Clerc Olivier F, Possner Mathias, Maire René, Liga Riccardo, Fuchs Tobias A, Stehli Julia, Vontobel Jan, Mikulicic Fran, Gräni Christoph, Benz Dominik C, Lüscher Thomas F, Herzog Bernhard A, Buechel Ronny R, Kaufmann Philipp A, Gaemperli Oliver
Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland Department of Cardiology, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland.
Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, Zurich CH-8091, Switzerland.
Eur Heart J Cardiovasc Imaging. 2016 Jul;17(7):765-71. doi: 10.1093/ehjci/jev202. Epub 2015 Aug 27.
Left bundle branch block (LBBB) is considered an unfavourable prognostic marker in patients with underlying heart disease. Testing for coronary artery disease (CAD) is often prompted by incidental LBBB finding, but published studies disagree about a significant association between LBBB and CAD. We therefore assessed the association of LBBB with previously unknown CAD in patients undergoing coronary computed tomography angiography (CCTA).
We enrolled 818 patients (mean age 57.2 ± 11.1 years, 106 patients with presumably new LBBB and 712 controls) without known CAD who underwent 64-slice CCTA. Image quality was assessed for each coronary segment. Comparison of obstructive CAD prevalence (defined as ≥50% stenosis) was performed using triple case-matching for pre-test probability (based on age, gender, and symptom typicality) in 101 LBBB patients and 303 matched controls with diagnostic quality in all segments. We found no difference in obstructive CAD prevalence between LBBB patients and matched controls (15 vs. 16%, P = 0.88). Similarly, there were no significant differences in cardiovascular risk factors (CVRF), stenosis severity, CAD extent, non-obstructive CAD, and vessel-based analysis between patient groups. Image quality was very high in LBBB patients and comparable to controls. On multivariate analysis, age, gender, typical angina, and CVRF, but not LBBB (P = 0.94), emerged as significant and independent predictors of obstructive CAD.
CAD prevalence is similar in LBBB patients at low-to-moderate pre-test probability compared with controls with similar CVRF matched for age, gender, and symptom typicality. CCTA is a useful imaging modality in LBBB patients, providing comparable image quality to non-LBBB controls.
