Prevalence of high-risk thallium-201 scintigraphic findings in left main coronary artery stenosis: Comparison with patients with multiple- and single-vessel coronary artery disease

Thomas W. Nygaard, Robert S. Gibson, James M. Ryan, Joseph A. Gascho, Denny D. Watson, George A. Beller

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Abstract

To determine the prevalence of high-risk thallium-201 (TI-201) scintigraphic findings in patients with left main (LM) coronary artery disease (CAD), quantitative exercise TI-201 scintigrams were analyzed in 295 consecutive patients with angiographic (≤ 50% stenosis) CAD, of which 43 (14%) had ≤ 50% LM stenosis. A high-risk scintigram was defined as one that demonstrated (1) a LMCAD scintigraphic pattern (≤ 25% homogeneous decrease in TI-201 activity in the middle and upper septal and posterolateral walls on the 45 ° left anterior oblique projection); (2) abnormal TI-201 uptake or washout in multiple vascular scan segments indicative of multivessel disease; and (3) increased lung TI-201 uptake on the initial anterior projection image. Of the 43 patients with LMCAD, 41 (95%) had an abnormal scintigram. Thirty-three (77%) had 1 or more high-risk scintigraphic findings, including 29 (67%) with a multivessel CAD scan pattern, of which 6 (14%) demonstrated a typical LMCAD pattern; and 18 (42%) with abnormal lung TI-201 uptake. The prevalence of a high-risk scintigram in patients with LMCAD was significantly greater than that in 53 patients with 3-vessel disease (58%) (p = 0.05), 99 patients with 2-vessel disease (60%) (p = 0.04) and 100 patients with 1-vessel disease (41%) (p < 0.0001). In this study, a high-risk electrocardiographic stress test was defined as one that had at least 2 of the following characteristics: (1) ≥ 2.0 mm of ST depression (ST↓); (2) horizontal or downsloping (> 1.0 mm) ST↓ persisting for 5 minutes or longer after exercise; (3) appearance of ST↓ at 5 METs or less; and (4) a decrease in systolic blood pressure of 10 mm Hg or more during exercise. The prevalence of a high-risk stress test (58%) in the 43 patients with LMCAD was significantly lower than the prevalence of a high-risk scintigram (77%) (p = 0.05). The prevalence of a high-risk electrocardiographic stress test was significantly greater than that in the 53 patients with 3-vessel disease (32%) (p < 0.01), the 99 patients with 2-vessel disease (31%) (p = 0.003) and the 100 patients with 1-vessel disease (16%; p < 0.0001). The combination of the TI-201 scintigraphic and exercise electrocardiographic stress testing was no better than scintigraphy alone (86 vs 77%, p = 0.2), but did improve the overall detection rate of high-risk in LMCAD patients compared to exercise electrocardiographic testing alone (86 vs 58%, p = 0.04). In conclusion, in patients with LMCAD of ≤ 50% narrowing, a typical scintigraphic finding for LMCAD, is infrequently observed, but a markedly positive exercise stress test or a high-risk scintigram (predominantly showing a multivessel disease pattern) is seen in most patients (86%) with this angiographic finding.

Original languageEnglish (US)
Pages (from-to)462-469
Number of pages8
JournalThe American journal of cardiology
Volume53
Issue number4
DOIs
StatePublished - Feb 1 1984

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Thallium
Coronary Stenosis
Coronary Artery Disease
Exercise Test
Exercise
Pathologic Constriction
Blood Pressure
Lung
Radionuclide Imaging
Blood Vessels

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{dca816eb6230406fba33d9ee4dac530e,
title = "Prevalence of high-risk thallium-201 scintigraphic findings in left main coronary artery stenosis: Comparison with patients with multiple- and single-vessel coronary artery disease",
abstract = "To determine the prevalence of high-risk thallium-201 (TI-201) scintigraphic findings in patients with left main (LM) coronary artery disease (CAD), quantitative exercise TI-201 scintigrams were analyzed in 295 consecutive patients with angiographic (≤ 50{\%} stenosis) CAD, of which 43 (14{\%}) had ≤ 50{\%} LM stenosis. A high-risk scintigram was defined as one that demonstrated (1) a LMCAD scintigraphic pattern (≤ 25{\%} homogeneous decrease in TI-201 activity in the middle and upper septal and posterolateral walls on the 45 ° left anterior oblique projection); (2) abnormal TI-201 uptake or washout in multiple vascular scan segments indicative of multivessel disease; and (3) increased lung TI-201 uptake on the initial anterior projection image. Of the 43 patients with LMCAD, 41 (95{\%}) had an abnormal scintigram. Thirty-three (77{\%}) had 1 or more high-risk scintigraphic findings, including 29 (67{\%}) with a multivessel CAD scan pattern, of which 6 (14{\%}) demonstrated a typical LMCAD pattern; and 18 (42{\%}) with abnormal lung TI-201 uptake. The prevalence of a high-risk scintigram in patients with LMCAD was significantly greater than that in 53 patients with 3-vessel disease (58{\%}) (p = 0.05), 99 patients with 2-vessel disease (60{\%}) (p = 0.04) and 100 patients with 1-vessel disease (41{\%}) (p < 0.0001). In this study, a high-risk electrocardiographic stress test was defined as one that had at least 2 of the following characteristics: (1) ≥ 2.0 mm of ST depression (ST↓); (2) horizontal or downsloping (> 1.0 mm) ST↓ persisting for 5 minutes or longer after exercise; (3) appearance of ST↓ at 5 METs or less; and (4) a decrease in systolic blood pressure of 10 mm Hg or more during exercise. The prevalence of a high-risk stress test (58{\%}) in the 43 patients with LMCAD was significantly lower than the prevalence of a high-risk scintigram (77{\%}) (p = 0.05). The prevalence of a high-risk electrocardiographic stress test was significantly greater than that in the 53 patients with 3-vessel disease (32{\%}) (p < 0.01), the 99 patients with 2-vessel disease (31{\%}) (p = 0.003) and the 100 patients with 1-vessel disease (16{\%}; p < 0.0001). The combination of the TI-201 scintigraphic and exercise electrocardiographic stress testing was no better than scintigraphy alone (86 vs 77{\%}, p = 0.2), but did improve the overall detection rate of high-risk in LMCAD patients compared to exercise electrocardiographic testing alone (86 vs 58{\%}, p = 0.04). In conclusion, in patients with LMCAD of ≤ 50{\%} narrowing, a typical scintigraphic finding for LMCAD, is infrequently observed, but a markedly positive exercise stress test or a high-risk scintigram (predominantly showing a multivessel disease pattern) is seen in most patients (86{\%}) with this angiographic finding.",
author = "Nygaard, {Thomas W.} and Gibson, {Robert S.} and Ryan, {James M.} and Gascho, {Joseph A.} and Watson, {Denny D.} and Beller, {George A.}",
year = "1984",
month = "2",
day = "1",
doi = "10.1016/0002-9149(84)90013-4",
language = "English (US)",
volume = "53",
pages = "462--469",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
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}

Prevalence of high-risk thallium-201 scintigraphic findings in left main coronary artery stenosis : Comparison with patients with multiple- and single-vessel coronary artery disease. / Nygaard, Thomas W.; Gibson, Robert S.; Ryan, James M.; Gascho, Joseph A.; Watson, Denny D.; Beller, George A.

In: The American journal of cardiology, Vol. 53, No. 4, 01.02.1984, p. 462-469.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Prevalence of high-risk thallium-201 scintigraphic findings in left main coronary artery stenosis

T2 - Comparison with patients with multiple- and single-vessel coronary artery disease

AU - Nygaard, Thomas W.

AU - Gibson, Robert S.

AU - Ryan, James M.

AU - Gascho, Joseph A.

AU - Watson, Denny D.

AU - Beller, George A.

PY - 1984/2/1

Y1 - 1984/2/1

N2 - To determine the prevalence of high-risk thallium-201 (TI-201) scintigraphic findings in patients with left main (LM) coronary artery disease (CAD), quantitative exercise TI-201 scintigrams were analyzed in 295 consecutive patients with angiographic (≤ 50% stenosis) CAD, of which 43 (14%) had ≤ 50% LM stenosis. A high-risk scintigram was defined as one that demonstrated (1) a LMCAD scintigraphic pattern (≤ 25% homogeneous decrease in TI-201 activity in the middle and upper septal and posterolateral walls on the 45 ° left anterior oblique projection); (2) abnormal TI-201 uptake or washout in multiple vascular scan segments indicative of multivessel disease; and (3) increased lung TI-201 uptake on the initial anterior projection image. Of the 43 patients with LMCAD, 41 (95%) had an abnormal scintigram. Thirty-three (77%) had 1 or more high-risk scintigraphic findings, including 29 (67%) with a multivessel CAD scan pattern, of which 6 (14%) demonstrated a typical LMCAD pattern; and 18 (42%) with abnormal lung TI-201 uptake. The prevalence of a high-risk scintigram in patients with LMCAD was significantly greater than that in 53 patients with 3-vessel disease (58%) (p = 0.05), 99 patients with 2-vessel disease (60%) (p = 0.04) and 100 patients with 1-vessel disease (41%) (p < 0.0001). In this study, a high-risk electrocardiographic stress test was defined as one that had at least 2 of the following characteristics: (1) ≥ 2.0 mm of ST depression (ST↓); (2) horizontal or downsloping (> 1.0 mm) ST↓ persisting for 5 minutes or longer after exercise; (3) appearance of ST↓ at 5 METs or less; and (4) a decrease in systolic blood pressure of 10 mm Hg or more during exercise. The prevalence of a high-risk stress test (58%) in the 43 patients with LMCAD was significantly lower than the prevalence of a high-risk scintigram (77%) (p = 0.05). The prevalence of a high-risk electrocardiographic stress test was significantly greater than that in the 53 patients with 3-vessel disease (32%) (p < 0.01), the 99 patients with 2-vessel disease (31%) (p = 0.003) and the 100 patients with 1-vessel disease (16%; p < 0.0001). The combination of the TI-201 scintigraphic and exercise electrocardiographic stress testing was no better than scintigraphy alone (86 vs 77%, p = 0.2), but did improve the overall detection rate of high-risk in LMCAD patients compared to exercise electrocardiographic testing alone (86 vs 58%, p = 0.04). In conclusion, in patients with LMCAD of ≤ 50% narrowing, a typical scintigraphic finding for LMCAD, is infrequently observed, but a markedly positive exercise stress test or a high-risk scintigram (predominantly showing a multivessel disease pattern) is seen in most patients (86%) with this angiographic finding.

AB - To determine the prevalence of high-risk thallium-201 (TI-201) scintigraphic findings in patients with left main (LM) coronary artery disease (CAD), quantitative exercise TI-201 scintigrams were analyzed in 295 consecutive patients with angiographic (≤ 50% stenosis) CAD, of which 43 (14%) had ≤ 50% LM stenosis. A high-risk scintigram was defined as one that demonstrated (1) a LMCAD scintigraphic pattern (≤ 25% homogeneous decrease in TI-201 activity in the middle and upper septal and posterolateral walls on the 45 ° left anterior oblique projection); (2) abnormal TI-201 uptake or washout in multiple vascular scan segments indicative of multivessel disease; and (3) increased lung TI-201 uptake on the initial anterior projection image. Of the 43 patients with LMCAD, 41 (95%) had an abnormal scintigram. Thirty-three (77%) had 1 or more high-risk scintigraphic findings, including 29 (67%) with a multivessel CAD scan pattern, of which 6 (14%) demonstrated a typical LMCAD pattern; and 18 (42%) with abnormal lung TI-201 uptake. The prevalence of a high-risk scintigram in patients with LMCAD was significantly greater than that in 53 patients with 3-vessel disease (58%) (p = 0.05), 99 patients with 2-vessel disease (60%) (p = 0.04) and 100 patients with 1-vessel disease (41%) (p < 0.0001). In this study, a high-risk electrocardiographic stress test was defined as one that had at least 2 of the following characteristics: (1) ≥ 2.0 mm of ST depression (ST↓); (2) horizontal or downsloping (> 1.0 mm) ST↓ persisting for 5 minutes or longer after exercise; (3) appearance of ST↓ at 5 METs or less; and (4) a decrease in systolic blood pressure of 10 mm Hg or more during exercise. The prevalence of a high-risk stress test (58%) in the 43 patients with LMCAD was significantly lower than the prevalence of a high-risk scintigram (77%) (p = 0.05). The prevalence of a high-risk electrocardiographic stress test was significantly greater than that in the 53 patients with 3-vessel disease (32%) (p < 0.01), the 99 patients with 2-vessel disease (31%) (p = 0.003) and the 100 patients with 1-vessel disease (16%; p < 0.0001). The combination of the TI-201 scintigraphic and exercise electrocardiographic stress testing was no better than scintigraphy alone (86 vs 77%, p = 0.2), but did improve the overall detection rate of high-risk in LMCAD patients compared to exercise electrocardiographic testing alone (86 vs 58%, p = 0.04). In conclusion, in patients with LMCAD of ≤ 50% narrowing, a typical scintigraphic finding for LMCAD, is infrequently observed, but a markedly positive exercise stress test or a high-risk scintigram (predominantly showing a multivessel disease pattern) is seen in most patients (86%) with this angiographic finding.

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