Abstract
The additional value of thallium-201 SPECT to a conventional exercise test for the identification of patients with severe coronary lesions was evaluated in 170 men, one month after an episode of unstable coronary artery disease. Severe coronary lesions at coronary angiography — defined as three vessel disease, left main stenosis or proximal left anterior descending artery stenosis as part of two vessel disease — were observed in 45.9%. In the SPECT image, the left ventricular myocardium was divided into nine segments and each segment was classified as either normal (=0), reduced uptake (=1) or uptake defect (=2). The sum of gradings in all segments post-exercise was denoted “SPECT score”. The patients were divided into nine different groups regarding ST-depression during exercise (no ST-depression, ST-depression in 1–2 leads or ≥ 3 leads) and “SPECT score” (no SPECT score, 1–3 scores or ≥ 4 scores). Severe coronary lesions were, in 68% identified by SPECT score ≥ 4 and in 65% by ST-depression in ≥ 1 lead at exercise test. The specificity for identification of severe coronary lesions was, for both tests, 65%. SPECT score ≥ 4 and/or ST-depression in ≥ 3 leads identified 82% of the patients with severe coronary lesions with a specificity of 63%. Furthermore, SPECT score ≥ 3 identified more patients with isolated proximal left anterior descending artery stenosis than ST-depression alone at exercise test.
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Cowley MJ, DiSciasscio G, Rehr RB, Vetrovec GW. Angiographic observations and clinical relevance of coronary thrombus in unstable angina pectoris. Am J Cardiol 1989;63: 108E-13E.
Williams AE, Freeman MR, Chisholm RJ, Patt NL, Armstrong, PW. Angiographic morphology in unstable angina pectoris. Am J Cardiol 1988;62: 1024–7.
Ambrose JA, Winters SL, Stern A, et al. Angiographic morphology and the pathogenesis in unstable angina. J Am Coll Cardiol 1985;5: 609–16.
Gibson RS, Beller GA, Gheroghiade M, et al. The prevalence and clinical significance of residual myocardial ischemia 2 weeks after uncomplicated non-Q-wave infarction: a prospective natural history study. Circulation 1986; 73: 1186–98.
Butman SM, Olson HG, Butman ME. Early exercise testing after stabilization of unstable angina: Correlation with coronary angiographic findings and subsequent cardiac events. Am Heart J 1986;111: 11–8.
Luchi RJ, Scott SM, Deupree RH and the principal investigators and their associates of veterans administration cooperative study no. 28. Comparison of medical and surgical treatment for unstable angina pectoris. N Engl J Med 1987;316: 977–84.
Parisi AF, Khuri S, Deupree RH, Sharma GVRK, Scott SM, Luchi RJ. Medical compared with surgical management of unstable angina. 5-year mortality and morbidity in the Vetarans Administration study. Circulation 1989;80: 1176–89.
European Coronary Surgery Study Group (director E. Varnauskas). Long-term results of prospective randomized study of coronary artery bypass surgery in stable angina pectoris. Lancet 1982;2: 1173–80.
Butman SM, Olson HG, Gardin J et al. Submaximal exercise testing after stabilization of unstable angina pectoris. J Am Coll Cardiol 1984;4: 667–73.
Swahn E, Areskog M, Wallentin L. Early exercise testing after coronary care for suspected unstable coronary artery disease — safety and diagnostic value. Eur Heart J 1986;7: 594–601.
Swahn E, Areskog M, Berglund U, Walfridsson H, Wallentin L. Predictive importance of clinical findings and a predischarge exercise test in suspected unstable coronary artery disease. Am J Cardiol 1987;59: 208–14.
Sia STB, Macdonald PS, Horowitz JD, Goble AJ, Doyle AE. Usefulness of early exercise test after non-Q-wave myocardial infarction in predicting prognosis. Am J Cardiol 1986;57: 738–44.
Wilcox I, Freedman SB, Allman KC, et al. Prognostic significance of a predischarge exercise test in risk stratification after unstable angina pectoris. J Am Coll Cardiol 1991;18: 677–83.
Nyman I, Larsson H, Areskog M, Areskog NH, Wallentin L. The predictive value of silent ischemia at an exercise test before discharge after an episode of unstable coronary artery disease. Am Heart J 1992; 123: 324–31.
Iskandrian AS, Hakki A. Thallium-201 myocardial scintigraphy. Am Heart J 1985;109: 113–28.
Iskandrian AS, Segal BL. Value of exercise thallium 201 imaging in patients with diagnostic and nondiagnostic exercise electrocardiograms. Am J Cardiol 1981;48: 233–8.
Bailey IK, Friffith LSC, Rouleau J, Strauss W, Pitt B. Thallium 201 myocardial perfusion imaging at rest and during exercise. Comparative sensitivity to electrocardiography in coronary artery disease. Circulation 1977;56: 66–71.
Brown KA, Prognostic value of thallium-201 myocardial perfusion imaging in patients with unstable angina who respond to medical treatment. J Am Coll Cardiol 1991;17: 1053–7.
Larsson H, Areskog M, Nylander E, Wallentin L. The additional prognostic value of SPECT thallium-201 scintigraphy at an exercise test after an episode of unstable anginaor non-Q-wave myocardial infarction. Int J Cardiac Imaging (in press)
Freeman MR, Chisholm RJ, Armstrong PW. Usefulness of exercise electrocardiography and thallium scintigraphy in unstable angina pectoris in predicting the extent and severity of coronary artery disease. Am J Cardiol 1988;62: 1164–70.
Karlsson J-E, Berglund U, Björkholm A, Ohlsson J, Swahn E, Wallentin L for the TRIC-study Group. Thrombolysis with recombinant human tissue-type plasminogen activator during instability in coronary artery disease: Effect on myocardial ischemia and need for coronary revascularization. Am Heart J 1992;124: 1419–26.
Gillum RF, Fortman SP, Prineas RJ, Kottke TE. International diagnostic criteria for acute myocardial infarction and stroke. Progress in Cardiology 1984;108: 150–7.
Borg G. Psycho-physical basis of perceived exertion. Med Sci Sports Exerc 1982;14: 377–81.
Borg G, Ottosson D, eds. The perception of exertion in physical work. Wennergren Center International Symposium Series. vol, 46. London: MacMillan Press, Ltd, 1986.
Nyman I, Wallentin L, Areskog M, Areskog N-H, Swahn E and the RISC study group. Risk stratification by early exercise testing after an episode of unstable coronary artery disease. Int J Cardiol 1993;39: 131–42.
Heger JJ, Weyman AE, Wann LS, Dillon JC, Feigenbaum H. Cross-sectional echocardiography in acute myocardial infarction: Detection and localization of regional left ventricular asynergy. Circulation 1979;60: 31–8.
Esquivel L, Pollock SG, Beller GA, Gibson RS, Watson DD, Kaul S. Effect of the degree of effort on the sensitivity of the exercise thallium-201 stress test in symptomatic coronary artery disease. Am J Cardiol 1989;63: 160–5.
Christian TF, Miller TD, Bailey KR, Gibbons RJ. Noninvasive identification of severe coronary artery disease using exercise tomographic thallium-201 imaging. Am J Cardiol 1992;70: 14–20.
Amanullah A, Bevegård S, Linvall K, Herlitz E. Early exercise thallium-201 single photon emission computed tomography in unstable angina: a prosepctive study. Clin Physiol 1992;12: 607–17.
Bone D, Holmgren A, Svane B. Thallium tomography in the detection of myocardial perfusion defects. Acta Med Scand (Suppl.) 1984;694: 109–19.
Iskandrian AS, Heo J, Lemlek J, Ogilby JD. 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.
DePasquale EE, Nody AC, DePuey EG et al. Quantitative rotational thallium-201 tomography for identifying and localizing coronary artery disease. Circulation 1988;77: 316–27.
Svane B, Bone D, Holmgren A. Coronary angiography and thallium-201 single photon emission computed tomography in multiple vessel coronary artery disease. Acta Radiol 1990;31: 325–32.
Marmur JD, Freeman MR, Langer A, Armstrong PW. Prognosis in medically stabilized unstable angina: Early Holter ST-segment monitoring compared with predischarge exercise thallium tomography. Ann Int Med 1990;113: 575–9.
Gibson RS, Watson DD, Craddock GB, et al. Prediction of cardiac events after uncomplicated myocardial infarction: a prosepctive study comparing predischarge exercise thallium-201 scintigraphy and coronary angiography. Circulation 1983;68: 321–36.
Romeo F, Rosano GMC, Martuscelli E, Valente A, Reale A. Unstable angina: Role of silent ischemia and total ischemic time (silent plus painful ischemia), a 6-year follow-up. J Am Coll Cardiol 1992;19: 1173–9.
Karlsson J-E, Björkholm A, Nylander E, Ohlsson J, Wallentin L. ST-changes in ECG at rest or during exercise indicate a high risk of severe coronary lesions after an episode of unstable coronary artery disease. Int J Cardiol 1993:42: 47–55.
Weiner DA, Ryan TJ, McCabe CH, et al. Value of exercise testing in determining the risk classification and the response to coronary artery bypass grafting in three-vessel coronary artery disease: A report form the coronary artery surgery study (CASS) registry. Am J Cardiol 1987;60: 262–6.
Iskandrian A S, 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.
Heller GV, Ahmed I, Tilkemeier PL, Barbour MM, Ewing C. Comparison of chest pain, electrocardiographic changes and thallium-201 scintigraphy during varying exercise intensities in men with stable anginapectoris. Am J Cardiol 1991;68: 569–74.
Cloninger KG, DePuey EG, Garcia EV, et al. Incomplete redistribution in delayed thallium-201 single photon emission computed tomographic (SPECT) images: an overestimation of myocardial scar. J Am Coll Cardiol 1988;12: 955–63.
Bonow RO, Dilsizian V. Assessing viable myocardium with thallium-201. Am J Cardiol 1992;70: 10E-17E.
Dilsizan V, Rocco TP, Freedman NMT, Leon MB, Bonow RO. Enhanced detection of ischemic but viable myocardium by the reinjection of thallium after stress-redistribution imaging. N Engl J Med 1990;323: 141–6.
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Karlsson, J.E., Björkholm, A., Nylander, E. et al. Additional value of thallium-201 SPECT to a conventional exercise test for the identification of severe coronary lesions after an episode of unstable coronary artery disease. Int J Cardiac Imag 11, 127–137 (1995). https://doi.org/10.1007/BF01844710
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DOI: https://doi.org/10.1007/BF01844710