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Septal Perfusion and Wall Thickening in Patients with Left Bundle Branch Block Assessed by Technetium99m-Sestamibi Gated Tomography

Septal Perfusion and Wall Thickening in Patients with Left Bundle Branch Block Assessed by Technetium99m-Sestamibi Gated Tomography,Hideki Sugihara,Na

Septal Perfusion and Wall Thickening in Patients with Left Bundle Branch Block Assessed by Technetium99m-Sestamibi Gated Tomography   (Citations: 28)
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Septal hypoperfusion is often observed in patients with complete left bundle branch block (LBBB) in myocardial perfusion imaging. Abnormal wall motion in the septal region may potentially cause artifactual perfusion abnormalities. To assess the effect of abnormal wall thickening on myocardial perfusion images, ECG-gated sesta- mibi SPECT was performed on 12 patients with LBBB and 10 normal subjects used as controls. Methods: After administration of 740 MBq ""Tc-sestamibi injection at rest, ECG-gated SPECT was obtained 60 min later with division of the cardiac cycle into eight frames. Results: Septal hypoperfusion was noted in 10 patients on nongated images and 11 patients on end-systolic (ES) images, whereas only two patients showed abnormalities on end-diastolic (ED)images. The septal to lateral wall count ratio in the LBBB group was lower (0.72 ±0.09) than in the control group (0.84 ±0.09) (p < 0.01) at nongated images, while it was similar at ED images (0.84 ± 0.11 versus 0.86 ±0.12; ns). In addition, the count increasefrom ED to ES during a cardiac cycle in the septal region was smaller compared with the lateral region in the LBBB patients (25% ±19% in the septal region, versus 48% ±14% in the lateral region; p < 0.01), indicating less wall thickening in the septal region. Conclusion: Smallercount increasedue to reducedwallthickening in the septal region may mimic hypoperfusion in patients with LBBB. This artifact can be eliminated with ECG-gated 99mTc-sestamibi
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    • ...The effects of the increased lateral wall workload can be seen in imaging studies which found that LBBB causes increased wallthickening in thelateralwall [76]‐[78] compared with the septal wall as well as increased remodeling following the same pattern [77], [78]...

    Alexander I. Veresset al. Incorporation of a Left Ventricle Finite Element Model Defining Infarc...

    • ...Possible explanations for the heart-rate-dependent artifact include prolonged compression of the septal perforators, reduced diastolic flow, small-vessel CAD, septal fibrosis, and wall motion artifact [...

    Sharjeel Usmaniet al. Prediction of Cardiac Events in Patients Having Left Bundle-Branch Blo...

    • ...ECG-gated SPECT permits the evaluation of both perfusion and functions of the left ventricular myocardium, and can considerably help to distinguish true and artifactual abnormalities owing to the LBBB [5, 6]. The width of the QRS complex is an electrocardiographic refl ection of ventricular conduction abnormality as well as intra- and inter-ventricular dyssynchrony [8, 9]. In the LBBB literature, the relations between QRS duration and ...
    • ...Today, we know that SPECT perfusion artifacts owing to LBBB can resolve on the frozen images of the end-diastolic phase of the cardiac cycle [5, 6]. Disappearance of perfusion abnormalities on the end-diastolic images, in which the myocardial walls were thinner, and the aggravation of defects at end-systole suggest a more pronounced effect of the Table 3 Myocardial perfusion, function, and electrocardiographic QRS width...

    Sabahat Inaniret al. QRS complex duration and dipyridamole gated SPECT findings in the left...

    • ...It has been postulated that a higher partial-volume effect and therefore a smaller count increase during systole because of reduced systolic wall thickening in the septum may mimic this hypoperfusion (3)...

    Bernd Nowaket al. Comparison of Regional Myocardial Blood Flow and Perfusion in Dilated ...

    • ...Sugihara et al. (35) reported that patients with complete left bundle branch block have reduced uptake of 123I-BMIPP in the septum...

    Mamoru Nanasatoet al. Evaluation of Left Ventricular Function Using Electrocardiographically...

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