Abstract
Three cases of postoperative myocardial infarction are reported inpatients with normal or fixed defects on preoperative dipyridamole thallium scans (interpreted as “negative” for active cardiac ischaemic risk). All patients were monitored with an ambulatory electrocardiographic recorder from the evening before surgery through the first two postoperative days. Two of the patients demonstrated preoperative or early postoperative ischaemia, suggesting that the test was a false negative. The third patient did not demonstrate ischaemia during the period of monitoring, but developed a myocardial infarction during the third postoperative day, suggesting progression of the underlying coronary artery disease. Preoperative dipyridamole thallium imaging may result in false negative scans in selected high-risk populations.
Résumé
Le présent rapport concerne trois cas d’infarctus du myocarde postopératoire chez des patients avec des scintigraphies au thallium avec dipyridamole normales ou avec déficits fixes en période préopératoire (interprétées comme étant «négatif» face aux risques d’ischémie cardiaque active). Tous les patients ont été surveillés a l’aide d’une enregistreuse électrocardio-graphique ambulatoire, à partir de la veille de la chirurgie jusqu’à la fin de la deuxième journée postopératoire. Deux des patients ont démontré de l’ischémie préopératoire ou tôt dans la période postopératoire, suggérant que le test était un «faux négatif». Le troisième patient n’a pas démontré d’ischémie pendant la période de surveillance, mais a dévéloppé un infarctus myocardique au troisième jour postopératoire, suggérant une progression de la maladie coronarienne sous-jacente. L’imagerie préopératoire au thallium avec dipyridamole peut produire des scintigraphies faussement négatives chez des populations sélectives à haut risque.
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References
Iskandrian AS, Hes J, Askenass A, Segal BL, Auerbach N. Dipyridamole cardiac imaging. Am Heart J 1988; 115: 432–43.
Boucher CA, Brewster DC, Darling RC, Okada RD, Strauss HW, Pohost GM. Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery. N Engl J Med 1985; 312: 389–94.
Eagle KA, Singer DE, Brewster DC, Darling RC, Mulley AG, Boucher CA. Dipyridamole-thallium scanning in patients undergoing vascular surgery. JAMA 1987; 257: 2185–9.
Eagle KA, Coley CM, Newell JB et al. Combining clinical and thallium data optimizes preoperative assessment of cardiac risk before major vascular surgery. Ann Intern Med 1989; 110: 859–66.
Mangano DT, Browner WS, Hollenberg M et al. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. N Engl J Med 1990; 323: 1781–8.
Pasternack PF, Grossi EA, Baumann FG et al. The value of silent myocardial ischemia monitoring in the prediction of perioperative myocardial infarction in patients undergoing peripheral vascular surgery. J Vasc Surg 1989; 10: 617–25.
Ouyang P, Gerstenblith G, Furman WR, Golueke PJ, Gottlieb SO. Frequency and significance of early postoperative silent myocardial ischemia in patients having peripheral vascular surgery. Am J Cardiol 1989; 64: 1113–6.
Fleisher LA, Rosenbaum SH, Hawes AD, Barash PG. The predictive value of preoperative silent ischemia for postoperative ischemic cardiac events in vascular and nonvascular surgical patients. Am Heart J 1991; 122: 980–6.
Leppo J, Boucher CA, Okada RD, Newell JB, Strauss HW, Pohost GM. Serial thallium-201 myocardial imaging after dipyridamole infusion. Diagnostic utility in detecting coronary stenoses and relationship to regional wall motion. Circulation 1982; 66: 649–57.
Bertrand M, Coriat P, Baron JF, Barre E, Thomas D, Viars P. Dipyridamole thallium scan is not accurate in detecting coronary stenosis in patients undergoing abdominal aortic surgery. Anesthesiology 1990; 73: A86.
Chin W, Go R, Lenehan S, Underwood DA. Failure of dipyridamole-thallium myocardial imaging to detect severe coronary disease. Cleve Clin J Med 1989; 56: 587–9.
Okada RD, Glover DK, Leppo JA. Dipyridamole 201-T1 scintigraphy in the evaluation of prognosis after myocardial infarction. Circulation 1991; 84 (Suppl I): 1-132–1-139.
Mangano DT, London MJ, Tubau JF et al. Dipyridamole thallium-201 scintigraphy as a preoperative screening test: a reexamination of its predictive potential. Circulation 1991; 84: 493–502.
Shuman P. Bayes’ theorem. A review. Cardiol Clin 1984; 2: 319–28.
Rocco TP, Dilsizian V, McKusick KA, Fischman AJ, Boucher CA, Strauss HW. Comparison of thallium reinjection with rest “reinjection” imaging for the detection of viable myocardium. Am J Cardiol 1990; 66: 158–63.
McEnroe CS, O’Donnell TF, Yeager A et al. Comparison of ejection fraction and Goldman risk factor analysis to dipyridamole-thallium imaging 201 studies in the evaluation of cardiac morbidity after aortic aneurysm surgery. J Vasc Surg 1990; 11: 497–504.
Fuster V, Stein B, Ambrose JA et al. Atherosclerotic plaque rupture and thrombosis. Evolving concepts. Circulation 1990; 82: (Suppl II) 47–59.
Ygge J. Changes in blood coagulation and fibrinolysis during the postoperative period. Am J Surg 1970; 119: 225–32.
Master AM, Dack S, Jaffe H. Postoperative coronary artery occlusion. JAMA 1938; 110: 1415–8.
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Fleisher, L.A., Nelson, A.H. & Rosenbaum, S.H. Failure of negative dipyridamole thallium scans to predict perioperative myocardial ischaemia and infarction. Can J Anaesth 39, 179–183 (1992). https://doi.org/10.1007/BF03008653
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DOI: https://doi.org/10.1007/BF03008653