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CLINICAL STUDIES

Phasic coronary flow pattern and flow reserve in patients with left bundle branch block and normal coronary arteries

^a Department of Cardiology, University Hospital of Heraklion, Crete, Greece
^* Department of Nuclear Medicine, University Hospital of Heraklion, Crete, Greece

Manuscript received May 26, 1998; revised manuscript received November 6, 1998, accepted December 23, 1998.

Reprint requests and correspondence: Prof. Panos E. Vardas, Cardiology Department, Heraklion University Hospital, P.O. Box 1352 Stavrakia, GR 711 10 Heraklion, Crete, Greece
cardio{at}danae.med.uoc.gr

OBJECTIVES

The purpose of this study was to determine whether scintigraphic myocardial perfusion defects in patients with left bundle branch block (LBBB) and normal coronary arteries are related to abnormalities in coronary flow velocity pattern and/or coronary flow reserve.

BACKGROUND

Septal or anteroseptal defects on exercise myocardial perfusion scintigraphy are common in patients with LBBB and normal coronary arteries.

METHODS

Thirteen patients (7 men, age 61 ± 8 years) with LBBB and normal coronary arteries underwent stress thallium-201 scintigraphy and cardiac catheterization. In all patients and in 11 control subjects coronary blood flow parameters were calculated from Doppler measurements of flow velocity in the left anterior descending coronary artery (LAD) before and after adenosine administration.

RESULTS

The time to maximum peak diastolic flow velocity was significantly longer both for the seven patients with (134 ± 19 ms) and for the six without (136 ± 7 ms) exercise perfusion defects than for controls (105 ± 12 ms, p < 0.05), whereas the acceleration was slower (170 ± 54, 186 ± 42 and 279 ± 96 cm/s², respectively, p < 0.05). Coronary flow reserve in the patients with exercise perfusion defects (2.7 ± 0.3) was significantly lower than in those without (3.7 ± 0.5, p < 0.05) or in the control group (3.4 ± 0.5, p < 0.05).

CONCLUSIONS

Patients with LBBB have an impairment of early diastolic blood flow in the LAD due to an increase in early diastolic compressive resistance resulting from delayed ventricular relaxation. Furthermore, exercise scintigraphic perfusion defects in these patients are associated with a reduced coronary flow reserve, indicating abnormalities of microvascular function in the same vascular territory.

Abbreviations and Acronyms   ANOVA = analysis of variance   ECG = electrocardiographic   IV = intravenous   LAD = left anterior descending coronary artery   LBBB = left bundle branch block

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