Abnormal thallium-201 scans in patients with chest pain and angiographically normal coronary arteries

Berger, Bruce C.; Abramowitz, Richard; Park, Chan H.; Desai, Anil G.; Madsen, Mark T.; Chung, Edward K.; Brest, Albert N.

doi:10.1016/0002-9149(83)90140-6

Cited by 73 publications

(18 citation statements)

References 16 publications

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“…However, the rate of positive study results varies from 15% to 90% among these studies. [26][27][28][29] In the present study, we could not find an area of hypoperfusion in 7 of the 24 patients, but all these patients showed increased fasting myocardial glucose utilization, which raises the possibility that myocardial perfusion is generally depressed in syndrome X patients without areas of hypoperfusion on the thallium study, and thus, focal abnormalities could not be detected. This possibility is also supported by our observations in 7 patients with a positive thallium study and focal FDG uptake.…”

Section: Myocardial Metabolism In Syndrome Xmentioning

confidence: 61%

Myocardial Glucose Metabolism Assessed by Positron Emission Tomography and the Histopathologic Findings of Microvessels in Syndrome X

Satake

Kouji

Ishikawa

et al. 2004

Circ J

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Background Syndrome X has been recognized as a disease that is primarily reflected in the cardiac microvasculature. Myocardial metabolism in this condition has been studied, but not in relation to small vessel pathology. Methods and ResultsIn order to examine the relationship between myocardial metabolism and small vessel pathology, 24 consecutive patients with syndrome X (7 men, 17 women; mean age 58 years) were evaluated by the thallium exercise stress test, positron emission tomography using F-18 fluoro-deoxyglucose (FDG), and an endomyocardial biopsy. All patients showed either diffuse or focal increase in the myocardial uptake of FDG, but only 17 patients (71%) showed hypoperfused areas with partial or complete redistribution in the thallium study. Quantification of myocardial FDG uptake revealed that the value in syndrome X patients was 10-fold higher than in controls (p<0.0001). Histopathological examination revealed that in syndrome X there is an extensive increase in smooth muscle cells and thickening of the vascular wall, even in capillary vessels, and the small vessel lumen was markedly narrowed. There was a significant inverse correlation between FDG myocardial uptake and the microvessel luminal area. Conclusions In syndrome X patients, myocardial FDG uptake is increased extensively, which is strongly associated with narrowed myocardial microvasculature. (Circ J 2004; 68: 220 -226)

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Section: Myocardial Metabolism In Syndrome Xmentioning

confidence: 61%

Myocardial Glucose Metabolism Assessed by Positron Emission Tomography and the Histopathologic Findings of Microvessels in Syndrome X

Satake

Kouji

Ishikawa

et al. 2004

Circ J

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“…In fact, exercise thallaium-201 scans have been shown to produce 'false positive' result in these group of patients as well. However, these patients have benign prognosis generally, and their symptoms may be relieved by medications 12 .…”

Section: Discussionmentioning

confidence: 99%

A Study of Patients With Normal Coronary Angiogram Over A Period of 14 Months in A Military Hospital

et al. 2013

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Objectives: The objectives were to study the incidence of the normal coronary artery anatomy, to determine their clinical, electrocardiographic, stress testing, echocardiographic and angiographic characteristics. Methods: This is a retrospective study carried out in cardiac center, Combined Military Hospital, Dhaka, Bangladesh on patients seen during the period from November 2010 to Dec 2011. The coronary artery angiography data was collected by a check list and was revised by the authors. Results: Twelve hundred and two fifty patients who had coronary angiography which showed normal coronary artery or minor coronary artery disease were included in this study. 13% were females. The mean age of the patients was 45.6. 74% patients had one or more coronary risk factors and predominant risk factor was hypertension (31%). More than 50% patients had significant cardiac symptoms and about 40% study subjects were found to have prominent ECG changes which preclude noninvasive tests. Only 38% of study subjects underwent exercise ECG tests, among them 12% had positive ETT. Two hundred and forty nine patients (20%) had normal coronary artery anatomy. Right dominant circulation was found in 79% of the patients. Conclusions: The incidence of normal coronary artery anatomy is similar to those reported in other literatures. Although there are limitations of common noninvasive tests to exclude coronary artery disease, proper clinical evaluation and appropriate use of other noninvasive investigations will definitely reduce the burden of coronary angiogram in patients with angina or suspected ischemic heart disease. DOI: http://dx.doi.org/10.3329/uhj.v8i2.16078 University Heart Journal Vol. 8, No. 2, July 2012

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confidence: 99%

“…Thallium-201 (Tl-201) myocardial perfusion imaging has been employed in the investigation of patients with syndrome X, and often shows regional defects of tracer uptake after stress. [3][4][5] However, the physical limitations of the lower energy emis-sion of Tl-201 as a myocardial perfusion agent have long been recognized. 6,7) The major advantage of technetium-99m (Tc-99m) labeled compounds over Tl-201 for myocardial perfusion imaging is the optimum features it has for single photon emission computed tomography (SPECT).…”

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confidence: 99%

<b>Technetium-99m Tetrofosmin Myocardial Perfusion Single Photon Emission Computed Tomography in Syndrome X</b>

Hsu¹,

Shiau

Kao³

et al. 2003

Jpn Heart J

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SUMMARYSyndrome X is used to describe patients with chest pain and a normal coronary angiogram. We reviewed technetium-99m tetrofosmin (Tc-99m TF) myocardial perfusion single photon emission computed tomography (SPECT) results and clinical data of 43 syndrome X patients and 30 healthy controls with normal left ventricular ejection fraction and no cardiac abnormalities. The Tc-99m TF myocardial perfusion SPECT results showed 12 (27.9%) syndrome X patients had normal myocardial perfusion and 31 (72.1%) had abnormal myocardial perfusion, including 6 (14.0%) patients with fixed defects, 20 (46.5%) patients with transient defects, and 5 (11.6%) patients with reverse defects. The results of exercise ECG were not related to perfusion defects in Tc-99m TF myocardial perfusion SPECT. In contrast, all of the 30 (100.0%) healthy controls had normal myocardial perfusion SPECT results. We conclude that abnormal Tc-99m TF myocardial perfusion SPECT is common in syndrome X and does not correlate well with the exercise ECG. However, further studies with larger case numbers and long term follow up in patients with myocardial events are necessary to support our findings. (Jpn Heart J 2003; 44: 153-162) Key words: Technetium-99m teterfosmin, Single photon emission computed tomography, Syndrome X SOME 20%-30% of all patients undergoing coronary angiography have normal or near-normal coronary arteries.1) In 1973, Kemp 2) introduced the term syndrome X to describe patients with chest pain and a normal coronary angiogram. Thallium-201 (Tl-201) myocardial perfusion imaging has been employed in the investigation of patients with syndrome X, and often shows regional defects of tracer uptake after stress. [3][4][5] However, the physical limitations of the lower energy emisFrom the

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Abnormal thallium-201 scans in patients with chest pain and angiographically normal coronary arteries

Cited by 73 publications

References 16 publications

Myocardial Glucose Metabolism Assessed by Positron Emission Tomography and the Histopathologic Findings of Microvessels in Syndrome X

Myocardial Glucose Metabolism Assessed by Positron Emission Tomography and the Histopathologic Findings of Microvessels in Syndrome X

A Study of Patients With Normal Coronary Angiogram Over A Period of 14 Months in A Military Hospital

<b>Technetium-99m Tetrofosmin Myocardial Perfusion Single Photon Emission Computed Tomography in Syndrome X</b>

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