Effects of Left Bundle-Branch Block on Cardiac Structure, Function, Perfusion, and Perfusion Reserve: Implications for Myocardial Contrast Echocardiography Versus Radionuclide Perfusion Imaging for the Detection of Coronary Artery Disease
Abstract
Background— We aimed to investigate the cardiac effects of left bundle-branch block (LBBB) using myocardial contrast echocardiography (MCE) to ascertain the value of MCE for detecting coronary artery disease (CAD) and to uncover the mechanism that affects the accuracy of single-photon emission computed tomography (SPECT) in these patients. Methods and Results— Sixty-three symptomatic LBBB patients (group A), 10 left ventricular ejection fraction–matched control subjects without LBBB and no CAD (group B), and 10 normal control subjects (group C) underwent resting echocardiography. Rest and vasodilator MCE and SPECT were undertaken in LBBB patients. Septal (SW) and posterior wall (PW) thickness, thickening, quantitative myocardial blood flow (MBF), and MBF reserve were measured. SW/PW thickness and percentage thickening ratios were lower ( P <0.01 and P <0.05, respectively) in group A compared with both groups B and C, but resting SW/PW MBF and MBF reserve ratios were similar in all 3 groups. MBF reserve but not MBF was reduced in groups A and B (2.2±0.7 versus 2.2±0.2; P =0.98) compared with group C (3.1±0.5; P <0.01). SW thickness was an independent predictor ( P =0.006) of SPECT perfusion defects in LBBB patients without CAD. MCE (92%) had a sensitivity similar to SPECT (92%); however, the specificity of MCE (95%) was superior ( P <0.0001) to SPECT (47%) for the detection of CAD. Conclusions— Despite asymmetrical reduction in SW thickness and function, MBF is preserved and MBF reserve is homogeneously reduced in LBBB patients with left ventricular systolic dysfunction. Because of partial volume effects, the accuracy of SPECT for detecting CAD was significantly compromised compared with MCE in this patient cohort.
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In left bundle-branch block patients with left-ventricular systolic dysfunction, myocardial blood flow is preserved while myocardial blood flow reserve is reduced.
“Hayat and coworkers investigated the cardiac effects of left bundle-branch block (LBBB) using myocardial contrast echocardiography and demonstrated that myocardial blood flow is preserved while myocardial blood flow resreve is reduced in LBBB patients with left-ventricular systolic dysfunction.27”
From The Year of 2008 in Electrocardiology (2010) · cites this paper as [27]
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- Authors
- Hayat, S. A., Dwivedi, G., Jacobsen, A., Lim, T. K., Kinsey, C., & Senior, R.
- Affiliations
- Northwick Park Hospital (GB)
- Venue
- Circulation
- Published
- 2008-04-08
- Volume
- 117
- Issue
- 14
- Pages
- 1832-1841
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2109678995
- Cited by
- 83
- References
- 26
- Citations by year
- 2026: 3 · 2025: 3 · 2023: 3 · 2022: 3 · 2021: 4 · 2020: 7 · 2019: 4 · 2018: 1 · 2017: 4 · 2016: 4 · 2015: 8 · 2014: 1 · 2013: 5 · 2012: 5
- FWCI
- 7.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- left bundle branch block, myocardial perfusion, myocardial blood flow, myocardial flow reserve, coronary artery disease detection, myocardial contrast echocardiography, single photon emission computed tomography, partial volume effect, left ventricular wall thickness, left ventricular systolic dysfunction, vasodilator stress
- MeSH terms
- Bundle-Branch Block, Contrast Media, Coronary Circulation, Coronary Disease, Echocardiography, False Positive Reactions, Heart Septum, Humans, Radiography, ROC Curve, Sensitivity and Specificity, Tomography, Emission-Computed, Single-Photon, Single-Blind Method, Artifacts, Technetium Tc 99m Sestamibi, Echocardiography, Doppler, Color, Microbubbles
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