Key result
Rest and exercise SPECT accurately identify healed MI and coronary stenosis in LBBB patients.
Why the study?
The diagnostic value of myocardial perfusion scintigraphy in patients with left bundle branch block and previous acute myocardial infarction had not been evaluated.
Does stress-rest myocardial perfusion SPECT accurately diagnose coronary stenosis and localise myocardial necrosis in patients with LBBB and previous myocardial infarction?
Cross-Sectional (n=72)
Does stress-rest myocardial perfusion SPECT accurately diagnose coronary stenosis and localise myocardial necrosis in patients with LBBB and previous myocardial infarction?
Effect estimate: kappa 0.836
p-value: p=0.0001
Rest myocardial perfusion SPECT is useful for localising healed myocardial infarction in patients with LBBB, and stress SPECT has high positive predictive value and specificity for diagnosing coronary stenosis, though sensitivity is suboptimal.
May support SPECT for localizing prior MI and detecting CAD in LBBB; leaves open prospective validation before routine use.
BACKGROUND: The diagnostic value of myocardial perfusion scintigraphy in patients with left bundle branch block (LBBB) and previous acute myocardial infarction has not been evaluated. OBJECTIVE: To determine the utility of single photon emission computed tomography (SPECT) in patients with LBBB and previous acute myocardial infarction. METHODS: Seventy two consecutive patients with permanent LBBB and previous acute myocardial infarction were studied with stress-rest SPECT using 99mTc compounds. The same stress procedures were followed in all patients: (1) exercise alone when it was sufficient; (2) exercise plus simultaneous administration of dipyridamole if exercise was insufficient. RESULTS: In 26 of 28 patients (93%) who had a Q wave acute myocardial infarct before the development of LBBB, there was concordance between abnormal Q waves and rest SPECT in the localisation of myocardial necrosis (kappa = 0.836; p = 0.0001). In 48 patients who had coronary angiography, the positive predictive value of exercise (+dipyridamole) myocardial SPECT for the diagnosis of left anterior descending coronary artery stenosis was 93%, for left circumflex coronary artery stenosis, 96%, and for right coronary artery stenosis, 89%. Specificity values were 83%, 91%, and 69%, respectively. However, sensitivity (69%, 64%, and 89%) and negative predictive values (48%, 46%, and 82%) were suboptimal. CONCLUSIONS: Rest myocardial perfusion SPECT with technetium compounds is useful for localising healed myocardial infarction in patients with LBBB, and exercise (+dipyridamole) SPECT has a high positive predictive value and specificity for the diagnosis of coronary stenosis in these patients.
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Jaume Candell‐Riera (2003) conducted a cross-sectional in Left bundle branch block and previous acute myocardial infarction (n=72). Myocardial perfusion SPECT vs. Coronary angiography and ECG was evaluated on Concordance between abnormal Q waves and rest SPECT in the localisation of myocardial necrosis (kappa 0.836, p=0.0001). Rest myocardial perfusion SPECT accurately localized healed myocardial infarction in LBBB patients (kappa=0.836, p=0.0001), and exercise SPECT had high positive predictive value for coronary stenosis.
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