Sequential SPECT/CT imaging starting with stress SPECT in patients with left bundle branch block suspected for coronary artery disease

To investigate the impact of left bundle branch block (LBBB) on sequential single photon emission computed tomography (SPECT)/ CT imaging starting with stress-first SPECT. Consecutive symptomatic low- to intermediate-risk patients without a history of coronary artery disease (CAD) referred for SPECT/CT were included from an observational registry. If stress SPECT was abnormal, additional rest SPECT and, if feasible, coronary CT angiography (CCTA) were acquired. Of the 5,018 patients, 218 (4.3 %) demonstrated LBBB. Patients with LBBB were slightly older than patients without LBBB (65 +/- 12 vs. 61 +/- 11 years, p < 0.001). Stress SPECT was more frequently abnormal in patients with LBBB (82 % vs. 46 %, p < 0.001). After reviewing stress and rest images, SPECT was normal in 43 % of the patients with LBBB, compared to 77 % of the patients without LBBB (p < 0.001). Sixty-four of the 124 patients with LBBB and abnormal stress-rest SPECT underwent CCTA (52 %), which could exclude obstructive CAD in 46 of the patients (72 %). Sequential SPECT/CT imaging starting with stress SPECT is not the optimal imaging protocol in patients with LBBB, as the majority of these patients have potentially false-positive stress SPECT. First-line testing using CCTA may be more appropriate in low- to intermediate-risk patients with LBBB. aEuro cent Stress-first SPECT imaging is attractive if many patients demonstrate normal stress perfusion. aEuro cent The majority of left bundle branch block patients have abnormal stress-first SPECT. aEuro cent Coronary CT excluded obstructive CAD in many LBBB patients with abnormal SPECT. aEuro cent Stress-first SPECT imaging is not the optimal imaging protocol in LBBB patients. aEuro cent In LBBB patients imaging with initial coronary CT may be more appropriate.