Left atrial (LA) abnormality, an easily quantifiable parameter of left ventricular
(LV) diastolic dysfunction, has been associated with cardiovascular risk. Because
during myocardial perfusion study (MPS), the abnormal LV activation pattern in patients
with left bundle branch block (LBBB) frequently induces perfusion defects, a clinical
correlate of early myocardial ischemia such as LA enlargement could alleviate some
of these inherent challenges. We prospectively studied 144 consecutive patients with
LBBB who underwent MPS after screening for electrocardiographic and echocardiographic
LA enlargement over a 6-month period. Of those, 114 had a positive MPS result. We
found that LA size (p <0.0001) and P-wave duration (p = 0.001) were significantly
increased in patients as the severity of the defects increased on MPS, whereas LV
ejection fraction was decrementally reduced (p = 0.001). Importantly, LA size (≥43.5
mm; sensitivity 70%, specificity 89%) and P-wave duration (≥135 milliseconds; sensitivity
63%, specificity 90%) were greatest when the MPS defect was severe. In conclusion,
the presence of LA enlargement appears significantly correlated with myocardial ischemia
among patients with LBBB and could therefore assist during MPS interpretation among
patients in whom MPS interpretation could be challenging.
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Article Info
Publication History
Published online: June 17, 2013
Accepted:
April 19,
2013
Received in revised form:
April 19,
2013
Received:
February 18,
2013
Footnotes
See page 663 for disclosure information.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
