Dipyridamole thallium-201 scintigraphy for improved detection of left anterior descending coronary artery stenosis in patients with left bundle branch block

In patients with left bundle branch block (LBBB) undergoing thallium-201 exercise scintigraphy septal perfusion defects are frequently observed irrespective of the presence or absence of coronary artery disease. Consequently, in these patients the specificity for detecting stenoses in the left anterior descending coronary artery (LAD) by thallium-201 scintigraphy is relatively low. It has been hypothesized that pharmacological vasodilation would result in higher specificity than conventional exercise thallium-201 scintigraphy because of a more uniform exploitation of coronary flow reserve. Twenty-five consecutive patients with LBBB underwent dipyridamole thallium-201 imaging and coronary arteriography within 3 months. The prevalence of coronary artery disease was estimated at 48 +/- 19%. Sensitivity for detection of LAD lesions was 100% and specificity was 88%. The positive predictive accuracy and the negative predictive accuracy were 80% and 100% respectively. The 'false positive' septal defects were of the non-reversible type. The appearance of septal perfusion defects was not dependent on changes in heart rate during dipyridamole infusion. This study indicates the value of dipyridamole thallium-201 imaging for non-invasive detection of LAD stenosis in patients with LBBB.