PMID- 29574887
OWN - NLM
STAT- MEDLINE
DCOM- 20180917
LR  - 20180917
IS  - 1932-8737 (Electronic)
IS  - 0160-9289 (Linking)
VI  - 41
IP  - 3
DP  - 2018 Mar
TI  - Is exercise stress echocardiography useful in patients with suspected obstructive
      coronary artery disease who have resting left bundle branch block?
PG  - 360-365
LID - 10.1002/clc.22875 [doi]
AB  - BACKGROUND: Current guidelines support exercise stress echocardiography (ESE) for
      evaluation of suspected obstructive coronary artery disease (OCAD) in ambulant
      patients with left bundle branch block (LBBB). Data regarding the diagnostic
      utility of ESE in patients with LBBB are limited. HYPOTHESIS: We hypothesized
      that the diagnostic performance of ESE for the assessment of suspected OCAD is
      reduced in the context of LBBB. METHODS: We studied 191 consecutive patients with
      resting LBBB undergoing ESE for the investigation of suspected OCAD between 2008 
      and 2015 at our center. The studies were categorized as inconclusive, normal, or 
      abnormal. Patients with an abnormal response were subcategorized as regional
      ischemic response or globally abnormal. RESULTS: Eighty-two patients (43%)
      demonstrated a normal left ventricular contractile response (LVCR) to exercise;
      92 (48%) developed an abnormal LVCR to exercise, including 70 patients with
      globally abnormal and 22 patients with regional ischemic responses. Of the
      patients with abnormal responses, 62 patients had anatomic imaging, only 29 of
      whom had significant OCAD, conferring an overall specificity of ESE for
      significant OCAD of 21% and accuracy of 52%. Of patients who developed a
      regionally abnormal response, 89% had significant OCAD. CONCLUSIONS: For patients
      with LBBB who develop a globally abnormal LVCR during ESE, the specificity of ESE
      for reliably excluding significant OCAD is significantly reduced. ESE appears to 
      be a suboptimal test for the evaluation of OCAD in patients with resting LBBB, as
      about 50% of patients will have an abnormal response, the majority due to
      globally abnormal contraction where OCAD cannot be reliably diagnosed.
      Alternative testing should be considered for the investigation of suspected OCAD 
      in patients with resting LBBB.
CI  - (c) 2018 Wiley Periodicals, Inc.
FAU - Xu, Bo
AU  - Xu B
AUID- ORCID: http://orcid.org/0000-0002-2985-7468
AD  - MonashHeart, Monash Health, Clayton, Victoria, Australia.
FAU - Dobson, Laura
AU  - Dobson L
AD  - MonashHeart, Monash Health, Clayton, Victoria, Australia.
FAU - Mottram, Philip M
AU  - Mottram PM
AD  - MonashHeart, Monash Health, Clayton, Victoria, Australia.
FAU - Nasis, Arthur
AU  - Nasis A
AD  - MonashHeart, Monash Health, Clayton, Victoria, Australia.
FAU - Cameron, James
AU  - Cameron J
AD  - MonashHeart, Monash Health, Clayton, Victoria, Australia.
FAU - Moir, Stuart
AU  - Moir S
AD  - MonashHeart, Monash Health, Clayton, Victoria, Australia.
LA  - eng
PT  - Journal Article
DEP - 20180325
PL  - United States
TA  - Clin Cardiol
JT  - Clinical cardiology
JID - 7903272
SB  - IM
MH  - Aged
MH  - Bundle-Branch Block/*complications/diagnosis/physiopathology
MH  - Coronary Artery Disease/complications/*diagnosis/physiopathology
MH  - Echocardiography, Stress/*methods
MH  - Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Rate/physiology
MH  - Heart Ventricles/*diagnostic imaging/physiopathology
MH  - Humans
MH  - Male
MH  - Myocardial Contraction/*physiology
MH  - Reproducibility of Results
MH  - Retrospective Studies
MH  - Time Factors
MH  - Ventricular Function, Left/*physiology
OTO - NOTNLM
OT  - Exercise Stress Echocardiography
OT  - Left Bundle Branch Block
OT  - Obstructive Coronary Artery Disease
EDAT- 2018/03/27 06:00
MHDA- 2018/09/18 06:00
CRDT- 2018/03/26 06:00
PHST- 2017/10/03 00:00 [received]
PHST- 2017/11/23 00:00 [revised]
PHST- 2017/12/13 00:00 [accepted]
PHST- 2018/03/27 06:00 [pubmed]
PHST- 2018/09/18 06:00 [medline]
PHST- 2018/03/26 06:00 [entrez]
AID - 10.1002/clc.22875 [doi]
PST - ppublish
SO  - Clin Cardiol. 2018 Mar;41(3):360-365. doi: 10.1002/clc.22875. Epub 2018 Mar 25.