Prognostic value of vasodilator myocardial perfusion imaging in patients with left bundle-branch block

Article

关键词: CORONARY-ARTERY DISEASE;    EMISSION COMPUTED-TOMOGRAPHY;    NEWLY ACQUIRED LEFT;    TL-201 SCINTIGRAPHY;    EXERCISE TL-201;    DIAGNOSTIC-ACCURACY;    ADENOSINE TL-201;    DIPYRIDAMOLE;    CARDIOMYOPATHY;    DEFECTS;   

DOI  :  10.1161/01.CIR.97.16.1563

来源: SCIE

【 摘 要 】

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.

【 授权许可】

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