Manrique Alain, Guery Clément, Legallois Damien, Richard Pascal, Roule Vincent, Agostini Denis
Department of Nuclear Medicine, CHU de Caen Normandie, Normandie Univ, UNICAEN UR 4650 PSIR, Avenue Cote de Nacre, 14000 Caen, France.
Department of Cardiology, CHU de Caen Normandie, Normandie Univ, UNICAEN, INSERM U1086 ANTICIPE, Avenue Cote de Nacre, 14000 Caen, France.
Eur Heart J Imaging Methods Pract. 2024 Dec 7;2(3):qyae129. doi: 10.1093/ehjimp/qyae129. eCollection 2024 Jul.
The aim of this retrospective study was to evaluate the ability of dynamic SPECT with quantitative analysis of myocardial blood flow (MBF) and myocardial flow reserve (MFR) for the detection of coronary artery disease (CAD) in patients with presumed new left bundle branch block (LBBB).
We evaluated the dynamic SPECT results from 174 consecutive patients with LBBB without a history of CAD from a single center. MBF was assessed at rest and during regadenoson (400 μg). Normal MFR was defined as ≥ 2.1. Left ventricular function and segmental perfusion were assessed from conventional gated SPECT. SPECT abnormalities were found in 17/174 (10%) patients including a reversible SPECT defect in 4 patients (2.3%), a fixed defect in 12 patients (7%), and both in 1 patient. Global left ventricular function was normal despite a significant impairment of septal wall motion. Stress and rest MBF was decreased in the septum and the inferior wall compared with other walls ( < 0.0001), resulting in similar MFR. A reduced MFR was associated with a fixed defect ( = 0.04). Only 18 patients (10%) presented with a decreased MFR. They were more often referred to subsequent coronary angiography (8/18, 44%) compared with patients with a normal MFR (9/156, 6%, χ = 27.382, < 0.0001). However, significant coronary lesions were finally found in only 4/174 patients (2%).
Although a decreased MFR was associated with a fixed defect on conventional perfusion imaging, the low rate of CAD finally demonstrated in this study questions the relevance of routine screening for CAD in patients with presumed new LBBB.
本回顾性研究旨在评估动态单光子发射计算机断层扫描（SPECT）结合心肌血流（MBF）定量分析和心肌血流储备（MFR）检测疑似新发左束支传导阻滞（LBBB）患者冠状动脉疾病（CAD）的能力。
我们评估了来自单一中心的174例无CAD病史的连续LBBB患者的动态SPECT结果。在静息状态和注射雷加曲班（400μg）期间评估MBF。正常MFR定义为≥2.1。通过传统门控SPECT评估左心室功能和节段性灌注。174例患者中有17例（10%）发现SPECT异常，其中4例（2.3%）为可逆性SPECT缺损，12例（7%）为固定缺损，1例两者皆有。尽管室间隔壁运动明显受损，但整体左心室功能正常。与其他壁相比，室间隔和下壁的静息和负荷MBF降低（<0.0001），导致MFR相似。MFR降低与固定缺损相关（P = 0.04）。只有18例患者（10%）MFR降低。与MFR正常的患者相比，他们更常接受后续冠状动脉造影（18例中的8例，44% 对比156例中的9例，6%，χ² = 27.382，P < 0.0001）。然而，最终仅在174例患者中的4例（2%）发现明显的冠状动脉病变。
尽管MFR降低与传统灌注成像中的固定缺损相关，但本研究中最终证实的CAD低发生率质疑了对疑似新发LBBB患者进行CAD常规筛查的相关性。
