Usefulness of Hyperventilation Thallium-201 Single Photon Emission Computed Tomography for the Diagnosis of Vasospastic Angina.

Masuoka, Takeshi; Ajisaka, Ryuichi; Watanabe, Shigeyuki; Yamanouchi, Takayoshi; Iida, Kaname; Sato, Motohiro; Takeda, Takahiro; Toyama, Hinako; Ishikawa, Nobuyoshi; Itai, Yuji; Sugishita, Yasuro

doi:10.1536/ihj.36.405

Cited by 6 publications

(4 citation statements)

References 27 publications

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“…This relatively low correlation might be caused by: 1) a relatively poor signal-to-noise ratio of first-pass images in method, 2) the geometrical difference due to RAO and LAO projection generated different segment values. This segment difference was also reported in regional LVEF studies by Papapietro et al' 8 After HV stress test, EF decreased in 69% of patients with vasospastic angina. This result supports the finding of reduced LV wall motion after HV stress reported in previous studies.7 ' 9 In CAD patients a relationship between EF decrease and SD increase in stress tests has been reported.…”

Section: Discussionsupporting

confidence: 83%

“…[7][8][9] The response of left ventricular (LV) ejection fraction (EF) to HV stress has been reported to be sensitive for identifying coronary spasm and its sensitivity ranged from 66.7% to 74% in patients with spastic angina. 7 '9 Phase analysis which can demonstrate LV contraction sequence, is used to detect various abnormalities in interventricular electrical conduction and ischemic heart dis -e a s e s .…”

Section: Introductionmentioning

confidence: 99%

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Phase changes caused by hyperventilation stress in spastic angina pectoris analyzed by first-pass radionuclide ventriculography

Takeda

Toyama

et al. 1999

Ann Nucl Med

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To understand the effect of hyperventilation (HV) stress in patients with spastic angina, left ventricular (LV) contraction was analyzed by quantitative phase analysis. The study was performed on 36 patients with spastic angina pectoris, including vasospastic angina pectoris (VspAP: 16 patients) and variant angina pectoris (VAP: 20 patients). First-pass radionuclide ventriculography (first-pass RNV) was performed at rest and after HV stress, and standard deviation of the LV phase distribution (SD) was analyzed. The SD was lower in patients with VspAP than in VAP (12.8+/-1.4 degrees vs. 14.6+/-2.2 degrees, p < 0.005) at rest. After HV stress, the SD (HVSD) tended to increase in VspAP patients (62.5%), whereas the SD decreased in VAP patients (70%). Due to HV stress, the percentage change in SD (%SD) in VspAP patients was 8.9+/-23.7% whereas that in VAP patients was -9.1+/-17.3% (p < 0.01). Moreover, phase histograms were divided into HVSD increase and HVSD decrease groups. The HVSD increase group had a decrease of HVEF, but the HVSD decrease group tended to have more decreased HVEF than the HVSD increase group. These results indicate that spastic angina pectoris patients show various responses to HV stress. The HVSD increase group might have additional myocardial ischemia due to regional coronary spasm. In contrast, in the HVSD decrease group severe LV dysfunction or diffuse wall motion abnormality might have been generated, and this caused a reduction in the SD value. Phase analysis would therefore add new information regarding electrocardiographically silent myocardial ischemia due to coronary spasm, and HV stress might increase sensitivity for the detection of abnormalities in quantitative phase analysis, especially in VspAP patients.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Phase changes caused by hyperventilation stress in spastic angina pectoris analyzed by first-pass radionuclide ventriculography

Takeda

Toyama

et al. 1999

Ann Nucl Med

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“…Cardiologists employ hyperventilation-Tl myocardial scintigraphy to diagnose coronary spasm. As shown in Table 1, in 57 patients with VSA, 41 (71.9%) patients had abnormal scintigraphic findings during hyperventilation-Tl [24][25][26]. Sensitivity was 64.9%, while discordance was observed in 4 patients (7%).…”

Section: Hyperventilation-tlmentioning

confidence: 94%

Clinical usefulness of myocardial scintigraphy in patients with vasospastic angina

Sueda

2020

Journal of Cardiology

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Background: Myocardial scintigraphy is defined as class IIb in the Japanese Circulation Society guideline for diagnosis of vasospastic angina (VSA). However, Caucasian guidelines had no classification of cardiac scintigraphy for diagnosis of VSA. Objectives: To clarify the clinical usefulness of myocardial scintigraphy, we analyzed the sensitivity and specificity of each cardiac scintigraphy. Methods: We extracted the 136 papers of myocardial scintigraphy from the PubMed database from 1980 to 2018 in patients with VSA. Finally we analyzed the 88 papers including 33 papers of 201thallium (Tl), 10 papers of 123 I beta-methyl 15-para-iodophenyl 3(R, S)-methylpentadecanoic acid (BMIPP), 9 papers of 123 I-metaiodobenzylguanidine (MIBG), 4 papers of 99m Tc-sestamibi (MIBI: methoxy-isobutylisonitrile), and 2 papers of tetrofosmin to investigate the sensitivity and specificity of each tracer. Results: Tl, BMIPP, or MIBG cardiac scintigraphy were useful to diagnose patients with VSA, because sensitivity was 57-73%. Specificity was 55-83%. Sensitivity of left circumflex artery was significantly lower than other vessels. BMIPP imaging may be helpful for clinical course of VSA. However, myocardial scintigraphic abnormal findings may not always show the ischemic memory due to coronary artery spasm. Conclusions: Recent cardiologists do not perform hyperventilation tests or MIBG scintigraphy for diagnosis of coronary spasm. After understanding the flow of the times, cardiologists should use Tl or BMIPP myocardial scintigraphy for VSA as one of supplementary tools in the real world.

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“…Of the 16 studies included, 7 (44%) provided enough information to assess accuracy based on sex, yielding a total of 271 males (262 with VSA, 97%) and females (66 with VSA, 84%): 7 reported on ECG, 45,[49][50][51][52][53]55 2 on TTE, 49,50 and 3 on MPI [51][52][53] (Table S2). Pooled sensitivity for all modalities combined were 90% (95% CI: 75%-97%, i 2 = 0.65) for males and 78% (95% CI: 52%-92%, i 2 = 0) for females.…”

Section: Accuracy and Sexmentioning

confidence: 99%

Hyperventilation testing in the diagnosis of vasospastic angina: A clinical review and meta‐analysis

Boivin‐Proulx,

Marquis‐Gravel,

Rousseau‐Saine

et al. 2024

Eur J Clin Investigation

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BackgroundGiven the limited access to invasive vasospastic reactivity testing in Western Countries, there is a need to further develop alternative non‐invasive diagnostic methods for vasospastic angina (VSA). Hyperventilation testing (HVT) is defined as a class IIa recommendation to diagnose VSA by the Japanese Society of Cardiology.MethodsIn this systematic review and meta‐analysis reported according to the PRISMA statement, we review the mechanisms, methods, modalities and diagnostic accuracy of non‐invasive HVT for the diagnostic of VSA.ResultsA total of 106 articles published between 1980 and 2022 about VSA and HVT were included in the systematic review, among which 16 were included in the meta‐analysis for diagnostic accuracy. Twelve electrocardiogram‐HVT studies including 804 patients showed a pooled sensitivity of 54% (95% confidence intervals [CI]; 30%–76%) and a pooled specificity of 99% (95% CI; 88%–100%). Four transthoracic echocardiography‐HVT studies including 197 patients revealed a pooled sensitivity of 90% (95% CI; 82%–94%) and a pooled specificity of 98% (95% CI; 86%–100%). Six myocardial perfusion imaging‐HVT studies including 112 patients yielded a pooled sensitivity of 95% (95% CI; 63%–100%) and a pooled specificity of 78% (95% CI; 19%–98%). Non‐invasive HVT resulted in a low rate of adverse events, ventricular arrhythmias being the most frequently reported, and were resolved with the administration of nitroglycerin.ConclusionsNon‐invasive HVT offers a safe alternative with high diagnostic accuracy to diagnose VSA in patients with otherwise undiagnosed causes of chest pain.

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Usefulness of Hyperventilation Thallium-201 Single Photon Emission Computed Tomography for the Diagnosis of Vasospastic Angina.

Cited by 6 publications

References 27 publications

Phase changes caused by hyperventilation stress in spastic angina pectoris analyzed by first-pass radionuclide ventriculography

Phase changes caused by hyperventilation stress in spastic angina pectoris analyzed by first-pass radionuclide ventriculography

Clinical usefulness of myocardial scintigraphy in patients with vasospastic angina

Hyperventilation testing in the diagnosis of vasospastic angina: A clinical review and meta‐analysis

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