Increased lung uptake of thallium-201 during exercise myocardial imaging: Clinical, hemodynamic and angiographic implications in patients with coronary artery disease

Boucher, Charles A.; Zir, Leonard M.; Beller, George A.; Okada, Robert D.; McKusick, Kenneth A.; Strausś, H. William; Pohost, Gerald M.

doi:10.1016/0002-9149(80)90057-0

Cited by 192 publications

(36 citation statements)

References 24 publications

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“…It is therefore apparent that post-stress myocardial stunning can be used as a highly specific marker of extensive or severe CAD. 9,25 Transient ischemic dilatation of the left ventricle and increased thallium uptake by the lungs are both well-known indexes for severe CAD, [26][27][28] but are usually seen in patients with multivessel CAD. From our results, it is noteworthy that post-stress myocardial stunning appears even in patients with 1-vessel CAD, if there is high-grade coronary narrowing.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Post-Exercise and Post-Vasodilator Stress Myocardial Stunning as Assessed by Electrocardiogram-Gated Single-Photon Emission Computed Tomography

Tanaka

Chikamori

Hida

et al. 2005

Circ J

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lthough stress-induced wall motion abnormalities usually disappear rapidly once myocardial ischemia is eliminated, there are a few cases in which wall motion abnormalities remain, even >30 min after elimination of the ischemia; myocardial stunning is the apparent mechanism in such cases. [1][2][3][4][5][6] The characteristics of technetium-99m ( 99m Tc)-sestamibi, which rarely redistributes, 7 in conjunction with electrocardiogram-gated single-photon emission computed tomography (SPECT) enables assessment of both myocardial ischemia during stress and left ventricular wall motion and function at least 30 min after the stress. 8,9 Although myocardial stunning has been mainly shown after exercise-induced ischemia, 1-6 pharmacologic vasodilation, which induces maldistribution of the blood flow in the intramyocardium, is commonly used as the method of inducing stress during myocardial perfusion imaging. Therefore, the aims of the present study were to evaluate the myocardial stunning induced by standard stress tests in clinical practice, and to compare the development of myocardial stunning with either exercise or pharmacologic stress. Methods SubjectsThe subjects were 179 consecutive patients with known or suspected coronary artery disease (CAD), who underwent exercise or adenosine triphosphate disodium (ATP) stress myocardial perfusion imaging. Patients with a history of coronary angioplasty or bypass graft surgery were considered to have known CAD, whereas those with a clinical risk profile, symptoms or electrocardiographic abnormalities were considered as having suspected CAD. Patients with a history of prior myocardial infarction were excluded. In total, there were 112 men and 67 women, with a mean age of 66±9 years, and 77 of them underwent coronary angiography because of clinical symptoms, electrocardiographic abnormalities or scintigraphic findings. Of those with known CAD, 50 patients had a history of coronary revascularization (coronary angioplasty in 39 patients, coronary artery bypass grafting in 11). Written informed consents were given by all participants. Stress 99m Tc-Sestamibi SPECTStress myocardial SPECT with 99m Tc-sestamibi was performed using a 1-day exercise -rest protocol. 10 Exercise Background Exercise gated single-photon emission computed tomography (SPECT) using technetium-99m ( 99m Tc)-sestamibi evaluates both myocardial perfusion during stress and wall motion >30 min after the stress, which has the potential to assess not only exercise-induced myocardial ischemia but also the development of myocardial stunning. Methods and ResultsTo evaluate the incidence of post-stress myocardial stunning, as well as comparing the effects of different stress methods on the development of stunning, 179 consecutive patients with known or suspected coronary artery disease (CAD) underwent 99m Tc-sestamibi SPECT with either exercise (n=135) or adenosine triphosphate disodium (ATP) (n=44). Electrocardiogram-gated SPECT images were acquired >30 min after the stress and again 4 h later, and perfusion and wall mo...

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Section: Discussionmentioning

confidence: 99%

Comparison of Post-Exercise and Post-Vasodilator Stress Myocardial Stunning as Assessed by Electrocardiogram-Gated Single-Photon Emission Computed Tomography

Tanaka

Chikamori

Hida

et al. 2005

Circ J

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“…Those methods correlate ET data with myocardial cintilography with Thallium, associated to stress echocardiogram or to other procedures such as Holter and thoracic radiogram, radionuclide ventriculography, fl uoroscopy, Thallium and vectorcardiogram increased pulmonary activity [16][17][18][19][20][21][22][23] .…”

Section: Introductionmentioning

confidence: 99%

Duplo produto elevado como preditor de ausência de coronariopatia obstrutiva de grau importante em pacientes com teste ergométrico positivo

Fornitano

Godoy

2006

Arq. Bras. Cardiol.

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30.000 mmHg.bpm; desses, 38 (76%) eram angiograficamente normais ou tinham coronariopatia obstrutiva leve e 12 (24%) tinham coronariopatia importante. Entre os outros 115 pacientes com teste ergométrico positivo, mas duplo produto < 30.000 mmHg.bpm, 59 (51,3%) eram normais ou com coronariopatia obstrutiva leve, e 56 (48,7%) apresentavam coronariopatia obstrutiva importante (Odds Ratio = 0,3327 IC 95% = 0,1579 a 0,7009; P = 0,0034). CONCLUSÃO: Com base nos dados obtidos dessa investigação, demonstrou-se que o duplo produto elevado constituiu-se em uma variável importante para prever a ausência de coronariopatia obstrutiva significante em indivíduos com teste ergométrico positivo, podendo tornar-se ferramenta útil na tomada de decisão clínica.]]>

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“…The predictive power of MPI for subsequent cardiac events and the severity of CAD is significantly enhanced when stress 201 Tl lung uptake is added to the extent and severity of perfusion defects (4,(18)(19)(20). Several studies have shown that increased stress 201 Tl lung uptake correlates very well with increased left ventricular filling pressure (4-7).…”

Section: Discussionmentioning

confidence: 99%

“…Elevated stress 201 Tl lung uptake during myocardial perfusion imaging (MPI) reflects left ventricular diastolic dysfunction. Studies have shown that increased stress 201 Tl lung uptake correlates well with increased left ventricular filling pressure (4)(5)(6)(7). Hence, an increased stress 201 Tl lungto-heart ratio (LHR) identifies diastolic dysfunction, which can be considered in combination with the presence of perfusion defects.…”

mentioning

confidence: 99%

Diastolic Filling Parameters Derived from Myocardial Perfusion Imaging Can Predict Left Ventricular End-Diastolic Pressure at Subsequent Cardiac Catheterization

Patel¹,

Robinson²,

Arteaga³

et al. 2008

J Nucl Med

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Morbidity and mortality increase when diastolic dysfunction accompanies coronary artery disease (CAD). An elevated stress 201 Tl lung-to-heart ratio (LHR) is a traditional marker of elevated left ventricular end-diastolic pressure (LVEDP), which adds prognostic value in CAD. Since the introduction of 99m Tc-labeled agents, this valuable marker has been lost. Hence, there is only a limited ability to assess diastolic dysfunction by myocardial perfusion imaging (MPI). Methods: Fifty-two consecutive patients with an ejection fraction of $45% underwent MPI and cardiac catheterization within 15 d. Peak filling rate (PFR), time to PFR (TPFR), and filling rate during the first third of diastole (1/3FR) were obtained from MPI with SPECT software. Resting 201 Tl LHR was calculated manually, and LVEDP was obtained at catheterization. Results: PFR, TPFR, and 1/3FR correlated significantly with LVEDP (r 5 20.53, 0.45, and 20.45, respectively; P 5 0.00005, 0.0009, and 0.0009, respectively), whereas resting 201 Tl LHR did not (r 5 0.10, P 5 0.49). Receiver-operatingcharacteristic curve analysis of PFR, TPFR, and 1/3FR for detecting LVEDPs of $18 mm Hg showed areas under the curve of 0.83, 0.75, and 0.80, respectively. The combination of PFR and 1/3FR showed a negative predictive value of 84%, a positive predictive value of 86%, and a specificity of 94%. Conclusion: Diastolic filling variables obtained with the SPECT software showed a significant correlation with LVEDP. PFR, TPFR, and 1/3FR were superior to resting 201 Tl LHR and showed good sensitivity, specificity, and predictive power for detecting LVEDPs of $18 mm Hg. Hence, combining data on the presence of perfusion defects with data on diastolic impairments can be achieved by adding these variables to MPI results.

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Increased lung uptake of thallium-201 during exercise myocardial imaging: Clinical, hemodynamic and angiographic implications in patients with coronary artery disease

Cited by 192 publications

References 24 publications

Comparison of Post-Exercise and Post-Vasodilator Stress Myocardial Stunning as Assessed by Electrocardiogram-Gated Single-Photon Emission Computed Tomography

Comparison of Post-Exercise and Post-Vasodilator Stress Myocardial Stunning as Assessed by Electrocardiogram-Gated Single-Photon Emission Computed Tomography

Duplo produto elevado como preditor de ausência de coronariopatia obstrutiva de grau importante em pacientes com teste ergométrico positivo

Diastolic Filling Parameters Derived from Myocardial Perfusion Imaging Can Predict Left Ventricular End-Diastolic Pressure at Subsequent Cardiac Catheterization

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