Dipyridamole thallium-201 scintigraphy as a preoperative screening test. A reexamination of its predictive potential. Study of Perioperative Ischemia Research Group

Journal Article · Thu Aug 01 00:00:00 EDT 1991 · Circulation; (United States)

DOI:https://doi.org/10.1161/01.CIR.84.2.493· OSTI ID:5265655

Mangano, D T; London, M J; Tubau, J F; Browner, W S; Hollenberg, M; Krupski, W; Layug, E L; Massie, B ^[1]

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1. University of California, San Francisco (USA)

The authors examined the value of dipyridamole thallium-201 (201Tl) scintigraphy as a preoperative screening test for perioperative myocardial ischemia and infarction. They prospectively studied 60 patients undergoing elective vascular surgery. They performed 201Tl scintigraphy preoperatively and blinded all treating physicians to the results. Historical, clinical, laboratory, and physiological data were gathered throughout hospitalization. Myocardial ischemia was assessed during the intraoperative period using continuous 12-lead electrocardiography (ECG) and transesophageal echocardiography (TEE) and during the postoperative period using continuous two-lead ambulatory ECG. Adverse cardiac outcomes (cardiac death, myocardial infarction, unstable angina, severe ischemia, or congestive heart failure) were assessed daily throughout hospitalization. Twenty-two patients (37%) had defects that improved or reversed on delayed scintigrams (redistribution defects), 18 (30%) had persistent defects, and 20 (33%) had no defects on 201Tl scintigraphy. There was no association between redistribution defects and adverse cardiac outcomes: 54% (seven of 13) of adverse outcomes occurred in patients without redistribution defects, and the risk of an adverse outcome was not significantly increased in patients with redistribution defects. Consistent with these findings, there was also no association between redistribution defects and perioperative ischemia: 54% (19 of all 35) of perioperative ECG and TEE ischemic episodes and 58% (14 of 24) of severe ischemic episodes occurred in patients without redistribution defects. The sensitivity of 201Tl scintigraphy for perioperative ischemia and adverse outcomes ranged from 40% to 54%, specificity from 65% to 71%, positive predictive value from 27% to 47% and negative predictive value from 61% to 82%.

• OSTI ID: 5265655
• Journal Information: Circulation; (United States), Vol. 84:2; ISSN 0009-7322
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
HEART
SCINTISCANNING
ISCHEMIA
DIAGNOSIS
MYOCARDIAL INFARCTION
ELECTROCARDIOGRAMS
PATIENTS
SENSITIVITY ANALYSIS
THALLIUM 201
ULTRASONOGRAPHY
VASODILATORS
ANEMIAS
BETA DECAY RADIOISOTOPES
BODY
CARDIOVASCULAR AGENTS
CARDIOVASCULAR DISEASES
CARDIOVASCULAR SYSTEM
COUNTING TECHNIQUES
DAYS LIVING RADIOISOTOPES
DIAGNOSTIC TECHNIQUES
DIAGRAMS
DISEASES
DRUGS
ELECTRON CAPTURE RADIOISOTOPES
HEAVY NUCLEI
HEMIC DISEASES
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
NUCLEI
ODD-EVEN NUCLEI
ORGANS
RADIOISOTOPE SCANNING
RADIOISOTOPES
SECONDS LIVING RADIOISOTOPES
SYMPTOMS
THALLIUM ISOTOPES
VASCULAR DISEASES
550601* - Medicine- Unsealed Radionuclides in Diagnostics