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Comparison of Regional Myocardial Blood Flow and Perfusion in Dilated Cardiomyopathy and Left Bundle Branch Block: Role of Wall Thickening

¹ Department of Nuclear Medicine, University Hospital, Aachen University of Technology, Aachen, Germany
² Department of Internal Medicine I (Cardiology), University Hospital, Aachen University of Technology, Aachen, Germany

Heterogeneous perfusion in left bundle branch block (LBBB) has been demonstrated by ^99mTc-methoxyisobutylisonitrile (MIBI) SPECT. Locally different contraction is also associated with LBBB. Quantitative analysis of myocardial SPECT is influenced by partial-volume effects depending on systolic wall thickening. Therefore, partial-volume effects may mimic perfusion heterogeneity in LBBB. Methods: Fifteen patients with nonischemic dilated cardiomyopathy and LBBB underwent resting ¹⁵O-water PET, ^99mTc-MIBI SPECT, and gated ¹⁸F-FDG PET for analysis of wall thickening. Myocardial blood flow corrected for rate–pressure product (corrMBF), ^99mTc-MIBI uptake, and wall thickening were determined in 4 left ventricular wall areas. In 14 patients, M-mode echocardiographic recordings were available for comparison. Results: Homogeneous distribution was found for corrMBF (1.09 ± 0.41 to 1.19 ± 0.31 mL x g^-1 x min^-1). ^99mTc-MIBI uptake and wall thickening were heterogeneous (P < 0.0001), with the lowest values septal (^99mTc-MIBI, 65% ± 10%; wall thickening, 16% ± 14%) and the highest lateral (^99mTc-MIBI, 84% ± 5%; wall thickening, 55% ± 17%). Similar relationships in systolic wall thickening were observed by M-mode echocardiography (anteroseptal, 20% ± 11%; posterolateral, 37% ± 18%; P < 0.001). Conclusion: Heterogeneity of ^99mTc-MIBI uptake in LBBB corresponds to differences in wall thickening and does not reflect distribution of corrMBF. Supplementary analysis of wall thickening is recommended when assessing ^99mTc-MIBI SPECT in LBBB.

Key Words: left bundle branch block • ¹⁵O-water • ^99mTc-methoxyisobutylisonitrile • wall thickening

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