False-Positive Tc-99m Sestamibi SPECT in a Patient with Left Bundle Branch Block

Campeau, Richard J.; García, Olga Milena; Colon, Richard; Agusala, Madhava; Correa, Olga A.

doi:10.1097/00003072-199301000-00009

Cited by 11 publications

(2 citation statements)

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“…6 -7 Unfortunately, the results of exercise perfusion scintigraphy with thallium-201 and technetium-99m sestamibi have also been disappointing. Specificity has been reported to be 10% to 30% for the diagnosis of coronary artery disease, 8 ' 11 primarily because of falsepositive septal perfusion abnormalities. DePuey et al 9 and Matzer et al 10 proposed the use of abnormal perfusion in the anterior wall or the apex to improve the specificity of perfusion images, but others 12 were unable to confirm any benefit with this approach.…”

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confidence: 99%

Prognostic Value of Vasodilator Myocardial Perfusion Imaging in Patients With Left Bundle-Branch Block

Wagdy¹,

Hodge²,

Christian³

et al. 1998

Circulation

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Background-The prognostic value of tomographic myocardial perfusion imaging with dipyridamole or adenosine in patients with left bundle-branch block has not been established. Methods and Results-The study group consisted of 245 patients with left bundle-branch block who underwent tomographic (single photon emission tomography) myocardial perfusion imaging with thallium-201 (n=173) or technetium-99m sestamibi (n=72) and either dipyridamole (n=153) or adenosine (n=92) stress. Patients were prospectively classified into two groups. Patients were classified as "high risk" if they had (1) a large severe fixed defect (n=28), (2) a large reversible defect (n=36), or (3) cardiac enlargement and either increased pulmonary uptake (thallium) or a decreased resting ejection fraction (sestamibi) (n=20). The remaining 161 patients (66% of the study group) were at "low risk." Follow-up was 99% complete at 3 ±1.4 years. Three-year overall survival was 57% in the high-risk group compared with 87% in the low-risk group (P<.0001). Survival free of cardiac death/nonfatal myocardial infarction/cardiac transplantation was 55% in the high-risk group and 93% in the low-risk group (P<.0001). The presence of a high-risk scan had significant incremental prognostic value after adjustment for age, sex, diabetes, and previous myocardial infarction (P<.0001). Patients with a low-risk scan had an overall survival that was not significantly different from that of a US age-matched population (P=.86). Conclusions-Tomographic myocardial perfusion imaging with adenosine or dipyridamole stress provides important prognostic information in patients with left bundle-branch block, which is incremental to clinical assessment.

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confidence: 99%

Prognostic Value of Vasodilator Myocardial Perfusion Imaging in Patients With Left Bundle-Branch Block

Wagdy¹,

Hodge²,

Christian³

et al. 1998

Circulation

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“…However, stress scintigraphy is not specific for the frequent occurrence of septal, anterior, and apical defects in the absence of CAD. Specificity has been reported to be low primarily due to false-positive septal perfusion abnormalities [8] . But it has been shown that specificity can be improved using dipyridamole stress [9][10][11] .…”

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confidence: 99%

Prediction of Cardiac Events in Patients Having Left Bundle-Branch Block with/without Chest Pain Using Dipyridamole Technetium-99m-Sestamibi Myocardial Perfusion Imaging

Usmani

Khan²,

Zaman³

et al. 2009

Med Princ Pract

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Objective: To determine the prognostic value of myocardial perfusion scintigraphy with dipyridamole stress in patients with preexisting left bundle-branch block (LBBB) with or without chest pain. Subjects and Methods: Seventy-six patients, mean age 53 ± 10 years, with preexisting LBBB underwent technetium-99m-sestamibi perfusion imaging with dipyridamole infusion protocol (0.56 mg/kg). Stress and rest single photon emission computed tomography (SPECT) images were interpreted by consensus of 2 experienced nuclear medicine physicians and classified as low-risk scans (normal myocardial perfusion scan, small reversible/small fixed defect) and high-risk scans (large, severe, fixed or reversible defect and dilated left ventricle cavity). The patients were followed up for 24 ± 8 months and occurrences of hard cardiac events (infarction or cardiac death) were noted. Results: Of the 76 patients, 52 (68%) had low-risk scans and the remaining 24 (32%) had high-risk scans. In the low-risk group, 1 (1.9%) cardiac death and 2 (3.8%) cases of nonfatal myocardial infarction occurred, while in the high-risk group, 5 (20.8%) suffered cardiac death, and 3 (12.5%) nonfatal myocardial infarction. Overall survival rate was 98.1% in the low-risk group compared with 79.2% in the high-risk group with a significant difference of p = 0.034. Negative predictive value of normal myocardial perfusion scintigraphy for the occurrence of death was 100%. No significant difference in survival rate among patients with or without chest pain (p = 0.31) was observed. Conclusions: Myocardial perfusion imaging with dipyridamole provided important prognostic information in patients with LBBB; it was useful in stratifying the patients according to cardiovascular morbidity and mortality, and would thus allow the clinician to provide early treatment especially in the high-risk category.

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Quantification of Myocardial Perfusion

Slomka¹,

Berman²,

Germano³

2006

Clinical Gated Cardiac SPECT

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False-Positive Tc-99m Sestamibi SPECT in a Patient with Left Bundle Branch Block

Cited by 11 publications

References 0 publications

Prognostic Value of Vasodilator Myocardial Perfusion Imaging in Patients With Left Bundle-Branch Block

Prognostic Value of Vasodilator Myocardial Perfusion Imaging in Patients With Left Bundle-Branch Block

Prediction of Cardiac Events in Patients Having Left Bundle-Branch Block with/without Chest Pain Using Dipyridamole Technetium-99m-Sestamibi Myocardial Perfusion Imaging

Quantification of Myocardial Perfusion

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