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Atrial pacing with two-dimensional echocardiography for evaluation of chest pain: comparison with thallium 201
H G Stratmann1, D L Janosik, L E Mezei
1Department of Cardiology, St. Louis Veterans Administration Medical Center, Missouri.
Insights
Atrial pacing combined with 2D echocardiography and thallium 201 scintigraphy helps diagnose coronary artery disease (CAD). Both methods show similar diagnostic value, with echocardiography excelling in detecting LAD artery issues.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Nuclear Medicine
Background:
- Stable chest pain is a common symptom requiring accurate diagnosis of coronary artery disease (CAD).
- Non-invasive imaging techniques are crucial for evaluating myocardial perfusion and function in patients with suspected CAD.
Purpose of the Study:
- To compare the diagnostic efficacy of two-dimensional (2-D) echocardiography and thallium 201 scintigraphy during atrial pacing for detecting coronary artery disease (CAD).
- To assess the sensitivity and specificity of each modality in identifying significant CAD, particularly in specific coronary arteries.
Main Methods:
- Forty men with stable chest pain underwent atrial pacing, 2-D echocardiography, and thallium 201 scintigraphy.
- Coronary angiography was used as the gold standard to confirm the presence and severity of CAD.
- Left ventricular wall motion abnormalities (WMA) and perfusion defects were analyzed at rest and during pacing.
Main Results:
- Significant CAD was confirmed in 36 patients (90%).
- 2-D echocardiography detected WMA in 78% of CAD patients, with 47% showing new/worsened WMA during pacing.
- Thallium 201 scintigraphy revealed perfusion defects in 72% of CAD patients, with 50% having reversible defects.
- Overall, 94% of CAD patients had either a WMA or perfusion defect (or both).
- 2-D echocardiography showed higher sensitivity for the LAD artery (81%) compared to thallium 201 (54%).
- Both modalities had limited sensitivity for the right coronary and circumflex arteries.
Conclusions:
- Combined atrial pacing with 2-D echocardiography and thallium 201 scintigraphy are valuable for diagnosing CAD in patients with stable chest pain.
- These non-invasive methods demonstrate similar overall diagnostic value for CAD presence.
- 2-D echocardiography is superior to thallium 201 scintigraphy in detecting significant CAD in the Left Anterior Descending artery.
Abstract:
Atrial pacing was performed with two-dimensional (2-D) echocardiography and thallium 201 scintigraphy in 40 men with stable chest pain. Coronary angiography showed significant (one or more lesions greater than or equal to 50%) coronary artery disease (CAD) in 36 patients and no or insignificant CAD in 4. Two dimensional echocardiography showed a left ventricular wall motion abnormality (WMA) either at rest or with pacing in 28 (78%) patients with CAD, with 17 (47%) showing a new or worsened WMA with pacing. A thallium scan showing abnormality (reversible or fixed perfusion defect) was seen in 26 (72%) patients with CAD; 18 (50%) had a reversible defect. In all, 34 of the 36 patients with CAD (94%) had a WMA, a perfusion defect, or both (specificity 50%). Occurrence of both a WMA and a perfusion defect in individual segments ranged from 10 of 25 patients with septal abnormalities to 0 of 12 with abnormalities of the lateral segment. Sensitivity of 2-D echocardiography for identifying CAD in specific vessels was 81% for the left anterior descending (LAD) artery, 30% for the right coronary artery, and 20% for the circumflex artery (both p less than .001 compared with the LAD artery). Corresponding sensitivities for thallium 201 imaging were 54% (p less than .05 compared with 2-D echocardiography), 27%, and 8% (both p less than .05 compared with the LAD artery). When combined with atrial pacing, 2-D echocardiography and thallium 201 perfusion imaging are of similar value for diagnosing the presence of CAD in patients with stable chest pain. Two-dimensional echocardiography is superior to thallium 201 imaging for identifying the presence of significant CAD in the LAD artery, but both tests are limited in their ability to detect lesions of the right coronary or circumflex arteries.