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False-Positive Reversible Perfusion Defect During Dobutamine-Thallium Imaging in Left Bundle Branch Block

Division of Cardiology and Division of Nuclear Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

Correspondence: For correspondence or reprints contact: Joel S. Raichlen, MD, Division of Cardiology, Thomas Jefferson University Hospital, 132 South 10th St., Philadelphia, PA 19107.

ABSTRACT

In the presence of pre-existing left bundle branch block (LBBB) exercise stress thallium scans have been associated with false-positive septal and apical perfusion abnormalities. Recent reports have documented a lower incidence of false-positive septal perfusion defects when pharmacologic agents such as dipyridamole or adenosine are utilized in patients with LBBB. Dobutamine, a synthetic catecholamine, is being used with increasing frequency in combination with perfusion agents for the diagnosis of coronary artery disease in patients unable to achieve an adequate exercise workload. Because the positive inotropic and chronotropic actions of dobutamine are similar to the physiologic effects of treadmill exercise, it is conceivable that false-positive perfusion abnormalities will be observed in patients with pre-existing LBBB undergoing dobutamine perfusion imaging. We describe a patient with underlying LBBB who underwent dobutamine thallium imaging which revealed septal and periapical defects. Subsequent coronary angiography showed these abnormalities to be false-positive. It is concluded that septal and periapical perfusion abnormalities during dobutamine thallium imaging may be false-positive and should be interpreted cautiously.

Key Words: thallium perfusion imaging • dobutamine • left bundle branch block

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