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[The importance of 201-thallium myocardial scintigraphy in the hypertensive patient]
D Jäger1, A Vogel, S von Dryander
1Abteilung für Kardiologie und Angiologie, Ruhr-Universität Bochum.
Insights
Thallium-201 scintigraphy in hypertensive angina patients often yields false positives, indicating potential macroangiopathy. This necessitates invasive diagnosis, making it unsuitable as a screening tool.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Systemic hypertension and angina are common conditions.
- Coronary macroangiopathy is a primary concern in patients with angina.
- Left ventricular hypertrophy and left bundle branch block can complicate electrocardiogram interpretation.
Purpose of the Study:
- To evaluate the utility of Thallium-201 exercise myocardial scintigraphy in hypertensive patients with angina but no coronary macroangiopathy.
- To assess the rate of false-positive findings in this patient population.
Main Methods:
- Thallium-201 exercise myocardial scintigraphy was performed in 57 hypertensive patients with angina.
- Coronary angiography was used to exclude coronary macroangiopathy.
- Cardiac catheterization was performed in a subset of patients to assess hemodynamics.
Main Results:
- Only 10 out of 57 patients had normal myocardial scintigrams.
- 12 patients showed extensive ischemic zones in the left ventricle.
- All patients with left bundle branch block exhibited exercise-dependent apical ischemia, suggesting "false-positive" results.
Conclusions:
- Thallium-201 exercise myocardial scintigraphy is not recommended as a screening tool for hypertensive patients with angina.
- The high rate of "false-positive" findings necessitates early invasive diagnosis, diminishing the screening value of scintigraphy.
Abstract:
Thallium-201 exercise myocardial scintigraphy was performed in 57 patients (37 males, 20 females; mean age 55.4 [43-78] years) with angina and systemic hypertension after exclusion by coronary angiography of any coronary macroangiopathy. The exercise ECG of 32 patients could not be used in the diagnosis of ischaemia because of the presence of left ventricular hypertrophy with abnormal repolarization or left bundle branch block. Abnormal haemodynamics were demonstrated at cardiac catheterization in 23 patients (Swan-Ganz). Only 10 of the studied hypertensives with normal coronary angiograms had a myocardial scintigram within normal limits, while 12 had extensive ischaemic zones in the left ventricle. All patients with left bundle branch block had evidence of exercise-dependent apical "ischaemia". Thallium-201 myocardial scintigraphy should not be used as a screening method in hypertensives with angina, because the high proportion of "false-positive" findings, in the sense of a macroangiopathy, will nevertheless require early invasive diagnosis.