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DOI: 10.1055/s-0038-1632315
Septale Myokardperfusion bei komplettem Linksschenkelblock: Kasuistik und Literaturübersicht
Septal Perfusion in Left Bundle Branch Block: Case Report and Review of the LiteraturePublication History
received:
23 September 1997
Accepted after major revision
30 September 1997
Publication Date:
03 February 2018 (online)
Zusammenfassung
Bei einer 55jährigen Frau mit komplettem Linksschenkelblock (LSB) wurden bei koronarangiographisch ausgeschlossener RIVA-Stenose innerhalb eines Jahres drei Myokardszintigraphien durchgeführt. Die erste Szintigraphie mit Tc-99m-Sestamibi zeigte einen anteroseptalen Defekt nach Fahrradergometrie. Dieser Defekt konnte in den beiden folgenden Szintigraphien nach pharmakologischer Belastung mit Dipyridamol weder mit TI-201 noch mit Tc-99m-Sestamibi reproduziert werden. Die Ruheuntersuchung erfolgte in allen Fällen mit TI-201 und war normal. Schlußfolgernd ist bei LSB der pharmakologischen Belastung mit Dipyridamol der Vorzug vor der Ergometrie zu geben; die Wahl des Radiopharmakons spielt demgegenüber für die diagnostische Genauigkeit der Myokardszintigraphie eine untergeordnete Rolle.
Summary
Myocardial scintigraphy was performed three times in a 55-year-old woman with left bundle branch block (LBBB). A significant LAD stenosis had been excluded by coronary angiography. The first scintigraphy was performed with Tc-99m sestamibi after submaximal bicycle exercise and revealed a septal perfusion deficit. This deficit could not be reproduced in the following examinations after pharmacological stress testing with dipyridamole using both TI-201 and Tc-99m sestamibi. Perfusion at rest assessed with TI-201 was normal in all studies. It is concluded that pharmacological stress testing with dipyridamole is to be preferred in patients with LBBB. With respect to the accuracy of myocardial perfusion imaging the choice of the radiopharmaceutical plays a less important role.
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