The detection of coronary artery disease: A comparison of exercise thallium imaging and exercise equilibrium radionuclide ventriculography (original) (raw)
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European Journal of Nuclear Medicine, 1990
Quantitative analysis of myocardial exercise scintigraphy has been previously reported to be superior to visual image interpretation for detection of the presence and extent of coronary artery disease. Computer analysis of perfusion defects and washout rate of thallium 201 was performed on scintigrams from a group of 131 consecutive patients (prospective group), using criteria defined from a previous group of 72 patients (initial group), and compared with visual interpretation of scintigrams for detection and evaluation of coronary artery disease. The sensitivity of the quantitative technique with regard to overall detection of coronary artery disease was not significantly different from the visual method (69% and 74%, respectively), whereas the specificity was higher (86% and 68%). Quantitative analysis did not increase the sensitivity of thallium imaging over the visual method in the left anterior descending artery (46% vs 65%) and the right coronary artery (51% vs 72%) but did increase sensitivity in the left circumflex artery (75% vs 47%). Whereas in the initial group quantitative analysis resulted in a better identification of multivessel disease (sensitivity 81% vs 57%), in the prospective group sensitivity decreased (54% vs 67%) without significant loss of specificity. The initial group had a 40 % incidence of three-vessel disease and the prospective group, 22% (P<0.05). One-vessel disease was higher in the prospective group (32% vs 11%, P< 0.05). Thus, assessing the quantitative technique in a larger prospective patient population, there was no improvement of Offprint requests to." E.K.J. Pauwels detection of the presence and extent of coronary artery disease when compared with visual interpretation. Key words: Thallium 201 myocardial scintigraphy -Thallium 201 washout -Exercise test -Coronary artery disease Eur J Nucl Med (1990) 16:697-704
Journal of the American College of Cardiology, 1989
This study examined the effect of the level of exercise on the ability of thallium-201 imaging with single photon emission computed tomography (SPECT) to detect coronary artery disease. Patients in group 1 (n = 164) achieved adequate exercise end points, defined as positive exercise electrocardiograms or ~85% of maximal predicted heart rate. Patients in group 2 (n = 108) had submaximal exercise. The SPECT thallium301 images showed perfusion defects in 74%, 88% and 98%, respectively, of patients with one, two and three vessel coronary artery disease in group 1, compared with 52%, 84% and 79%, respectively, of such patients in group 2 (p < 0.05). Perfusion defects showed partial or complete redistribution consistent with ischemia in 56%, 80% and 88%, respectively, of patients with one, two and three vessel Exercise thallium-201 imaging has been wisely used in the diagnosis of coronary artery disease and risk stratification (14). Over the past 15 years, important developments have Single photon emission computed tomography (SPECT) with thallium-201 has certain advantages over planar images. occurred in this technique that have improved the quality of Because SPECT images are capable of displaying individual tomographic slices at different levels in multiple planes, the images and enhanced the accuracy of the results (5-10). there is no problem of superimposition of shallow and deep structures, and, therefore, identification of perfusion defects is easier. Also, with planar imaging, segments of the left ventricular myocardium that are farthest away from the detector are more difficult to visualize than those closest to
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1980
Rest and exercise radionuclide ventriculograms were obtained on 77 symptomatic patients without prior documented coronary artery disease (CAD). Coronary artery disease was present by angiograms in 48. Radionuclide ventriculography (RNV) was abnormal in 41 patients (overall sensitivity 85%). In 29 patients with normal coronary arteries, RNV was normal in 24 (specificity 83%). To determine if the exercise level affects sensitivity, the studies were graded for adequacy of exercise. It was considered adequate if patients developed (a) chest pain, or (b) ST segment depression of at least 1 mm, or (c) if they achieved a pressure rate produce greater than 250. Among the 48 patients with coronary artery disease, 35 achieved adequate exercise. Thirty-three had an abnormal RNV (sensitivity 94%). In 13 patients who failed to achieve adequate exercise, RNV was abnormal in eight (sensitivity of only 62%). Some patients with coronary artery disease may have a normal ventricular response at inadeq...
Post-exercise thallium-201 myocardial scanning: A clinical appraisal
American Heart Journal, 1977
Rapid progress has been made in radionuclide scanning of the myocardium. The choice of isotopes and imaging systems allows practical application of scanning in the diagnosis of coronary artery disease, myocardial infarction, and in the evaluation of aortocoronary bypass graft status. Whereas the limitations of the conventional diagnostic techniques of angiography and exercise electrocardiography have been defined in recent years, the advantages and disadvantages of myocardial scanning in the clinical setting are just beginning to be appreciated. To assess the value of myocardial scanning, we evaluated 42 consecutive stress and resting myocardial scans, using thallium-201 (Tl-201) and a new, mobile gamma camera 1 in 38 patients with suspected or documen~ted coronary disease. Among these were 17 patients with aortocoronary bypass grafts. The results of these scans were compared with treadmill exercise electrocardiograms and with coronary and ventricular cineangiography. Methods The patients were considered in four groups: Group I had 15 patients with severe coronary artery disease, defined as coronary luminal obstruction on angiogram greater than 75 per
Revista Española de Cardiología (English Edition), 2015
Introduction and objectives: Up to 4% of patients with acute chest pain, normal electrocardiogram, and negative troponins present major adverse cardiac events as a result of undiagnosed acute coronary syndrome. Our aim was to compare the diagnostic performance of multidetector computed tomography and exercise echocardiography in patients with a low-to-intermediate probability of coronary artery disease. Methods: We prospectively included 69 patients with acute chest pain, normal electrocardiogram, and negative troponins who underwent coronary tomography angiography and exercise echocardiography. Patients with coronary stenosis ! 50% or Agatston calcium score ! 400 on coronary tomography angiography or positive exercise echocardiography, or with inconclusive results, were admitted to rule out acute coronary syndrome. Results: An acute coronary syndrome was confirmed in 17 patients (24.6%). This was lower than the suspected 42% based on coronary tomography angiography (P < .05) and not significantly different than the suspected 29% based on the results of exercise echocardiography (P = .56). Exercise echocardiography was normal in up to 37% of patients with pathological findings on coronary tomography angiography. The latter technique provided a higher sensitivity (100% vs 82.3%; P = .21) but lower specificity (76.9% vs 88.4%; P = .12) than exercise echocardiography for the diagnosis of acute coronary syndrome, although without reaching statistical significance. Increasing the stenosis cutoff point to 70% increased the specificity of coronary tomography angiography to 88.4%, while maintaining high sensitivity. Conclusions: Coronary tomography angiography offers a valid alternative to exercise echocardiography for the diagnosis of acute coronary syndrome among patients with low-to-intermediate probability of coronary artery disease. A combination of both techniques could improve the diagnosis of acute coronary syndrome.
The American journal of cardiology, 1994
This study examines the prognostic implications of normal exercise tomographic thallium images in medically treated patients with angiographic evidence of coronary artery disease (CAD). There were 97 patients aged 60 +/- 10 years; 52 had 1-, 30 had 2-, and 15 had 3-vessel CAD (> or = 50% diameter stenosis). The exercise test was submaximal in 51 patients (53%); ST-segment depression during exercise occurred in 20 patients (21%), and angina during exercise occurred in 23 patients (24%). Most patients (71%) were receiving antianginal therapy. During a mean follow-up of 32 months, only 3 patients had cardiac events: 2 died of cardiac causes and 1 had nonfatal myocardial infarction (event rate 1.1%/year). None of those 3 patients had positive ST response during exercise. Thus, medically treated patients with CAD (including those with multivessel CAD) have a benign prognosis in the presence of normal exercise thallium images. These results have important implications in patient manage...
Journal of the American College of Cardiology, 1984
Exercise thallium-201 perfusion scans and gated equilibrium blood pool scans were performed in 120 catheterized patients with a chest pain syndrome. Eighty-six patients had coronary artery disease and 34 patients did not. The effects of gender, propranolol, exercise level, exercise ischemia, history of typical angina, history of previous myocardial infarction, electrocardiographic Q waves, number of diseased vesselsand extent of coronary artery obstruction on diagnostic accuracy were evaluated. The overall sensitivity and specificity of thallium scans were 76 and 68%, respectively, and those of gated blood pool scans 80 and 62% (p = not significant). Propranolol decreased the specificity of thallium scans (propranolol = 42%; no propranolol = 87%, P < 0.05).