Exercise echocardiography versus thallium-201 SPECT for assessing patients before and after PTCA

Abstract

This study was designed (1) to assess the relationship between stress exercise echocardiography (echo) and 201-Tl single photon emission computed tomography (SPECT) applied simultaneously in 23 patients who were candidates to percutaneous transluminal coronary angioplasty (PTCA), (2) to assess the relationship between the development of exercise-induced wall motion abnormalities, transient perfusion defects and the severity of quantitatively assessed coronary stenoses and (3) to compare the functional improvement after PTCA by exercise echo and SPECT. Before PTCA there was an agreement of 78% between stress echo (new wall motion abnormalities) and SPECT (transient perfusion defects) results. All patients with a percentage diameter stenosis greater than 70% had a positive echo and SPECT, while they were both negative if the percentage diameter stenosis was less than 50%. In 19 patients re-studied 4 weeks after PTCA, an ischaemic response at stress echo was found in two of the 13 patients who had a positive stress echo test before PTCA, and SPECT was still positive in three of the 10 patients who had a positive SPECT study before PTCA. Echo and SPECT were concordant in 17/19 cases. It is concluded that exercise echo and 201-Tl SPECT are useful non-invasive tools for the functional assessment of patients before and after PTCA, and that they provide highly concordant results.

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

“…Transient or permanent ST-segment changes ate observed [252]. Signs of ischemia in electrocardiography, echocardiography or scintigraphy may persist or disappear incompletely [18,67,85,142,252]. With close follow-up of cardiac enzymes after interventions, CK and CK-MB were elevated in 15 to 40% of patients [2,35,99,104,105,215].…”

Quantitative Functional Assessment of Ischemic Patients by Cardiopulmonary Exercise and Recovery Indices

“…Exercise stress testing has become a valuable clinical tool to assess myocardial efficacy and patient's prognosis following PTCA (Kent et al, 1982). As a result, traditional modalities are used before and after the PTCA procedure, including bicycle ergometer or treadmill exercise test, sequential isotopes myocardial perfusion or stress echocardiography (Fioretti et al, 1992), to assess persistence (dilated) or recurrence (stenosis) of the ischemic response. The success of PTCA may be manifested in global and regional cardiovascular function indices like reduced chest pain, increased ejection fraction, reduced abnormal ST segment morphology as well as improved wall motion and perfusion defects.…”

ACC/AHA/SCAI Practice Guidelines, February 21, 2006

“…However, the ACC/AHA practice guidelines for exercise testing favor selective evaluation in patients considered to be at particularly high risk (e.g., patients with decreased LV function, multivessel CAD, proximal LAD disease, previous sudden death, diabetes mellitus, left main disease, hazardous occupations, and suboptimal PCI results) (793). The exercise ECG is an insensitive predictor of restenosis, with sensitivities ranging from 40% to 55%, significantly less than those obtainable with single photon emission computed tomography (SPECT) (804,805) or exercise echocardiography (806)(807)(808). This lower sensitivity of the exercise ECG and its inability to localize disease limit its usefulness in patient management both before and after PCI (797,804,809).…”