title: Comparative utility of gated myocardial perfusion imaging and transthoracic coronary flow reserve for the assessment of coronary artery disease in patients with left bundle branch block.
abstract: OBJECTIVE
  To compare the diagnostic utility of gated single-photon emission computed tomography (SPECT) methoxy isobutyl isonitrile (MIBI) myocardial perfusion imaging and transthoracic Doppler echocardiography (TTDE) coronary flow reserve (CFR) to coronary angiography for detecting coronary artery disease (CAD) in patients with left bundle branch block (LBBB).
  
  
  METHODS
  Forty-three patients with complete LBBB and an intermediate pretest probability for CAD underwent dipyridamole stress TTDE and gated SPECT MIBI during the same session and coronary angiography within a month. The parameters of myocardial perfusion (summed stress score, summed difference scores) regional wall function (wall motion score, wall thickening score) and ejection fraction were derived using the 17-segment model and 4D-MSPECT software. TTDE variables included peak flow velocity at rest and during hyperemia in left anterior descending artery (LAD), based on which CFR was calculated (normal>2).
  
  
  RESULTS
  Perfusion ischemic scores were significantly higher in group 1 with angiographic evidence of greater than 50% LAD stenosis compared with group 2 with less than 50% LAD stenosis (summed stress score 12.4+/-5.5 vs. 8.3+/-3.5, P<0.05, summed difference score 3.7+/-1.2 vs. 1.1+/-0.3, P<0.01, respectively). Left ventricular regional wall function and ejection fraction were not different between the two groups. CFR was significantly lower in group 1 than in group 2 (1.65+/-0.21 vs. 2.31+/-0.28, P<0.001). Gated SPECT MIBI and CFR had similar sensitivity (88 vs. 88%), specificity (80 vs. 84%), and accuracy (84 vs. 86%) for detecting CAD in patients with LBBB. The agreement between the two methods was 85%.
  
  
  CONCLUSIONS
  Our results show comparable diagnostic utility and high agreement between gated SPECT MIBI perfusion imaging and TTDE CFR assessment for detecting CAD in patients with LBBB. The advantage of gated SPECT MIBI over TTDE CFR measurements is the ability to assess the perfusion abnormalities in multiple vascular territories during the same procedure, which is convenient for detecting multi-vessel disease in patients with LBBB.
authors.affiliation: Institute of Nuclear Medicine, Belgrade, Serbia.
authors.forename: Smiljana
authors.initials: S
authors.lastname: Pavlovic
authors.forename: Dragana
authors.initials: D
authors.lastname: Sobic-Saranovic
authors.forename: Ana
authors.initials: A
authors.lastname: Djordjevic-Dikic
authors.forename: Branko
authors.initials: B
authors.lastname: Beleslin
authors.forename: Jelena
authors.initials: J
authors.lastname: Stepanovic
authors.forename: Vera
authors.initials: V
authors.lastname: Artiko
authors.forename: Vojislav
authors.initials: V
authors.lastname: Giga
authors.forename: Zorica
authors.initials: Z
authors.lastname: Petrasinovic
authors.forename: Miodrag
authors.initials: M
authors.lastname: Ostojic
authors.forename: Bosiljka
authors.initials: B
authors.lastname: Vujisic-Tesic
authors.forename: Vladimir
authors.initials: V
authors.lastname: Obradovic
mesh_terms: D002037:Bundle-Branch Block / Q000150:complications*; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D017256:Technetium Tc 99m Sestamibi
chemical_list: D017256:Technetium Tc 99m Sestamibi