Myocardial perfusion SPECT identifies patients with left bundle branch block patterns at high risk for future coronary events

Abstract

Group 2 had a significantly worse cardiac prognosis compared to Group 1. The annual cardiac death rate of <1% in Group 1 warrants a watchful waiting strategy, whereas the cardiac death rate in Group 2 warrants aggressive invasive coronary strategies.

Patients with left bundle branch block pattern and high cardiac risk myocardial SPECT: does the current management suffice?

“…The annual cardiac death rate was <1%/year in patients with low-risk MPS whereas this figure was >6%/year for high-risk patients. Patients with a high-risk MPS had much higher cardiac death and non-fatal AMI rate of 18% compared with 4% for those considered at a low risk (p<0.001) [30]. No difference in prognosis between patients with LBBB or RVA pacing was found.…”

“…Of these 2 were not written in the English language, 19 did not assess the prognosis of patients with LBBB or RVA pacing with SPECT and 1 study could not be retrieved from the journal [24]. This left 11 articles for review that were carried out in patients with known or suspected CAD [19][20][21][22][25][26][27][28][29][30]. Two studies from the same investigators with possible double counting or overlap of patients, described the prognostic value of MPS in patients with RVA pacing [20,21].…”

“…Two studies from the same investigators with possible double counting or overlap of patients, described the prognostic value of MPS in patients with RVA pacing [20,21]. Two studies were carried out in a mixed population of LBBB and RVA pacing [22,30], only the study assessing low-and high-risk MPS in this patient population was used for review [30]. The remaining 10 studies are listed in Table 1.…”

“…Myocardial perfusion SPECT in a mixed population of LBBB and RVA pacing A more recent report assessed the prognostic value of MPS in 197 patients with LBBB or RVA pacing [30]. The study characteristics are described in Table 1.…”

“…Patients with only AARD and otherwise normal myocardial perfusion demonstrated a similar prognosis to patients with the same conduction characteristics and normal myocardial perfusion on MPS [22]. Hence, both MPS results were considered to be low risk and compared with all other MPS results that were considered high risk [30]. The annual cardiac death rate was <1%/year in patients with low-risk MPS whereas this figure was >6%/year for high-risk patients.…”