Diagnosis of coronary artery disease by controlled coronary vasodilation with adenosine and thallium-201 scintigraphy in patients unable to exercise.

Verani, Mario S.; Mahmarian, John J.; Hixson, Judy; Boyce, Terri M.; Staudacher, Richard

doi:10.1161/01.cir.82.1.80

Cited by 273 publications

(52 citation statements)

References 50 publications

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“…27,28 In contrast, the primary coronary vasodilator adenosine has an exceedingly short half-life of only several seconds29 and therefore affords a high degree of safety because its pharmacological effects disappear promptly on discontinuation of the drug infusion. 30,31 Accordingly, we prospectively assessed the clinical value of quantitative 20`T1 SPECT during pharmacological coronary vasodilation with adenosine for determining the anatomic extent and location of coronary artery stenoses, the frequency and severity of residual myocardial ischemia, and whether the perfusion defect size and the presence or extent of residual ischemia could predict cardiac events in an otherwise low-risk, stable group of patients very early after acute myocardial infarction.…”

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confidence: 99%

Quantitative adenosine 201Tl single-photon emission computed tomography for the early assessment of patients surviving acute myocardial infarction.

Mahmarian

Pratt²,

Nishimura

et al. 1993

Circulation

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BACKGROUND We prospectively investigated whether adenosine 201Tl tomography (SPECT) could determine the extent of coronary artery disease, the presence of jeopardized myocardium, and the risk for in-hospital cardiac events in 120 clinically stable patients early (5 +/- 3 days) after myocardial infarction. METHODS AND RESULTS All patients had coronary angiography and SPECT in close proximity. Adenosine SPECT identified 99% of infarct-related arteries and 82% of severely stenosed (> or = 70%) noninfarct arteries. Multivessel disease was accurately predicted in 69% of patients. Sixty-five percent of stenosed noninfarct arteries had matching thallium perfusion defects, and 92% of these were reversible. The specificity of adenosine SPECT was > 90%. Thallium redistribution occurred often within infarct (59%) and noninfarct (92%) zones. The patency status of the arteries, however, did not predict the presence or extent of jeopardized myocardium. The perfusion defect size was larger (p = 0.0001) in patients with (45 +/- 18%) than in those without (22 +/- 15%) in-hospital cardiac events. Furthermore, 90% of patients with events had a > or = 20% perfusion defect compared with only 38% of those without events (p = 0.0001). The positive-predictive accuracy for developing a cardiac event was 70% when the perfusion defect size was > 30%. The ischemic defect also was larger in patients with (19 +/- 14%) than in those without (10 +/- 10%) events (p = 0.001). The positive- and negative-predictive values for developing early postinfarction angina were 43% and 91%, respectively, when the ischemic defect was > 12%. CONCLUSIONS In selected low-risk survivors of myocardial infarction, early quantitative adenosine SPECT is safe and accurate in detecting and localizing coronary stenoses, assessing the extent of jeopardized myocardium, and determining subsequent risk for in-hospital cardiac events.

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confidence: 99%

Quantitative adenosine 201Tl single-photon emission computed tomography for the early assessment of patients surviving acute myocardial infarction.

Mahmarian

Pratt²,

Nishimura

et al. 1993

Circulation

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“…During adenosine infusion, however, it has been shown that the majority of patients with reversible MPI scans do not have ST-segment depression. Its presence, however, has been shown to be predictive of significant coronary artery disease (24)(25)(26). This has also been found to be true in the presence of left ventricular hypertrophy but not in patients taking digitalis (26).…”

Section: Discussionmentioning

confidence: 99%

High-frequency electrocardiogram analysis in the ability to predict reversible perfusion defects during adenosine myocardial perfusion imaging

Trägårdh

Schlegel

Carlsson

et al. 2007

Journal of Electrocardiology

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“…For instance, Goldberg et al [1,2] reported that there were fewer "classical" complaints among women than in men. Cardiac effort pain may occasionally be experienced predominantly in the neck or jaw [4]. Existing data on the significance and specificity of different symptoms of CHD at presentation are still inconclusive, and so clinicians must be familiar with the numerous characteristic as well as atypical symptoms of CHD for enhanced early diagnosis [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Cardiac effort pain may occasionally be experienced predominantly in the neck or jaw [4]. Existing data on the significance and specificity of different symptoms of CHD at presentation are still inconclusive, and so clinicians must be familiar with the numerous characteristic as well as atypical symptoms of CHD for enhanced early diagnosis [4,5]. The increasing prevalence of angina pectoris and CHD among the growing numbers of elderly people together with the often life-threatening repercussions of mis diagnosis make it imperative to hone the diagnostic skills of the primary physician, especially in cases of atypical pain.…”

Section: Introductionmentioning

confidence: 99%

Streamlining Differential Diagnosis of Coronary Heart Disease in a Primary Care Clinic: Atypical and Typical Symptoms and Their Combinations

Charach¹,

Rabinovich²,

Weintraub³

2009

TOGMJ

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Background: We sought to identify the most predictive symptoms of coronary heart disease (CHD) in the setting of a very busy community primary care clinic. By examining the variability, distribution and frequency of symptoms singly and in combination we hoped to streamline the process of correctly identifying a patient presenting with CHD. Methods: All 449 patients suspected of having CHD by one primary physician (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004) were evaluated by thallium scan, treadmill ergometry, and/or coronary angiography, as well as ECG and creatine phosphokinase /troponin levels. Group 1 included 216 subjects (117 males, 98 females, mean age 69.7±11.2 years) diagnosed as having acute coronary syndrome, stable angina pectoris or acute myocardial infarction. Group 2 included 233 (126 males, 108 females, mean age 65.2±12.1 years) subjects whose comprehensive evaluations ruled out CHD. Results: The leading symptom in Groups 1 and 2 was chest pain [80%] vs [80.3%] (NS). Dyspnea was present in 10% and 5%; (p<0.037) patients, and jaw pain in 11% and 1% (p<0.0001) patients. The symptom combinations found more frequently in Group 1 were chest pain+jaw pain (7% vs 1. 04%; p<0.0001) and dyspnea+sweating (2.8% vs 0%, p<0.01). Conclusion: Isolated symptoms (jaw pain, dyspnea) and combined symptoms (chest pain+jaw pain, dyspnea+sweating) were more specific for CHD than classical chest pain.

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Diagnosis of coronary artery disease by controlled coronary vasodilation with adenosine and thallium-201 scintigraphy in patients unable to exercise.

Cited by 273 publications

References 50 publications

Quantitative adenosine 201Tl single-photon emission computed tomography for the early assessment of patients surviving acute myocardial infarction.

Quantitative adenosine 201Tl single-photon emission computed tomography for the early assessment of patients surviving acute myocardial infarction.

High-frequency electrocardiogram analysis in the ability to predict reversible perfusion defects during adenosine myocardial perfusion imaging

Streamlining Differential Diagnosis of Coronary Heart Disease in a Primary Care Clinic: Atypical and Typical Symptoms and Their Combinations

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