Myocardial blood flow assessment with <sup>82</sup>rubidium-PET imaging in patients with left bundle branch block

Falcão, Andréa; Chalela, William; Giorgi, Maria Clementina; Imada, Rodrigo; Soares Jr, José; Do Val, Renata; Oliveira, Marco Antonio; Izaki, Marisa; Kalil Filho, Roberto Kalil; Meneghetti, José C.

doi:10.6061/clinics/2015(11)02

Andréa Falcão ^** Corresponding author: E-mail:andrea.falcao@incor.usp.br

Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Serviço de Medicina Nuclear e Imagem Molecular, São Paulo/SP, Brasil

William Chalela

Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Serviço de Medicina Nuclear e Imagem Molecular, São Paulo/SP, Brasil

Maria Clementina Giorgi

Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Serviço de Medicina Nuclear e Imagem Molecular, São Paulo/SP, Brasil

Rodrigo Imada

Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Serviço de Medicina Nuclear e Imagem Molecular, São Paulo/SP, Brasil

José Soares Jr

Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Serviço de Medicina Nuclear e Imagem Molecular, São Paulo/SP, Brasil

Renata Do Val

Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Serviço de Medicina Nuclear e Imagem Molecular, São Paulo/SP, Brasil

Marco Antonio Oliveira

Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Serviço de Medicina Nuclear e Imagem Molecular, São Paulo/SP, Brasil

Marisa Izaki

Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Serviço de Medicina Nuclear e Imagem Molecular, São Paulo/SP, Brasil

Roberto Kalil Kalil Filho

Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Serviço de Medicina Nuclear e Imagem Molecular, São Paulo/SP, Brasil

José C. Meneghetti

Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Serviço de Medicina Nuclear e Imagem Molecular, São Paulo/SP, Brasil

Falcão A was responsible for the elaboration of the project, ECG data collection and processing, manuscript writing and review. Chalela W was responsible for the elaboration of the project, review of and contribution to the manuscript. Giorgi MC imaging data collection and processing, elaboration of the manuscript. Imada R was responsible for the ECG data collection and processing, elaboration of the manuscript. Soares Jr J, Izaki M were responsible for imaging data collection and processing, and manuscript review. Val R provided assistance with data collection. Oliveira MA was responsible for the imaging data collection and processing. Kalil R was responsible for the elaboration of the project and review of the manuscript. Meneghetti JC was responsible for the coordination and elaboration of the project, manuscript writing and review.

* Corresponding author: E-mail:andrea.falcao@incor.usp.br

No potential conflict of interest was reported.

	GI (n=38)	GI-A (n=12)	GI-B (n=26)	GII (n=30)	p-value
Age (yrs)	63.5 (58.25 - 68)	65 (62 - 69.25)	63.5 (58 - 67.75)	59.5 (53 - 64.75)	0.06
BMI (kg/m²)	25.3 (23.45 - 28.7)	25.9 (24.75 - 28.58)	24.8 (22.8 - 28.7)	27.85 (25.12 - 29.37)	0.23
Female	58%	67%	54%	57%	0.76
FH of CAD	30%	33%	29%	8%	0.13
Hypertension	73%	83%	67%	73%	0.64
Diabetes	39%	58%	29%	29%	0.20
Dyslipidemia	61%	58%	62%	52%	0.83
Smoking	30%	50%	19%	16%	0.07
Prior MI	22%	58%	0%	0%	< 0.001
Prior PCI	3%	8%	0%	0%	0.21
Prior CABG	6%	17%	0%	0%	0.04

	GI (n=38)	GII (n=30)	p-value
Stress (mL/min/g)
ANT	1.38 (1.07 - 1.99)	2.33 (1.74 - 3.01)	< 0.001
SEP	1.75 (1.31 - 2.33)^Δ Δp<0.05 in a comparison between the anterior and other walls in GI.	2.95 (2.23 - 3.39)	< 0.001
APX	1.25 (0.96 - 1.90)	2.31 (1.87 - 2.75)	< 0.001
LAT	1.68 (1.43 - 2.36)^Δ Δp<0.05 in a comparison between the anterior and other walls in GI.	2.52 (2.03 - 3.04)	< 0.001
INF	1.99 (1.48 - 2.95)^† †p<0.05 in a comparison between the septal and other walls in GI; ^Δ Δp<0.05 in a comparison between the anterior and other walls in GI.	2.72 (2.17 - 3.49)	0.001
GLOBAL	1.64 (1.22 - 2.54)	2.54 (1.99 - 3.15)	< 0.001
Rest (mL/min/g)
ANT	0.66 (0.54 - 0.94)	0.84 (0.64 - 0.98)	0.07
SEP	0.75 (0.62 - 1.04)^Δ Δp<0.05 in a comparison between the anterior and other walls in GI.	0.94 (0.75 - 1.15)	0.02
APX	0.65 (0.57 - 0.95)	0.86 (0.66 - 1.08)	0.01
LAT	0.79 (0.62 - 0.97)^Δ Δp<0.05 in a comparison between the anterior and other walls in GI.	0.86 (0.72 - 1.03)	0.18
INF	0.91 (0.68 - 1.13)^† †p<0.05 in a comparison between the septal and other walls in GI; ^Δ Δp<0.05 in a comparison between the anterior and other walls in GI.	0.88 (0.70 - 1.21)	0.44
GLOBAL	0.74 (0.62 - 1.07)	0.86 (0.73 - 1.10)	0.11
Coronary Flow Reserve
ANT	2.15 (1.74 - 2.76)	2.75 (2.36 - 3.55)	0.003
SEP	2.48 (1.82 - 3.11)^Δ Δp<0.05 in a comparison between the anterior and other walls in GI.	3.12 (2.62 - 3.46)	0.008
APX	1.94 (1.31 - 2.81)	2.74 (2.20 - 3.31)	0.001
LAT	2.30 (1.82 - 2.64)	2.96 (2.53 - 3.67)	< 0.001
INF	2.44 (1.95 - 3.09)	3.17 (2.50 - 3.95)	0.005
GLOBAL	2.46 (1.86 - 2.82)	3.03 (2.46 - 3.72)	0.007

Wall	GI-A (n=12)	GI-B (n=26)	p-value^♦ †refers to the comparison between the septal and other walls in GI-B;	GII (n=30)	p-value*
Stress (mL/min/g)
ANT	1.16 (0.82 - 1.89)	1.48 (1.20 - 1.99)	0.53	2.33 (1.74 - 3.01)	< 0.01
SEP	1.48 (1.15 - 2.29)^Δ †refers to the comparison between the septal and other walls in GI-B;	1.88 (1.53 - 2.33)^Δ †refers to the comparison between the septal and other walls in GI-B;	0.73	2.95 (2.23 - 3.39)	< 0.01
APX	1.12 (0.76 - 1.73)	1.29 (1.09 - 1.90)	0.67	2.31 (1.87 - 2.75)	< 0.01
LAT	1.70 (1.24 - 2.10)	1.65 (1.44 - 2.36)	0.96	2.52 (2.03 - 3.04)	< 0.01
INF	1.92 (1.48 - 2.33)^Δ †refers to the comparison between the septal and other walls in GI-B;	2.08 (1.51 - 2.95)^† ♦Comparison between GI-A and GI-B; * Comparison between GII and GI-B; ^Δ †refers to the comparison between the septal and other walls in GI-B;	0.73	2.72 (2.17 - 3.49)	0.03
GLOBAL	1.56 (1.13 - 2.05)	1.75 (1.44 - 2.54)	0.51	2.54 (1.99 - 3.15)	0.01
Rest (mL/min/g)
ANT	0.72 (0.55 - 1.02)	0.66 (0.54 - 0.90)	0.28	0.84 (0.64 - 0.98)	0.28
SEP	0.74 (0.62 - 1.12)	0.75 (0.63 - 0.92)^Δ †refers to the comparison between the septal and other walls in GI-B;	0.14	0.94 (0.75 - 1.15)	0.14
APX	0.72 (0.60 - 1.07)	0.64 (0.56 - 0.86)	0.45	0.86 (0.66 - 1.08)	0.02
LAT	0.86 (0.72 - 1.23)	0.68 (0.60 - 0.96)	0.10	0.86 (0.72 - 1.03)	0.10
INF	0.94 (0.77 - 1.27)^† ♦Comparison between GI-A and GI-B; * Comparison between GII and GI-B; ^Δ †refers to the comparison between the septal and other walls in GI-B;	0.79 (0.64 - 1.05)^Δ †refers to the comparison between the septal and other walls in GI-B;	0.50	0.88 (0.70 - 1.21)	0.50
GLOBAL	0.80 (0.66 - 1.11)	0.72 (0.62 - 1.04)	0.33	0.86 (0.73 - 1.10)	0.33
Coronary Flow Reserve
ANT	1.86 (1.18 - 2.49)	2.31 (1.98 - 2.76)	0.31	2.75 (2.36 - 3.55)	0.08
SEP	1.92 (1.31 - 2.64)	2.62 (2.13 - 3.16)^Δ †refers to the comparison between the septal and other walls in GI-B;	0.16	3.12 (2.62 - 3.46)	0.21
APX	1.40 (1.14 - 1.98)	2.00 (1.57 - 2.96)	0.25	2.74 (2.20 - 3.31)	0.04
LAT	2.04 (1.10 - 2.41)	2.44 (1.90 - 2.66)	0.36	2.96 (2.53 - 3.67)	0.01
INF	2.05 (1.40 - 2.49)	2.77 (2.31 - 3.13)	0.09	3.17 (2.50 - 3.95)	0.20
GLOBAL	1.94 (1.20 - 2.58)	2.59 (2.16 - 2.95)	0.05	3.03 (2.46 - 3.72)	0.28

	GI (n=38)	GII (n=30)	p-value
Stress LVEF (%)	43 (26 - 60)	74.5 (70 - 80.75)	< 0.001
Rest LVEF (%)	39.5 (21 - 55)	68.5 (60 - 74)	< 0.001
Stress ESV (ml)	84 (50 - 130)	24 (21 - 32)	0.07
Rest ESV (ml)	78.5 (37.25 - 129.25)	30 (21.25 - 39.25)	< 0.001
Stress EDV (ml)	147 (98 - 185)	91 (82.25 - 105)	< 0.001
Rest EDV (ml)	136 (80 - 176.75)	86.5 (73 - 97.5)	0.001

	GI-A (n=12)	GI-B (n=26)	p-value♦	GII (n=30)	p-value*
Stress LVEF (%)	35 (24 - 42.5)	51.5 (26.5 - 61.5)	0.18	74.5 (70 - 80.75)	< 0.01
Rest LVEF (%)	30.5 (22.75 - 41.75)	43 (21 - 56.75)	0.50	68.5 (60 - 74)	< 0.01
Stress ESV (ml)	109 (72.5 - 166)	74.5 (47.5 - 121.5)	0.32	24 (21 - 32)	< 0.01
Rest ESV (ml)	98 (70.25 - 151.5)	69 (26 - 124.75)	0.25	30 (21.25 - 39.25)	< 0.01
Stress EDV (ml)	171 (126 - 214.5)	137.5 (96.5 - 173.75)	0.26	91 (82.25 - 105)	0.03
Rest EDV (ml)	153 (96.75 - 193.25)	119 (58 - 160)	0.25	86.5 (73 - 97.5)	0.24

[1] Falcão A was responsible for the elaboration of the project, ECG data collection and processing, manuscript writing and review. Chalela W was responsible for the elaboration of the project, review of and contribution to the manuscript. Giorgi MC imaging data collection and processing, elaboration of the manuscript. Imada R was responsible for the ECG data collection and processing, elaboration of the manuscript. Soares Jr J, Izaki M were responsible for imaging data collection and processing, and manuscript review. Val R provided assistance with data collection. Oliveira MA was responsible for the imaging data collection and processing. Kalil R was responsible for the elaboration of the project and review of the manuscript. Meneghetti JC was responsible for the coordination and elaboration of the project, manuscript writing and review.

Brasil

Brasil

Myocardial blood flow assessment with ⁸²rubidium-PET imaging in patients with left bundle branch block

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OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Brasil

Brasil

Myocardial blood flow assessment with 82rubidium-PET imaging in patients with left bundle branch block

OBJECTIVES:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Myocardial blood flow assessment with ⁸²rubidium-PET imaging in patients with left bundle branch block