Key result
Diastolic SPECT imaging did not correct septal perfusion abnormalities in LBBB patients without CAD, showing increased stress perfusion defect extent compared to ungated imaging (6.2% vs 5.1%, P=0.01).
Why the study?
Does diastolic thallium gated SPECT imaging improve the assessment of septal perfusion abnormalities compared to ungated SPECT in patients with LBBB?
Observational (n=89)
Does diastolic thallium gated SPECT imaging improve the assessment of septal perfusion abnormalities compared to ungated SPECT in patients with LBBB?
Absolute Event Rate: 6.2% vs 5.1%
p-value: p=0.01
Diastolic gated SPECT imaging does not provide additional diagnostic value over ungated imaging for correcting septal perfusion abnormalities in patients with LBBB.
Ungated SPECT may suffice for LBBB perfusion assessment; leaves open whether diastolic gating improves accuracy in prospective studies.
OBJECTIVES: Septal perfusion abnormalities are frequently observed in patients with left bundle branch block (LBBB). The aim of this study was to compare myocardial perfusion imaging obtained from ungated and diastolic thallium gated single-photon emission computed tomography (SPECT) images in patients with LBBB. METHODS: Stress/rest SPECT was performed in 70 patients with LBBB [38 with coronary artery disease (CAD) (G1), 32 without (G2)] and 19 control participants (G3). Diastolic images were obtained as the sum of four diastolic bins. Perfusion was assessed by summed stress, rest, and difference scores for both diastolic and ungated images. RESULTS: In G1, there was no difference between diastolic and ungated perfusion scores. In G2, summed stress score and summed rest score were increased in diastolic versus ungated imaging, and perfusion defect extent was increased on diastolic versus ungated images at stress (diastole: 6.2 +/- 9.9% vs. ungated: 5.1 +/- 9.70/%, P = 0.01) and rest (diastole: 4.3 +/- 9.3% vs. ungated: 2.8 +/- 9.50%, P = 0.0014), with an increased extent of reversible defect (diastole: 3.4 4.7% vs. ungated: 2.3 3.7%, P = 0.01). In G2, diastolic images failed to correct septal perfusion abnormalities. The number of normal SPECT did not increase with diastolic versus ungated imaging (24 and 180% in G1, 66 and 53% in G2, respectively). Otherwise, a significant association between left ventricular dysfunction and CAD was found, stress ejection fraction being decreased in 20 patients (53%) in G1 and seven patients (22%) in G2 (CHI2 = 6.93, P < 0.01). CONCLUSION: In patients with LBBB, diastolic imaging did not provide additional information to ungated perfusion imaging, but left ventricular dysfunction was associated with CAD.
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Edet‐Sanson et al. (2009) conducted an observational in Left bundle branch block (n=89). Diastolic thallium gated SPECT imaging vs. Ungated SPECT imaging was evaluated on Perfusion defect extent at stress in LBBB patients without CAD (p=0.01). Diastolic SPECT imaging did not correct septal perfusion abnormalities in LBBB patients without CAD, showing increased stress perfusion defect extent compared to ungated imaging (6.2% vs 5.1%, P=0.01).
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