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Title: Altered myocardial perfusion in patients with angina pectoris or silent ischemia during exercise as assessed by quantitative thallium-201 single-photon emission computed tomography

Abstract

The extent of abnormally perfused myocardium was compared in patients with and without chest pain during treadmill exercise from a large, relatively low-risk consecutive patient population (n = 356) referred for quantitative thallium-201 single-photon emission computed tomography (SPECT). All patients had concurrent coronary angiography. Patients were excluded if they had prior coronary angioplasty or bypass surgery. Tomographic images were assessed visually and from computer-generated polar maps. Chest pain during exercise was as frequent in patients with normal coronary arteries (12%) as in those with significant (greater than 50% stenosis) coronary artery disease (CAD) (14%). In the 219 patients with significant CAD, silent ischemia was fivefold more common than symptomatic ischemia (83% versus 17%, p = 0.0001). However, there were no differences in the extent, severity, or distribution of coronary stenoses in patients with silent or symptomatic ischemia. Our major observation was that the extent of quantified SPECT perfusion defects was nearly identical in patients with (20.9 +/- 15.9%) and without (20.5 +/- 15.6%) exertional chest pain. The sensitivity for detecting the presence of CAD was significantly improved with quantitative SPECT compared with stress electrocardiography (87% versus 65%, p = 0.0001). Although scintigraphic and electrocardiographic evidence of exercise-induced ischemia were comparablemore » in patients with chest pain (67% versus 73%, respectively; p = NS), SPECT was superior to stress electrocardiography for detecting silent myocardial ischemia. The majority of patients in this study with CAD who developed ischemia during exercise testing were asymptomatic, although they exhibited an angiographic profile and extent of abnormally perfused myocardium similar to those of patients with symptomatic ischemia.« less

Authors:
; ; ;  [1]
  1. Baylor College of Medicine, Houston, TX (USA)
Publication Date:
OSTI Identifier:
6421951
Resource Type:
Journal Article
Journal Name:
Circulation; (USA)
Additional Journal Information:
Journal Volume: 82:4; Journal ID: ISSN 0009-7322
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARDIOVASCULAR DISEASES; DIAGNOSIS; HEART; SCINTISCANNING; ELECTROCARDIOGRAMS; EXERCISE; MYOCARDIUM; PAIN; PATIENTS; PERFUSED ORGANS; SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY; THALLIUM 201; BETA DECAY RADIOISOTOPES; BODY; CARDIOVASCULAR SYSTEM; COMPUTERIZED TOMOGRAPHY; COUNTING TECHNIQUES; DAYS LIVING RADIOISOTOPES; DIAGNOSTIC TECHNIQUES; DIAGRAMS; DISEASES; ELECTRON CAPTURE RADIOISOTOPES; EMISSION COMPUTED TOMOGRAPHY; HEAVY NUCLEI; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; MUSCLES; NUCLEI; ODD-EVEN NUCLEI; ORGANS; RADIOISOTOPE SCANNING; RADIOISOTOPES; SECONDS LIVING RADIOISOTOPES; SYMPTOMS; THALLIUM ISOTOPES; TOMOGRAPHY; 550601* - Medicine- Unsealed Radionuclides in Diagnostics

Citation Formats

Mahmarian, J J, Pratt, C M, Cocanougher, M K, and Verani, M S. Altered myocardial perfusion in patients with angina pectoris or silent ischemia during exercise as assessed by quantitative thallium-201 single-photon emission computed tomography. United States: N. p., 1990. Web. doi:10.1161/01.CIR.82.4.1305.
Mahmarian, J J, Pratt, C M, Cocanougher, M K, & Verani, M S. Altered myocardial perfusion in patients with angina pectoris or silent ischemia during exercise as assessed by quantitative thallium-201 single-photon emission computed tomography. United States. https://doi.org/10.1161/01.CIR.82.4.1305
Mahmarian, J J, Pratt, C M, Cocanougher, M K, and Verani, M S. 1990. "Altered myocardial perfusion in patients with angina pectoris or silent ischemia during exercise as assessed by quantitative thallium-201 single-photon emission computed tomography". United States. https://doi.org/10.1161/01.CIR.82.4.1305.
@article{osti_6421951,
title = {Altered myocardial perfusion in patients with angina pectoris or silent ischemia during exercise as assessed by quantitative thallium-201 single-photon emission computed tomography},
author = {Mahmarian, J J and Pratt, C M and Cocanougher, M K and Verani, M S},
abstractNote = {The extent of abnormally perfused myocardium was compared in patients with and without chest pain during treadmill exercise from a large, relatively low-risk consecutive patient population (n = 356) referred for quantitative thallium-201 single-photon emission computed tomography (SPECT). All patients had concurrent coronary angiography. Patients were excluded if they had prior coronary angioplasty or bypass surgery. Tomographic images were assessed visually and from computer-generated polar maps. Chest pain during exercise was as frequent in patients with normal coronary arteries (12%) as in those with significant (greater than 50% stenosis) coronary artery disease (CAD) (14%). In the 219 patients with significant CAD, silent ischemia was fivefold more common than symptomatic ischemia (83% versus 17%, p = 0.0001). However, there were no differences in the extent, severity, or distribution of coronary stenoses in patients with silent or symptomatic ischemia. Our major observation was that the extent of quantified SPECT perfusion defects was nearly identical in patients with (20.9 +/- 15.9%) and without (20.5 +/- 15.6%) exertional chest pain. The sensitivity for detecting the presence of CAD was significantly improved with quantitative SPECT compared with stress electrocardiography (87% versus 65%, p = 0.0001). Although scintigraphic and electrocardiographic evidence of exercise-induced ischemia were comparable in patients with chest pain (67% versus 73%, respectively; p = NS), SPECT was superior to stress electrocardiography for detecting silent myocardial ischemia. The majority of patients in this study with CAD who developed ischemia during exercise testing were asymptomatic, although they exhibited an angiographic profile and extent of abnormally perfused myocardium similar to those of patients with symptomatic ischemia.},
doi = {10.1161/01.CIR.82.4.1305},
url = {https://www.osti.gov/biblio/6421951}, journal = {Circulation; (USA)},
issn = {0009-7322},
number = ,
volume = 82:4,
place = {United States},
year = {Mon Oct 01 00:00:00 EDT 1990},
month = {Mon Oct 01 00:00:00 EDT 1990}
}