Circulation, Vol 85, 1125-1131, Copyright © 1992 by American Heart Association
S Ono, R Nohara, H Kambara, K Okuda and C Kawai
BACKGROUND. Several authors have reported cases in which 201Tl scintigraphy
demonstrated perfusion abnormality in the septum of patients with left
bundle branch block (LBBB) and normal coronary arteriogram. The mechanism
of this abnormality, however, remains to be clarified. METHODS AND RESULTS.
To determine whether LBBB itself induces abnormal myocardial perfusion and
ischemia and to elucidate its mechanism, we used an in vivo animal model.
LBBB was induced by right ventricular pacing in 17 open-chest dogs. We
examined myocardial perfusion and glucose uptake using 201Tl and
18F-labeled 2-fluoro-2- deoxy-D-glucose. 201Tl activity in the septum was
reduced to 74.7 +/- 14.5% of its maximal activity, and mean activity was
86.5 +/- 5.3% in the free wall (p less than 0.05). 18F activity in the
septum was also reduced compared with that in the free wall (67.4 +/- 12.1%
versus 88.0 +/- 5.2%, p less than 0.05). Regional myocardial blood flow was
significantly reduced in the septum compared with the free wall, averaging
0.53 +/- 0.18 ml/min/g versus 0.84 +/- 0.14 ml/min/g, respectively (p less
than 0.01). Systolic thickening in the septum was reduced from 1.36 +/-
0.20 to 0.98 +/- 0.04 (p less than 0.01) after the induction of LBBB, and
the intramyocardial pressure in the septum in diastolic phase, in which the
major flow of left anterior descending coronary artery (LAD) exists,
increased from 26.6 +/- 10.5 to 57.8 +/- 22.2 mm Hg (p less than 0.02).
Mean aortic pressure, LAD flow, and lactate extraction rate showed no
significant change. CONCLUSIONS. LBBB itself may reduce myocardial
perfusion and glucose uptake in the septum because of impaired systolic
thickening and augmented intramyocardial pressure in the septum; however,
this is not necessarily related to septal ischemia.
ARTICLES
Regional myocardial perfusion and glucose metabolism in experimental left bundle branch block
Department of Internal Medicine, Kyoto University, Japan.
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