From the Division of Cardiovascular Diseases and Internal Medicine and
Section of Biostatistics, Mayo Clinic, Rochester, Minn.
Correspondence to Raymond J. Gibbons, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail gibbons.raymond{at}mayo.edu
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.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Prognostic Value of Vasodilator Myocardial Perfusion Imaging in Patients With Left Bundle-Branch Block
Key Words: prognosis • radioisotopes • electrocardiography
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