Assessment of single vessel coronary artery disease: Results of exercise electrocardiography, thallium-201 myocardial perfusion imaging and radionuclide angiography

Abstract

The sensitivity of the commonly used stress tests for the diagnosis of coronary artery disease was analyzed in 46 patients with significant occlusion (greater than or equal to 70% luminal diameter obstruction) of only one major coronary artery and no prior myocardial infarction. In all patients, thallium-201 perfusion imaging (both planar and seven-pinhole tomographic) and 12 lead electrocardiography were performed during the same graded treadmill exercise test and radionuclide angiography was performed during upright bicycle exercise. Exercise rate-pressure (double) product was 22,307 +/- 6,750 on the treadmill compared with 22,995 +/- 5,622 on the bicycle (p = NS). Exercise electrocardiograms were unequivocally abnormal in 24 patients (52%). Qualitative planar thallium images were abnormal in 42 patients (91%). Quantitative analysis of the tomographic thallium images were abnormal in 41 patients (89%). An exercise ejection fraction of less than 0.56 or a new wall motion abnormality was seen in 30 patients (65%). Results were similar for the right (n = 11) and left anterior descending (n = 28) coronary arteries while all tests but the planar thallium imaging showed a lower sensitivity for isolated circumflex artery disease (n = 7). The specificity of the tests was 72, 83, 89 and 72% for electrocardiography, planar thallium imaging, tomographic thallium imaging and radionuclide angiography, respectively. The results suggest that exercise thallium-201 perfusion imaging is the most sensitive noninvasive stress test for the diagnosis of single vessel coronary artery disease.

Sensitivity of 99mTc Hexakis 2-Methoxyisobutyl Isonitrile (99mTc-Sestamibi) at Rest and during Exercise for Detection of Coronary Artery Disease and Comparison with 201TI: A Multicenter Study

“…The overall 99mTc-Sestamibi sensitivity for detecting CAD was 89% in both single-and multiple-vessel disease (table 5). This value is similar to the 89% for the 99mTc-Sestamibi sensitivity reported by Wackers et al [12] and compares with the 91 % sensitivity recently reported by Port et al [14] for 201T1 planar imaging. This moderate difference in sensitivity can be related to the different number of infarcted patients enrolled in our trial as well as to differences in coronary stenosis cutoff values for CAD significance (50 versus 75%).…”

“…The greater number of ischemic 201T1 segments is similar to that reported by Wackers et al [12] and Port et al [14], but in apparent disagreement with the high degree of correlation obtained by Kiat et al [ 10]. It is worth noting that when our segmental agreement analysis is compared with that of other authors, there is only a…”

201TI Myocardial SPECT and ß-Endorphin Levels in Patients with Suspected Silent Ischemia

“…Several studies have demonstrated that sensitivity and specificity of 2(,1 T1 myocardial SPECT for detection of CAD in symptomatic patients are very high (3,9,11,17). Also, exercise radionuclide angiography is more sensitive than exercise electrocardiography in detecting ischemia (16,22). Patterson et al (15) could show that silent myocardial ischemia in patients with angiographically proven stenosis (>50%) occurred as often as painful ischemia using stress and redistribution 201 T1 SPECT.…”

The role of cardiac computed tomography in pre‐participation screening of mature athletes

“…Specifically, low to moderate SCORE in athletes does not confer immunity to CAD, since obstructive coronary artery stenosis has been reported in approximately up to 6% of mature athletes, in the majority of whom resting ECG was normal and only exercise ECG was abnormal (Dores et al, 2020; Gervasi et al, 2019). Furthermore, individuals with significant CAD affecting left circumflex artery can occasionally display normal resting ECG and exercise ECG, with only the echocardiogram revealing regional wall motion abnormalities (Blanke, Cohen, Schlueter, Karsch, & Rentrop, 1984; Port, Oshima, Ray, McNamee, & Schmidt, 1985).…”