A new approach to quantitation of exercise thallium-201 scintigraphy before and after an intervention: Application to define the impact of coronary angioplasty on regional myocardial perfusion

Lim, Yean Leng; Okada, Robert D.; Chesler, David A.; Block, Peter C.; Boucher, Charles A.; Pohost, Gerald M.

doi:10.1016/0002-8703(84)90455-1

Cited by 40 publications

(2 citation statements)

References 12 publications

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“…In the era of coronary angioplasty, many studies reported that numerous "false positive" reversible perfusion defects occurred early after angioplasty, possibly as a result of inadequate early vessel remodeling or sustained abnormalities of coronary vasomotor tone. However, a significant percentage of patients showed persistent abnormalities in the later period [59][60][61][62][63][64][65][66] . In one study, 76% of patients without prior myocardial infarction showed improvement in perfusion abnormalities after angioplasty, but only 34% had completely reversible ischemia [60] .…”

Section: Mortality?mentioning

confidence: 99%

Myocardial ischemia is a key factor in the management of stable coronary artery disease

Iwasaki¹

2014

WJC

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Previous studies demonstrated that coronary revascularization, especially percutaneous coronary intervention (PCI), does not significantly decrease the incidence of cardiac death or myocardial infarction in patients with stable coronary artery disease. Many studies using myocardial perfusion imaging (MPI) showed that, for patients with moderate to severe ischemia, revascularization is the preferred therapy for survival benefit, whereas for patients with no to mild ischemia, medical therapy is the main choice, and revascularization is associated with increased mortality. There is some evidence that revascularization in patients with no or mild ischemia is likely to result in worsened ischemia, which is associated with increased mortality. Studies using fractional flow reserve (FFR) demonstrate that ischemia-guided PCI is superior to angiography-guided PCI, and the presence of ischemia is the key to decisionmaking for PCI. Complementary use of noninvasive MPI and invasive FFR would be important to compensate for each method's limitations. Recent studies of appropriateness criteria showed that, although PCI in the acute setting and coronary bypass surgery are properly performed in most patients, PCI in the non-acute setting is often inappropriate, and stress testing to identify myocardial ischemia is performed in less than half of patients. Also, some studies suggested that revascularization in an inappropriate setting is not associated with improved prognosis. Taken together, the presence and the extent of myocardial ischemia is a key factor in the management of patients with stable coronary artery disease, and coronary revascularization in the absence of myocardial ischemia is associated with worsened prognosis.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Coronary artery bypass surgery; Coronary revascularization; Fractional flow reserve; Myocardial ischemia; Myocardial perfusion imaging; Percutaneous coronary intervention Core tip: Studies of myocardial perfusion imaging demonstrate that, for patients with moderate to severe ischemia, revascularization is the preferred therapy for survival benefit. For patients with no to mild ischemia, medical therapy is the main choice, and revascularization is associated with increased mortality probably because of worsened ischemia. Studies using fractional flow reserve demonstrate that ischemia-guided percutaneous coronary intervention (PCI) is superior to angiography-guided PCI, and the presence of ischemia is the key factor in decision-making for PCI. Thus, myocardial ischemia is a key factor in the management of patients with stable coronary artery disease.Iwasaki K. Myocardial ischemia is a key factor in the management of stable coronary artery disease. World J Cardiol

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Section: Mortality?mentioning

confidence: 99%

Myocardial ischemia is a key factor in the management of stable coronary artery disease

Iwasaki¹

2014

WJC

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“…Thallium-201 imaging has been demonstrated to be an effective method to assess the beneficial effect of percutaneous coronary angioplasty in myocardial revascularization [ 1-51. By means of quantitative image analysis, the completeness of revascularization can be objectified [6]. More recently thallium-201 single photon emission computed tomography (SPECT) has been introduced, which improves the sensitivity of diagnosing coronary disease and detecting individual coronary stenoses .…”

Section: Introductionmentioning

confidence: 99%

Sequential multivessel coronary angioplasty assessed by thallium‐201 tomography

DePuey

Roubin

DePasquale

et al. 1989

Cathet. Cardiovasc. Diagn.

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In 11 patients with multivessel coronary artery disease, SPECT thallium-201 imaging was performed prior to and within 3 days after each of two sequential percutaneous transluminal coronary angioplasties on separate days designed to achieve total revascularization. Thallium-201 SPECT was analyzed quantitatively, and an ischemic score for the vascular bed(s) supplied by the dilated vessel(s) was derived. For the vessels dilated during the first procedure the mean diameter stenosis was 80 +/- 8%, reduced to 27 +/- 9%. For the second procedure mean stenosis was reduced from 67 +/- 10% to 26 +/- 6%. For the two procedures, the mean thallium scores decreased from 298 +/- 225 to 115 +/- 130 (P less than .001) and from 135 +/- 129 to 46 +/- 60 (P less than .001), respectively. Of 10 patients with abnormal thallium-201 SPECT prior to angioplasty, nine improved after the first procedure, and seven improved further following the second procedure. Thus, utilizing staged angioplasty with a strategy of dilating the most severe lesion first, thallium-201 SPECT documented progressive improvement in myocardial perfusion.

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Value of Computer Analysis of Exercise Thallium Images in the Noninvasive Detection of Coronary Artery Disease

Kaul

Chesler

Pohost

et al. 1986

JAMA

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A new approach to quantitation of exercise thallium-201 scintigraphy before and after an intervention: Application to define the impact of coronary angioplasty on regional myocardial perfusion

Cited by 40 publications

References 12 publications

Myocardial ischemia is a key factor in the management of stable coronary artery disease

Myocardial ischemia is a key factor in the management of stable coronary artery disease

Sequential multivessel coronary angioplasty assessed by thallium‐201 tomography

Value of Computer Analysis of Exercise Thallium Images in the Noninvasive Detection of Coronary Artery Disease

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