Thallium-201 myocardial SPECT in left bundle branch block:: Diagnosis of myocardial ischemia with a disease-specific reference database

Background. The aim of this study was to assess the value of a myocardial perfusion single photon emission computed tomography (SPECT) reference file for patients with left bundle branch block (LBBB). Methods and Results. TI-201 stress-redistribution myocardial perfusion SPECT studies of patients with complete, permanent LBBB were reviewed retrospectively. To develop a reference database, 18 patients with a low likelihood of coronary artery disease (CAD) were selected. Left ventricular regional average and standard deviation (SD) values of the reference file images were calculated. The diagnostic performance was tested on perfusion images of 49 patients with LBBB, undergoing both scintigraphic and coronary angiographic evaluation, and was compared with a commercial quantitative analysis system using a general reference database. The LBBB reference file performed significantly better in detecting epicardial CAD than did the general reference database (receiver operating characteristic area under the curve 0.835 +/- 0.06 vs 0.580 0.08, p < .01). Disease localization also was improved significantly in the territory of the left anterior descending and of the right coronary arteries. Conclusions. The use of a reference file of patients with LBBB and a low likelihood of CAD aids the detection and the localization of myocardial ischemia on TI-201 myocardial SPECT images of this patient group.