental prognostic value and cost-effectiveness. Circulation. 2002;105:823–9.PubMedCrossRef
7.
go back to reference Shaw LJ, Hendel R, Borges-Neto S, et al. Prognostic value of normal exercise and adenosine (99m)Tc-tetrofosmin SPECT imaging: results from the multicenter registry of 4,728 patients. J Nucl Med. 2003;44:134–9.PubMed Shaw LJ, Hendel R, Borges-Neto S, et al. Prognostic value of normal exercise and adenosine (99m)Tc-tetrofosmin SPECT imaging: results from the multicenter registry of 4,728 patients. J Nucl Med. 2003;44:134–9.PubMed
8.
go back to reference Skalidis E, Kochiadakis G, Koukouraki S, et al. Myocardial perfusion in patients with permanent ventricular pacing and normal coronary arteries. J Am Coll Cardiol. 2001;37:124–9.PubMedCrossRef Skalidis E, Kochiadakis G, Koukouraki S, et al. Myocardial perfusion in patients with permanent ventricular pacing and normal coronary arteries. J Am Coll Cardiol. 2001;37:124–9.PubMedCrossRef
9.
go back to reference Lakkis N, He Z, Verani M. Diagnosis of coronary artery disease by exercise thallium-201 tomography in patients with a right ventricular pacemaker. J Am Coll Cardiol. 1997;29:1221–5.PubMedCrossRef Lakkis N, He Z, Verani M. Diagnosis of coronary artery disease by exercise thallium-201 tomography in patients with a right ventricular pacemaker. J Am Coll Cardiol. 1997;29:1221–5.PubMedCrossRef
10.
go back to reference Lebtahi NE, Stauffer JC, Delaloye AB. Left bundle branch block and coronary artery disease: accuracy of dipyridamole thallium-201 single-photon emission computed tomography in patients with exercise anteroseptal perfusion defects. J Nucl Cardiol. 1997;4:266–73.PubMedCrossRef Lebtahi NE, Stauffer JC, Delaloye AB. Left bundle branch block and coronary artery disease: accuracy of dipyridamole thallium-201 single-photon emission computed tomography in patients with exercise anteroseptal perfusion defects. J Nucl Cardiol. 1997;4:266–73.PubMedCrossRef
11.
go back to reference Larcos G, Gibbons RJ, Brown ML. Diagnostic accuracy of exercise thallium-201 single-photon emission computed tomography in patients with left bundle branch block. Am J Cardiol. 1991;68:756–60.PubMedCrossRef Larcos G, Gibbons RJ, Brown ML. Diagnostic accuracy of exercise thallium-201 single-photon emission computed tomography in patients with left bundle branch block. Am J Cardiol. 1991;68:756–60.PubMedCrossRef
12.
go back to reference Tse HF, Lau CP. Long-term effect of right ventricular pacing on myocardial perfusion and function. J Am Coll Cardiol. 1997;29:744–9.PubMedCrossRef Tse HF, Lau CP. Long-term effect of right ventricular pacing on myocardial perfusion and function. J Am Coll Cardiol. 1997;29:744–9.PubMedCrossRef
13.
go back to reference Biagini E, Shaw LJ, Poldermans D, et al. Accuracy of non-invasive techniques for diagnosis of coronary artery disease and prediction of cardiac events in patients with left bundle branch block: a meta-analysis. Eur J Nucl Med Mol Imaging. 2006;33:1442–51.PubMedCrossRef Biagini E, Shaw LJ, Poldermans D, et al. Accuracy of non-invasive techniques for diagnosis of coronary artery disease and prediction of cardiac events in patients with left bundle branch block: a meta-analysis. Eur J Nucl Med Mol Imaging. 2006;33:1442–51.PubMedCrossRef
14.
go back to reference Ibrahim NS, Abboud G, Selvester RS, et al. Detecting exercise-induced ischemia in left bundle branch block using the electrocardiogram. Am J Cardiol. 1998; 82:832–5, A11. Ibrahim NS, Abboud G, Selvester RS, et al. Detecting exercise-induced ischemia in left bundle branch block using the electrocardiogram. Am J Cardiol. 1998; 82:832–5, A11.
15.
go back to reference Geleijnse ML, Vigna C, Kasprzak JD, et al. Usefulness and limitations of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. Eur Heart J. 2000;21:1666–73.PubMedCrossRef Geleijnse ML, Vigna C, Kasprzak JD, et al. Usefulness and limitations of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. Eur Heart J. 2000;21:1666–73.PubMedCrossRef
16.
go back to reference Yanik A, Yetkin E, Senen K, et al. Value of dobutamine stress echocardiography for diagnosis of coronary artery disease in patients with left bundle branch blockage. Coron Artery Dis. 2000;11:545–8.PubMedCrossRef Yanik A, Yetkin E, Senen K, et al. Value of dobutamine stress echocardiography for diagnosis of coronary artery disease in patients with left bundle branch blockage. Coron Artery Dis. 2000;11:545–8.PubMedCrossRef
17.
go back to reference Peteiro J, Monserrat L, Martinez D, et al. Accuracy of exercise echocardiography to detect coronary artery disease in left bundle branch block unassociated with either acute or healed myocardial infarction. Am J Cardiol. 2000; 85:890–3, A9. Peteiro J, Monserrat L, Martinez D, et al. Accuracy of exercise echocardiography to detect coronary artery disease in left bundle branch block unassociated with either acute or healed myocardial infarction. Am J Cardiol. 2000; 85:890–3, A9.
18.
go back to reference Wagdy HM, Hodge D, Christian TF, et al. Prognostic value of vasodilator myocardial perfusion imaging in patients with left bundle-branch block. Circulation. 1998;97:1563–70.PubMedCrossRef Wagdy HM, Hodge D, Christian TF, et al. Prognostic value of vasodilator myocardial perfusion imaging in patients with left bundle-branch block. Circulation. 1998;97:1563–70.PubMedCrossRef
19.
go back to reference Nigam A, Humen DP. Prognostic value of myocardial perfusion imaging with exercise and/or dipyridamole hyperemia in patients with preexisting left bundle branch block. J Nucl Med. 1998;39:579–81.PubMed Nigam A, Humen DP. Prognostic value of myocardial perfusion imaging with exercise and/or dipyridamole hyperemia in patients with preexisting left bundle branch block. J Nucl Med. 1998;39:579–81.PubMed
20.
go back to reference Lapeyre 3rd AC, Poornima IG, Miller TD, et al. Prognostic value of exercise stress myocardial perfusion imaging in patients with permanent pacemakers. Am J Cardiol. 2004;94:811–4.PubMedCrossRef Lapeyre 3rd AC, Poornima IG, Miller TD, et al. Prognostic value of exercise stress myocardial perfusion imaging in patients with permanent pacemakers. Am J Cardiol. 2004;94:811–4.PubMedCrossRef
21.
go back to reference Lapeyre 3rd AC, Poornima IG, Miller TD, et al. The prognostic value of pharmacologic stress myocardial perfusion imaging in patients with permanent pacemakers. J Nucl Cardiol. 2005;12:37–42.PubMedCrossRef Lapeyre 3rd AC, Poornima IG, Miller TD, et al. The prognostic value of pharmacologic stress myocardial perfusion imaging in patients with permanent pacemakers. J Nucl Cardiol. 2005;12:37–42.PubMedCrossRef
22.
go back to reference Ten Cate TJ, Kelder JC, Bogaard MD, et al. The prognostic significance of typical perfusion defects on vasodilator stress myocardial perfusion SPECT in patients with left bundle branch block or right ventricular apical pacing. Nucl Med Commun. 2009;30:232–9.PubMedCrossRef Ten Cate TJ, Kelder JC, Bogaard MD, et al. The prognostic significance of typical perfusion defects on vasodilator stress myocardial perfusion SPECT in patients with left bundle branch block or right ventricular apical pacing. Nucl Med Commun. 2009;30:232–9.PubMedCrossRef
23.
go back to reference ten Cate TJ, Visser FC, Panhuyzen-Goedkoop NM, et al. Pacemaker-related myocardial perfusion defects worsen during higher pacing rate and coronary flow augmentation. Heart Rhythm. 2005;2:1058–63.PubMedCrossRef ten Cate TJ, Visser FC, Panhuyzen-Goedkoop NM, et al. Pacemaker-related myocardial perfusion defects worsen during higher pacing rate and coronary flow augmentation. Heart Rhythm. 2005;2:1058–63.PubMedCrossRef
24.
go back to reference Soares A, Puig J, Pereira N, et al. Prognostic value of normal myocardial perfusion scintigraphy in patients with chest pain and left bundle branch block. Rev Port Cardiol. 2002;21:1241–55.PubMed Soares A, Puig J, Pereira N, et al. Prognostic value of normal myocardial perfusion scintigraphy in patients with chest pain and left bundle branch block. Rev Port Cardiol. 2002;21:1241–55.PubMed
25.
go back to reference Usmani S, Khan HA, Zaman MU, et al. Prediction of cardiac events in patients having left bundle-branch block with/without chest pain using dipyridamole technetium-99m-sestamibi myocardial perfusion imaging. Med Princ Pract. 2009;18:310–6.PubMedCrossRef Usmani S, Khan HA, Zaman MU, et al. Prediction of cardiac events in patients having left bundle-branch block with/without chest pain using dipyridamole technetium-99m-sestamibi myocardial perfusion imaging. Med Princ Pract. 2009;18:310–6.PubMedCrossRef
26.
go back to reference America YG, Bax JJ, Boersma E, et al. Prognostic value of gated SPECT in patients with left bundle branch block. J Nucl Cardiol. 2007;14:75–81.PubMedCrossRef America YG, Bax JJ, Boersma E, et al. Prognostic value of gated SPECT in patients with left bundle branch block. J Nucl Cardiol. 2007;14:75–81.PubMedCrossRef
27.
go back to reference Nallamothu N, Bagheri B, Acio ER, et al. Prognostic value of stress myocardial perfusion single photon emission computed tomography imaging in patients with left ventricular bundle branch block. J Nucl Cardiol. 1997;4:487–93.PubMedCrossRef Nallamothu N, Bagheri B, Acio ER, et al. Prognostic value of stress myocardial perfusion single photon emission computed tomography imaging in patients with left ventricular bundle branch block. J Nucl Cardiol. 1997;4:487–93.PubMedCrossRef
28.
go back to reference Gil VM, Almeida M, Ventosa A, et al. Prognosis in patients with left bundle branch block and normal dipyridamole thallium-201 scintigraphy. J Nucl Cardiol. 1998;5:414–7.PubMedCrossRef Gil VM, Almeida M, Ventosa A, et al. Prognosis in patients with left bundle branch block and normal dipyridamole thallium-201 scintigraphy. J Nucl Cardiol. 1998;5:414–7.PubMedCrossRef
29.
go back to reference Krishnan R, Lu J, Zhu YY, et al. Myocardial perfusion scintigraphy in left bundle branch block: a perspective on the issue from image analysis in a clinical context. Am Heart J. 1993;126:578–86.PubMedCrossRef Krishnan R, Lu J, Zhu YY, et al. Myocardial perfusion scintigraphy in left bundle branch block: a perspective on the issue from image analysis in a clinical context. Am Heart J. 1993;126:578–86.PubMedCrossRef
30.
go back to reference ten Cate TJ, Kelder JC, Plokker HW, et al. Myocardial perfusion SPECT identifies patients with left bundle branch block patterns at high risk for future coronary events. J Nucl Cardiol. 2010;17:216–24.PubMedCrossRef ten Cate TJ, Kelder JC, Plokker HW, et al. Myocardial perfusion SPECT identifies patients with left bundle branch block patterns at high risk for future coronary events. J Nucl Cardiol. 2010;17:216–24.PubMedCrossRef
31.
go back to reference Hesse B, Diaz LA, Snader CE, et al. Complete bundle branch block as an independent predictor of all-cause mortality: report of 7,073 patients referred for nuclear exercise testing. Am J Med. 2001;110:253–9.PubMedCrossRef Hesse B, Diaz LA, Snader CE, et al. Complete bundle branch block as an independent predictor of all-cause mortality: report of 7,073 patients referred for nuclear exercise testing. Am J Med. 2001;110:253–9.PubMedCrossRef
32.
go back to reference Groutars RG, Verzijlbergen JF, Muller AJ, et al. Prognostic value and quality of life in patients with normal rest thallium-201/stress technetium 99m-tetrofosmin dual-isotope myocardial SPECT. J Nucl Cardiol. 2000;7:333–41.PubMedCrossRef Groutars RG, Verzijlbergen JF, Muller AJ, et al. Prognostic value and quality of life in patients with normal rest thallium-201/stress technetium 99m-tetrofosmin dual-isotope myocardial SPECT. J Nucl Cardiol. 2000;7:333–41.PubMedCrossRef
33.
go back to reference Eriksson P, Wilhelmsen L, Rosengren A. Bundle-branch block in middle-aged men: risk of complications and death over 28 years. The Primary Prevention Study in Goteborg, Sweden. Eur Heart J. 2005;26:2300–6.PubMedCrossRef Eriksson P, Wilhelmsen L, Rosengren A. Bundle-branch block in middle-aged men: risk of complications and death over 28 years. The Primary Prevention Study in Goteborg, Sweden. Eur Heart J. 2005;26:2300–6.PubMedCrossRef
34.
go back to reference Fahy GJ, Pinski SL, Miller DP, et al. Natural history of isolated bundle branch block. Am J Cardiol. 1996;77:1185–90.PubMedCrossRef Fahy GJ, Pinski SL, Miller DP, et al. Natural history of isolated bundle branch block. Am J Cardiol. 1996;77:1185–90.PubMedCrossRef
35.
go back to reference Imanishi R, Seto S, Ichimaru S, et al. Prognostic significance of incident complete left bundle branch block observed over a 40-year period. Am J Cardiol. 2006;98:644–8.PubMedCrossRef Imanishi R, Seto S, Ichimaru S, et al. Prognostic significance of incident complete left bundle branch block observed over a 40-year period. Am J Cardiol. 2006;98:644–8.PubMedCrossRef
36.
go back to reference Nielsen JC, Kristensen L, Andersen HR, et al. A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: echocardiographic and clinical outcome. J Am Coll Cardiol. 2003;42:614–23.PubMedCrossRef Nielsen JC, Kristensen L, Andersen HR, et al. A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: echocardiographic and clinical outcome. J Am Coll Cardiol. 2003;42:614–23.PubMedCrossRef
37.
go back to reference Sweeney MO, Bank AJ, Nsah E, et al. Minimizing ventricular pacing to reduce atrial fibrillation in sinus-node disease. N Engl J Med. 2007;357:1000–8.PubMedCrossRef Sweeney MO, Bank AJ, Nsah E, et al. Minimizing ventricular pacing to reduce atrial fibrillation in sinus-node disease. N Engl J Med. 2007;357:1000–8.PubMedCrossRef
38.
go back to reference Nielsen JC, Andersen HR, Thomsen PE, et al. Heart failure and echocardiographic changes during long-term follow-up of patients with sick sinus syndrome randomized to single-chamber atrial or ventricular pacing. Circulation. 1998;97:987–95.PubMedCrossRef Nielsen JC, Andersen HR, Thomsen PE, et al. Heart failure and echocardiographic changes during long-term follow-up of patients with sick sinus syndrome randomized to single-chamber atrial or ventricular pacing. Circulation. 1998;97:987–95.PubMedCrossRef
39.
go back to reference Kristensen L, Nielsen JC, Mortensen PT, et al. Incidence of atrial fibrillation and thromboembolism in a randomised trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome. Heart. 2004;90:661–6.PubMedCrossRef Kristensen L, Nielsen JC, Mortensen PT, et al. Incidence of atrial fibrillation and thromboembolism in a randomised trial of atrial versus dual chamber pacing in 177 patients with sick sinus syndrome. Heart. 2004;90:661–6.PubMedCrossRef
Metagegevens
Titel
Patients with left bundle branch block pattern and high cardiac risk myocardial SPECT: does the current management suffice?
Auteurs
T. J. F. ten Cate
J. C. Kelder
H. W. M. Plokker
J. F. Verzijlbergen
N. M. van Hemel
Publicatiedatum
01-03-2013
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 3/2013
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-011-0174-5

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