Prognostic value of exercise thallium-201 imaging in patients presenting for evaluation of chest pain

Brown, Kenneth A.; Boucher, Charles A.; Okada, Robert D.; Guiney, Timothy E.; Newell, John; Strausś, H. William; Pohost, Gerald M.

doi:10.1016/s0735-1097(83)80100-4

Cited by 326 publications

(63 citation statements)

References 20 publications

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“…The best predictor of cardiac death or non-fatal MI was the number of myocardial segments with transient defects on 201 TI imaging. (8) Although the presence of jeopardized viable myocardium identifi es patients at increased risk for cardiac events, more importantly cardiac risk is directly related to the extent of jeopardized viable myocardium.…”

Section: Nuclear Imagingmentioning

confidence: 99%

Value of nuclear cardiology for the diagnosis and risk stratification of coronary artery disease

Libhaber

Vangu

2017

SAHJ

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Value of nuclear cardiology for the diagnosis and risk stratifi cation of coronary artery disease 106 INTRODUCTIONNuclear cardiology has undergone an outstanding growth during the last 25 years.With technical improvements and new radiopharmaceuticals, higher sensitivity and specifi city of myocardial perfusion imaging (MPI) scans has been achieved for detection and evaluation of ischemic heart disease.MPI is performed with the administration of radiopharmaceuticals which are taken up by the myocardial cells. Different radiotracers can be used, such as: 99m Tc- Sestamibi, 99m Tc-Tetrofosmin, etc.The investigation is performed at rest and stress, providing semiquantitative information on areas of myocardial infarction and ischemia.Beller et al. showed in the "anginal cascade"(1) that, with increasing stress time and myocardial oxygen demand, ischemic ST depression and anginal symptoms appear after fl ow heterogeneity, regional myocardial dysfunction, signifi cant perfusion defects and global left ventricular dysfunction. This accounts for the increased sensitivity, specifi city and accuracy of MPI over symptoms and stress ECG in the diagnosis and follow-up of coronary artery disease.It has developed into one of the most contributory fi elds in clinical decision making for the detection and risk stratifi cation in patients with suspected and known coronary artery disease. USE OF MYOCARDIAL PERFUSION SCINTIGRAPHY IN THE CLINICAL SETTINGMyocardial perfusion SPECT (single photon emission computed tomography) is a widely utilized noninvasive imaging modality for the diagnosis and management of ischemic heart disease. This modality allows a three-dimensional assessment and quantitation of the myocardium and functional assessment through ECG-gating of the perfusion images. Vol. 5, No. 3, 2008 There are several indications for the use of myocardial perfusion SPECT, whether it is for a patient who is not known to have coronary artery disease and the aim is confi rm or rule out the diagnosis, or in the patient with known ischemic heart disease, whether symptomatic or not, for risk-stratifi cation (Table 1). Indications for myocardial perfusion scintigraphy If the patient does not have diagnosis of CADTo exclude or diagnose CAD in patients with suspected CAD As a screening test in those with intermediate or high risk of CAD, e.g. familial hyperlipidemia, type II diabetes mellitus, family history of CAD, and those with atypical symptoms of ischemic heart disease (IHD). In patients with high pretest likelihood for CAD, MPI is mainly useful for risk stratifi cation purposes.In patients with non-diagnostic electrocardiography (ECG), at rest or post-stress. While there are many causes for an abnormal baseline ECG (Table 2), STRESS-ECG is frequently not conclusive. (range 17 to 100).Patients who are at risk of developing peri or postoperative cardiovascular events, i.e. peripheral vascular disease, aortic aneurysm, and the elderly.Acute chest pain -diagnosis of CAD.LBBB can induce perfusion defect in the basal ante...

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Section: Nuclear Imagingmentioning

confidence: 99%

Value of nuclear cardiology for the diagnosis and risk stratification of coronary artery disease

Libhaber

Vangu

2017

SAHJ

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“…Many studies demonstrated that the presence and extent of myocardial ischemia was closely related to adverse cardiac events [26][27][28][29][30][31][32][33][34][35][36] . Hachamovitch et al [36] identified 5183 patients who underwent MPI and were followed up for the occurrence of cardiac death or myocardial infarction.…”

Section: Mpimentioning

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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“…4 The prognostic value of the extent of myocardium at risk (as assessed by extent of reversible perfusion defects with Tl-201), and its subsequent relationship with cardiac death was initially described in a study of 100 patients with no known history of myocardial infarction who presented for evaluation of chest pain. 5 Since then, there have been a multitude of studies documenting the ability of abnormal MPS in predicting future cardiac deaths, nonfatal myocardial infarction and revascularization. 6,7 Equally, a negative/ normal MPS was shown to be associated with a good prognostic outcome.…”

Section: Diagnostic and Prognostic Value Of Myocardial Perfusion Scinmentioning

confidence: 99%

Abnormal myocardial perfusion in the absence of anatomically significant coronary artery disease: Implications and clinical significance

Venuraju

Yerramasu

Lahiri

2010

Journal of Nuclear Cardiology

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Prognostic value of exercise thallium-201 imaging in patients presenting for evaluation of chest pain

Cited by 326 publications

References 20 publications

Value of nuclear cardiology for the diagnosis and risk stratification of coronary artery disease

Value of nuclear cardiology for the diagnosis and risk stratification of coronary artery disease

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

Abnormal myocardial perfusion in the absence of anatomically significant coronary artery disease: Implications and clinical significance

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