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Correlation of Echocardiographic Left Atrial Abnormality With Myocardial Ischemia During Myocardial Perfusion Assessment in Patients With Left Bundle Branch Block

      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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      References

        • Benjamin E.J.
        • D'Agostino R.B.
        • Belanger A.J.
        • Wolf P.A.
        • Levy D.
        Left atrial size and the risk of stroke and death. The Framingham Heart Study.
        Circulation. 1995; 92: 835-841
        • Kizer J.R.
        • Bella J.N.
        • Palmieri V.
        • Liu J.E.
        • Best L.G.
        • Lee E.T.
        • Roman M.J.
        • Devereux R.B.
        Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: the Strong Heart Study (SHS).
        Am Heart J. 2006; 151: 412-418
        • Tandogan I.
        • Yetkin E.
        • Ileri M.
        • Ortapamuk H.
        • Yanik A.
        • Cehreli S.
        • Duru E.
        Diagnosis of coronary artery disease with Tl-201 SPECT in patients with left bundle branch block: importance of alternative interpretation approaches for left anterior descending coronary lesions.
        Angiology. 2001; 52: 103-108
        • DePuey E.G.
        • Krawezynska E.G.
        • Rubbins W.L.
        Thallium-201 SPECT in coronary artery disease patients with left bundle branch block.
        J Nucl Med. 1988; 29: 1479-1485
        • Ariyarajah V.
        • Apiyasawat S.
        • Moorthi R.
        • Spodick D.H.
        Potential clinical correlates and risk factors for interatrial block.
        Cardiology. 2006; 105: 213-218
        • Evangelista L.
        • Nai Fovino L.
        • Saladini F.
        • Saladini G.
        • Razzolini R.
        • Mormino G.P.
        • Al-Nahhas A.
        • Rubello D.
        Diagnostic and prognostic value of gated myocardial perfusion single-photon emission computed tomography in low-risk patients with left bundle-branch block.
        Nucl Med Commun. 2012; 33: 491-497
        • Koepfli P.
        • Wyss C.A.
        • Gaemperli O.
        • Siegrist P.T.
        • Klainguti M.
        • Schepis T.
        • Namdar M.
        • Bechir M.
        • Hoefflinghaus T.
        • Duru F.
        • Kaufmann P.A.
        Left bundle branch block causes relative but not absolute septal underperfusion during exercise.
        Eur Heart J. 2009; 30: 2993-2999
        • Hasegawa S.
        • Sakata Y.
        • Ishikura F.
        • Hirayama A.
        • Kusuoka H.
        • Nishimura T.
        • Kodama K.
        Mechanism for abnormal thallium-201 myocardial scintigraphy in patients with left bundle branch block in the absence of angiographic coronary artery disease.
        Ann Nucl Med. 1999; 13: 253-259
        • Matzer L.
        • Kiat H.
        • Friedman J.D.
        • Van Train K.
        • Maddahi J.
        • Berman D.S.
        A new approach to the assessment of tomographic thallium-201 scintigraphy in patients with left bundle branch block.
        J Am Coll Cardiol. 1991; 17: 1309-1317
        • Youn H.J.
        • Park C.S.
        • Cho E.J.
        • Jung H.O.
        • Jeon H.K.
        • Lee J.M.
        • Oh Y.S.
        • Chung W.S.
        • Kim J.H.
        • Choi K.B.
        • Hong S.J.
        Left bundle branch block disturbs left anterior descending coronary artery flow: study using transthoracic Doppler echocardiography.
        J Am Soc Echocardiogr. 2005; 18: 1093-1098
        • Nesto R.W.
        • Kowalchuk G.J.
        The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia.
        Am J Cardiol. 1987; 59: 23C-30C
        • Frink R.J.
        • James T.N.
        Normal blood supply to the human His bundle and proximal bundle branches.
        Circulation. 1973; 47: 8-18
        • Lie K.J.
        • Wellens H.J.J.
        • Durrer D.S.
        Mechanism and significance of widened QRS complexes during complete atrioventricular block in acute inferior myocardial infarction.
        Am J Cardiol. 1974; 33: 833-839