Combined evaluation of rest-redistribution thallium-201 tomography and low-dose dobutamine echocardiography enhances the identification of viable myocardium in patients with chronic coronary artery disease (original) (raw)
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Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1998
With the widely used 50% threshold, sensitivity is high, but specificity is low in detecting viable myocardium on 201Tl SPECT. In this study, we sought to identify the best threshold for semiquantitative 201Tl analysis. Rest-redistribution 201Tl SPECT was performed in 46 patients with chronic coronary artery disease before and after myocardial revascularization. Regional function was evaluated by two-dimensional echocardiography before and after myocardial revascularization using a 3-point scale (1 = normal, 2 = hypokinetic, 3 = a/dyskinetic). Myocardial segments with abnormal systolic function were defined as viable if the systolic function score decreased > or = 1 after myocardial revascularization. A second group of 12 patients with chronic coronary artery disease constituted the validation population. Sensitivity-specificity curves, as well as receiver operating characteristic curves, for rest and redistribution mages were generated by varying the 201Tl uptake threshold. A 65...
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 Electrocardiology, 1992
This study tested the hypothesis that discriminant function analysis of clinical and exercise test variables including computerized ST measurements could improve the prediction of severe coronary artery disease. Secondary objectives were to demonstrate the effect of digoxin and/or resting electrocardiographic (ECG) abnormalities, and to evaluate the relative importance of ST measurements made during the recovery phase and in the three lead group areas. The design was a retrospective analysis of data collected during exercise testing and coronary angiography. The ECG data were gathered and stored in digital format on optical discs and all ST measurements were made off-line using the authors' own software. Univariate and multivariate analytic methods were used to analyze all pretest characteristics as well as hemodynamic and computerized ECG responses to exercise. A l,OOO-bed Veterans Affairs Medical Center served as the setting. The study included 446 male veterans who underwent a sign or symptom limited treadmill exercise test and coronary angiography. Analysis was also performed on a subset of this population formed by excluding patients receiving digoxin or with resting ECGs exhibiting left ventricular hypertrophy or ST depression (n = 328). In the total study population, the authors derived a treadmill score using discriminant function analysis. This score included: (1) the time-slope area in lead V5 during recovery; (2) delta heart rate; (3) angina pectoris during the exercise test; and (4) presence of diagnostic Q waves on the resting ECG. This score was effective in predicting triple vessel/left main disease and outperformed exercise-induced ST depression for predicting severe coronary artery disease. After exclusion of patients with ECGs exhibiting left ventricular hypertrophy or resting ST depression and patients receiving digoxin, discriminant function analysis chose: (1) the time-slope area in lead Vs during recovery and (2) delta heart rate. Exclusion of these patients resulted in a nonsignificant decrease in specificity of all ST criteria. ST-segment amplitude or slope in lead V5 at 3.5 minutes in recovery clearly outperformed the maximal exercise measurements in both groups. Summing the depressions or selecting the most depression in the three areas (ie, lateral-V 5, inferior-II, anterior-V,) did not improve test performance. Leads other than Vs did not contain significant diagnostic information. A quantitative approach to exercise testing using discriminant function analysis enhanced the tests' performance for predicting severe coronary disease. The inclusion of patients taking digoxin or with resting ECG abnormalities nonsignificantly decreases the specificity of all ST criteria. Finally, recovery ST measurements appear to be superior to measurements made during exercise, and measurements in lead V5 have more discriminatory value than measurements in leads II or V2 for predicting severe coronary artery disease.
Journal of the American College of Cardiology, 1990
The clinical utility of exercise thallium-WI single photon emission computed tomography was investigated in 360 consecutive patients who had concomitant coronary arteriography. Tomographic images were assessed visually and from computer-quantified polar maps. Sensitivity for detecting coronary artery disease was comparably high using quantitative and visual analysis, although specificity tended to improve using the former method (87% versus 76%, p = 0.09). Quantitative analysis was superior to the visual method for identifying left anterior descending (81 % versus 68%, p < 0.05) and circumflex coronary artery (77% versus 60%, p < 0.05) stenoses and detected most patients (92 %) with multivessel coronary artery disease. Multivessel involvement was correctly predicted in 65% of the patients with more than one critically stenosed vessel.
European Journal of Nuclear Medicine, 2000
Accurate assessment of myocardial viability permits selection of patients who would benefit from myocardial revascularization. Currently, rest-redistribution thallium-201 scintigraphy and low-dose dobutamine echocardiography are among the most used techniques for the identification of viable myocardium. Thirty-one consecutive patients (all men, mean age 60±8 years) with chronic coronary artery disease and reduced left ventricular ejection fraction (31%±7%) were studied. Rest 201 Tl single-photon emission tomography (SPET), low-dose dobutamine echocardiography and radionuclide angiography were performed before revascularization. Radionuclide angiography and echocardiography were repeated after revascularization. An a/dyskinetic segment was considered viable on 201 Tl SPET when tracer uptake was >65%, while improvement on low-dose dobutamine echocardiography was considered a marker of viability. Increase in global ejection fraction was considered significant at ≥5%. In identifying viable segments, rest 201 Tl SPET showed higher sensitivity than low-dose dobutamine echocardiography (72% vs 53%, P<0.05), while specificity was not significantly different (86% vs 88%). In 17 patients, global ejection fraction increased ≥5% (group 1) while in 14 it did not (group 2). A higher number of a/dyskinetic segments were viable on 201 Tl SPET in group 1 than in group 2 (2.6±1.9 vs 0.6±1.2, P<0.005), while no significant differences were observed on low-dose dobutamine echocardiography (1.7±1.6 vs 1.1±1.6). A significant correlation was found between the number of a/dyskinetic segments viable on 201 Tl SPET and post-revascularization changes in ejection fraction (r=0.52, P<0.05), but such a correlation was not observed for low-dose dobutamine echocardiography. Using as the cut-off the presence of at least one viable a/dyskinetic segment, rest 201 Tl SPET had a higher sensitivity (82% vs 53%, P=0.07) and showed a trend towards higher accuracy and specificity (77% vs 58%, and 71% vs 64%, respectively) as compared with low-dose dobutamine echocardiography. In conclusion, these findings suggest that when severely reduced global function is present, rest 201 Tl SPET evaluation of viability is more accurate than low-dose dobutamine echocardiography for the identification of patients who will benefit most from revascularization.
Diagnostic accuracy of cardiac computed tomography angiography for myocardial infarction
World Journal of Radiology, 2013
AIM: To investigate diagnostic accuracy of high, low and mixed voltage dual energy computed tomography (DECT) for detection of prior myocardial infarction (MI). METHODS: Twenty-four consecutive patients (88% male, mean age 65 ± 11 years old) with clinically documented prior MI (> 6 mo) were prospectively recruited to undergo late phase DECT for characterization of their MI. Computed tomography (CT) examinations were performed using a dual source CT system (64-slice Definition or 128-slice Definition FLASH, Siemens Healthcare) with initial first pass and 10 min late phase image acquisitions. Using the 17-segment model, regional systolic function was analyzed using first pass CT as normal or abnormal (hypokinetic, akinetic, dyskinetic). Regions with abnormal systolic function were identified as infarct segments. Late phase DE scans were reconstructed into: 140 kVp, 100 kVp, mixed (120 kVp) images and iodine-only datasets. Using the same 17-segment model, each dataset was evaluated for possible (grade 2) or definite (grade 3) late phase myocardial enhancement abnormalities. Logistic regression for correlated data was used to compare reconstructions in terms of the accuracy for detecting infarct segments using late myocardial hyperenhancement scores. RESULTS: All patients reported prior history of documented myocardial infarction, with most occurring more than 5 years prior (n = 18; 75% of cohort). Fiftyfive of 408 (13%) segments demonstrated abnormal wall motion and were classified as infarct. The remaining 353 segments were classified as non-infarcted segments. A total of 1692 segments were analyzed for late phase enhancement abnormalities, with 91 (5.5%) segments not interpretable due to artifact. Combined grades 2 and 3 compared to grade 3 only enhancement abnormalities demonstrated significantly higher sensitivity and similar specificity for detection of infarct segments for all reconstructions evaluated. Evaluation of different voltage acquisitions demonstrated the highest diagnostic performance for the 100 kVp reconstruction which had higher diagnostic accuracy (87%; 95%CI: 80%-90%), sensitivity (86%-93%; 95%CI: 54%-78%) and specificity (90%; 95%CI: 86%-93%) compared to the other reconstructions. For sensitivity, there were significant differences noted between 100 kVp vs 140 kVp (P < 0.0005), 100 kVp vs mixed (P <
Cardiology journal, 2007
Coronary arteriography is still widely accepted as a gold standard for the diagnosis of coronary artery disease (CAD), despite emerging methods such as multi-slice computed tomography. None of the presently available non-invasive diagnostic tests is perfect. The aim of the article was to make a comparison of the value and limitations of history, resting electrocardiography, exercise electrocardiography and dobutamine stress echocardiography in the diagnosis of CAD, and to create a simple algorithm for non-invasive diagnosis of CAD to optimize indications for coronarography. Prospective, multicentre trial. The collection of clinical data, resting electrocardiography, exercise treadmill electrocardiography, dobutamine stress echocardiography and catheterization data was performed on 600 patients with chest pain regarded as angina pectoris and no previous history of myocardial infarction. CAD was defined as >/= 50% narrowing of at least one major vessel. Final results were obtained ...
Detection of Coronary Artery Disease Using Automutual Information
2012
utomated scores obtained from myocardial single-photon emission computed tomography (SPECT) imaging using Heart Score View software closely correlated with standard visual interpretations of perfusion and fatty acid images from patients with angina pectoris (AP) without previous myocardial infarction (MI) and the reproducibility of such scores was excellent. 1 Although the diagnostic accuracy of detecting the location of myocardial ischemia was confirmed by coronary angiography (CAG), data were acquired from only 7 patients in that study, 1 so Kawada et al recommended increasing the sample size to further determine the diagnostic value of automated scores. 2,3 Nakajima et al also reported the sensitivity and specificity of automated scores for detecting coronary artery disease (CAD) in 70 patients, but although they showed that such scores have diagnostic value, receiver-operating characteristics (ROC) curves were not analyzed. 4 The aim of the present study was thus to determine the diagnostic accuracy of automated scoring for detecting CAD in a larger patient population and we present data from ROC curves. Methods Patients We selected 87 consecutive patients with known or suspected AP but without prior MI who underwent 201 thallium (Tl) stress/ rest SPECT followed by CAG: 21 of them underwent exercise stress SPECT and the remainder underwent pharmacological stress SPECT. Significant CAD was visually determined by CAG as ≥75% diameter stenosis of the 3 major coronary artery branches. Patients with multivessel CAD were excluded from the present study. The interval between SPECT imaging and CAG was 30±34 (1-179) days. The Ethics Committee of Nagoya Daini Red Cross Hospital approved the study protocol. Analysis of SPECT Images Scintigraphic images of the patients were acquired at 5-10 min and then at 4 h after an intravenous injection of 111 MBq 201 Tl. An L-shaped, dual-head gamma camera (GE, Millennium, Hino, Japan