Advertisement

Journal of Nuclear Cardiology

, Volume 2, Issue 4, pp 334–338 | Cite as

Impact on exercise single-photon emission computed tomographic thallium imaging on patient management and outcome

  • Nasaraiah Nallamothu
  • Samir B. Pancholy
  • Kwan R. Lee
  • Jaekyeong Heo
  • Abdulmassin S. Iskandrian
Article

Abstract

Background

Stress perfusion imaging is useful in risk stratification of patients with known or suspected coronary artery disease. In the current era of managed health care, there is a need to provide data on patient outcome.

Methods and Results

This study examined the impact of exercise single-photon emission computed tomographic (SPECT) thallium imaging on patient management (the subsequent need for coronary angiography and revascularization) and outcome (the occurrence of hard cardiac events defined as cardiac death or nonfatal acute myocardial infarction) in 2700 patients who were being evaluated for diagnostic purposes. None of the patients had previous coronary angiography, coronary revascularization, or Q-wave myocardial infarction. The SPECT images were normal in 2027 patients (group 1) and abnormal in 673 patients (group 2). Within 6 months after thallium imaging 53 patients in group 1 (3%) and 242 patients in group 2 (36%) underwent coronary angiography (p=0.0001). The patients who underwent coronary angiography had higher pretest probability of coronary disease (group 1) or more perfusion defects (group 2) than patients who did not (p=0.0001 each). Coronary revascularization within 3 months of coronary angiography was performed in 1 of the 53 patients (2%) in group 1 and in 87 of 242 patients (30%) in group 2 (p=0.0001). Among the remaining patients who had coronary angiography but were medically treated there were no hard cardiac events in group 1 but there were 15 events in group 2 (p=0.02).

Conclusions

The results of exercise SPECT thallium imaging are important in patient management and outcome. Coronary angiography, coronary revascularization and events are rare in patients with normal exercise SPECT thallium images.

Key words

single-photon emission computed tomographic imaging thallium coronary artery disease patient outcome 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Iskandrian AS, Hakki AH, Kane-Marsh S. Prognostic implications of exercise thallium-201 scintigraphy in patients with suspected or known coronary artery diasease. Am Heart J 1985;110:135–43.PubMedCrossRefGoogle Scholar
  2. 2.
    Pamela FX, Gibson RS, Watson DD, Craddock GB, Sirowatka, Bell GA. Prognosis with chest pain and normal thallium-201 exercise scintigrams. Am J Cardiol 1985;55:920–6.CrossRefGoogle Scholar
  3. 3.
    Wackers FJ, Russo DJ, Russo D, Clements JP. Prognostic significance of normal quantitative planar thallium-201 stress scintigraphy in patients with chest pain. J Am Coll Cardiol 1985;6:27–30.PubMedGoogle Scholar
  4. 4.
    Iskandrian AS. Thallium-201 myocardial imaging and radio-nuclide ventriculography. In: Iskandrian AS, ed. Nuclear cardiac imaging: principles and applications. Philadelphia: FA Davis, 1986:81–167.Google Scholar
  5. 5.
    Ladenheim ML, Pollock BH, Rosanski A, et al. Extent and severity of myocardial hypoperfusion as predictors of prognosis in patients with suspected coronary artery disease. J Am Coll Cardiol 1986;17:464–71.Google Scholar
  6. 6.
    Staniloff HM, Forrester JS, Berman DS, Swan HJC. Prediction of death, myocardial infarction, and worsening chest pain using thallium scintigraphy and exercise electrocardiography. J Nucl Med 1986;27:1842–8.PubMedGoogle Scholar
  7. 7.
    Felsher J, Meissner MD, Hakki AH, Heo J, Kane-Marsh S, Iskandrian AS. Exercise thallium imaging in patients with diabetes mellitus: prognostic implications. Arch Intern Med 1987;147:313–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Gill JB, Ruddy TD, Newell JB, Finkelstein DM, Strauss HW, Boucher CA. Prognostic importance of exercise thallium uptake by the lungs during exercise in coronary artery disease. N Engl J Med 1987;317:1485–9.Google Scholar
  9. 9.
    Heo J, Thompson WO, Iskandrian AS. Prognostic implications of normal exercise thallium images. Am J Noninvasive Cardiol 1987;1:209–12.Google Scholar
  10. 10.
    Iskandrian AS, Heo J, Decoskey D, Askenase A, Segal BL. Use of exercise thallium-201 imaging for risk stratification of elderly patients with coronary artery disease. Am J Cardiol 1988;61:269–72.PubMedCrossRefGoogle Scholar
  11. 11.
    Brown FA. Prognostic value of thallium-201 myocardial perfusion imaging: a diagnostic tool comes of age. Circulation 1991;83:363–81.PubMedGoogle Scholar
  12. 12.
    Fattah AA, Kamal A, Pancholy S, et al. Prognostic implications of normal exercise tomographic thallium images in patients with angiographic evidence of significant coronary artery disease. Am J Cardiol 1994;74:769–71.PubMedCrossRefGoogle Scholar
  13. 13.
    Iskandrian AS, Johnson J, Le TT, Wasserleben V, Cave V, Heo J. Comparison of the treadmill exercise score and singlephoton emission computed tomographic thallium imaging in risk assessment. J Nucl Cardiol 1994;1:144–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Pryor DB, Harrell FE Jr, Lee KL, Califf RM, Rosati RA. Estimating the likelihood of significant coronary artery disease. Am J Med 1983;75:771–80.PubMedCrossRefGoogle Scholar
  15. 15.
    Iskandrian AS, Heo J, Askenase A, Segal BL, Helfant RH. Thallium imaging with single-photon emission computed tomography. Am Heart J 1987;114:852–65.PubMedCrossRefGoogle Scholar
  16. 16.
    Iskandrian AS, Heo J, Kong B, Lyons E. Effect of exercise level on the ability of thallium-201 tomographic imaging in detecting coronary artery disease: analysis of 461 patients. J Am Coll Cardiol 1989;14:1477–86.PubMedCrossRefGoogle Scholar
  17. 17.
    Heo J, Iskandrian AS. Stress thallium imaging. Am J Noninvasive Cardiol 1991;5:173–84.Google Scholar
  18. 18.
    Iskandrian AS, Ghods M, Helfeld H, Iskandrian B, Cave V, Heo J. The treadmill exercise score revisited: coronary arteriographic and thallium perfusion correlates. Am Heart J 1992;124:1581–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Ogilby JD, Iskandrian AS, Untereker WJ, Heo J, Nguyen TN, Mercuro J. Effect of intravenous adenosine infusion on myocardial perfusion and function. Circulation 1992;86:887–95.PubMedGoogle Scholar
  20. 20.
    Iskandrian AS, Chae SC, Heo J, Stanberry CD, Wasserleben V, Cave V. Independent and incremental prognostic value of exercise thallium tomographic imaging in coronary artery disease. J Am Coll Cardiol 1993;22:697–703.Google Scholar
  21. 21.
    Iskandrian AS, Heo J, Lemlek J, Ogilby DJ. Identification of high risk patients with left-main and three-vessel coronary artery disease using stepwise discriminant analysis of clinical, exercise and tomographic thallium data. Am Heart J 1993;125:221–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Colby J, Hakki AH, Iskandrian AS, Mattleman S. Hemodynamic, angiographic and scintigraphic correlates of positive exercise electrocardiograms: emphasis on strongly positive exercise electrocardiograms. J Am Coll Cardiol 1983;2:21–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Patterson RE, Eisner RL, Horowitz SF. Comparison of cost-effectiveness and utility of exercise ECG, single-photon emission computed tomography, positron emission tomography and coronary angiography for diagnosis of coronary artery disease. Circulation 1995;91:54–65.PubMedGoogle Scholar
  24. 24.
    Williams BR, Mullani NA, Jansen DE, Anderson BA. A retrospective study of the diagnostic accuracy of a community hospital-based PET center for the detection of coronary artery disease using Rubidium-82. J Nucl Med 1994;35:1586–92.PubMedGoogle Scholar
  25. 25.
    Nallamothu N, Ghods M, Heo J, Iskandrian AS. Comparison of thallium-201 single-photon emission computed tomography and electrocardiographic response during exercise in patients with normal rest electrocardiographic results. J Am Coll Cardiol 1995;25:830–6.PubMedCrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 1995

Authors and Affiliations

  • Nasaraiah Nallamothu
    • 1
  • Samir B. Pancholy
    • 1
  • Kwan R. Lee
    • 1
  • Jaekyeong Heo
    • 1
  • Abdulmassin S. Iskandrian
    • 1
  1. 1.Philadelphia Heart Institute Presbyterian Medical CenterPhiladelphia

Personalised recommendations