title: Sequential SPECT/CT imaging starting with stress SPECT in patients with left bundle branch block suspected for coronary artery disease.
abstract: OBJECTIVE
  To investigate the impact of left bundle branch block (LBBB) on sequential single photon emission computed tomography (SPECT)/ CT imaging starting with stress-first SPECT.
  
  
  METHODS
  Consecutive symptomatic low- to intermediate-risk patients without a history of coronary artery disease (CAD) referred for SPECT/CT were included from an observational registry. If stress SPECT was abnormal, additional rest SPECT and, if feasible, coronary CT angiography (CCTA) were acquired.
  
  
  RESULTS
  Of the 5,018 patients, 218 (4.3 %) demonstrated LBBB. Patients with LBBB were slightly older than patients without LBBB (65±12 vs. 61±11 years, p<0.001). Stress SPECT was more frequently abnormal in patients with LBBB (82 % vs. 46 %, p<0.001). After reviewing stress and rest images, SPECT was normal in 43 % of the patients with LBBB, compared to 77 % of the patients without LBBB (p<0.001). Sixty-four of the 124 patients with LBBB and abnormal stress-rest SPECT underwent CCTA (52 %), which could exclude obstructive CAD in 46 of the patients (72 %).
  
  
  CONCLUSIONS
  Sequential SPECT/CT imaging starting with stress SPECT is not the optimal imaging protocol in patients with LBBB, as the majority of these patients have potentially false-positive stress SPECT. First-line testing using CCTA may be more appropriate in low- to intermediate-risk patients with LBBB.
  
  
  CONCLUSIONS
  • Stress-first SPECT imaging is attractive if many patients demonstrate normal stress perfusion. • The majority of left bundle branch block patients have abnormal stress-first SPECT. • Coronary CT excluded obstructive CAD in many LBBB patients with abnormal SPECT. • Stress-first SPECT imaging is not the optimal imaging protocol in LBBB patients. • In LBBB patients imaging with initial coronary CT may be more appropriate.
authors.affiliation: Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. e.engbers@isala.nl.|Department of Nuclear Medicine, Isala, Zwolle, The Netherlands. e.engbers@isala.nl.
authors.forename: Elsemiek M
authors.initials: EM
authors.lastname: Engbers
authors.affiliation: Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: Jorik R
authors.initials: JR
authors.lastname: Timmer
authors.affiliation: Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.|Department of Nuclear Medicine, Isala, Zwolle, The Netherlands.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mouden
authors.affiliation: Department of Nuclear Medicine, Isala, Zwolle, The Netherlands.
authors.forename: Siert
authors.initials: S
authors.lastname: Knollema
authors.affiliation: Department of Nuclear Medicine, Isala, Zwolle, The Netherlands.
authors.forename: Pieter L
authors.initials: PL
authors.lastname: Jager
authors.affiliation: Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
keywords: Coronary CT angiography; Left bundle branch block; Sequential SPECT/CT imaging; Stress-first SPECT; Suspected coronary artery disease