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Atrial pacing and thallium-201 scintigraphy in patients with chest pain: correlation with coronary anatomy
H G Stratmann1, A L Mark, K E Walter
1Department of Cardiology, St. Louis VA Medical Center, MO 63125.
Insights
Thallium-201 scintigraphy is more sensitive than pacing-induced angina or ST depression for detecting coronary artery disease (CAD). Combining thallium scans with ECG provides the highest sensitivity for diagnosing CAD.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Chest pain evaluation often requires accurate diagnosis of coronary artery disease (CAD).
- Atrial pacing and thallium-201 scintigraphy are diagnostic tools for CAD.
Purpose of the Study:
- To compare the diagnostic accuracy of atrial pacing-induced angina, ST depression, and thallium-201 scintigraphy in patients with chest pain.
- To evaluate the sensitivity and specificity of these methods for detecting CAD.
Main Methods:
- 72 patients with chest pain underwent atrial pacing and thallium-201 scintigraphy.
- Cardiac catheterization was used to confirm the presence and extent of CAD.
Main Results:
- Thallium-201 scintigraphy showed higher sensitivity (79%) for CAD than pacing-induced angina (51%) or ST depression (49%).
- Combined sensitivity of ST depression and/or abnormal thallium scan reached 87%.
- Thallium scintigraphy demonstrated variable sensitivity in identifying lesions in specific coronary arteries.
Conclusions:
- Thallium-201 scintigraphy is a valuable tool for diagnosing CAD, outperforming angina and ST depression alone.
- Combining thallium scintigraphy with ECG findings enhances diagnostic accuracy for CAD.
Abstract:
Atrial pacing and thallium-201 scintigraphy were performed in 72 patients referred for evaluation of chest pain. Coronary artery disease (CAD) was present in 63 patients, as documented by cardiac catheterization performed at the same time or within 2 months of atrial pacing. Nine patients had no or insignificant (less than 50% stenosis) CAD. The sensitivity of pacing-induced angina for CAD was 51%, and was 49% for ST depression. Specificities were 89% and 78%, respectively. A reversible perfusion defect was seen in 54% of patients with CAD (specificity 89%), and a fixed defect in 29% (specificity 100%). The sensitivity of an abnormal thallium-201 scan (one or more reversible or fixed defects) was 79% (p less than 0.05 compared to angina or ST depression). Combined sensitivity of ST depression and/or an abnormal thallium-201 scan was 87%. There were no significant changes in any of these sensitivities as the number of vessels with CAD increased. Thallium-201 scintigraphy correctly identified 11 of 19 (58%) patients with single-vessel disease as having CAD in only one vessel, but underestimated the extent of disease in all but a few patients with multivessel disease. The sensitivity of perfusion imaging to identify lesions in specific vessels ranged from 27% (circumflex) to 57% (right coronary artery). Specificities were 100% for circumflex, 78% for anterior descending, and 83% for right coronary artery lesions.(ABSTRACT TRUNCATED AT 250 WORDS)