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Prognostic value of atrial pacing and thallium-201 scintigraphy in patients with stable chest pain
H G Stratmann1, A L Mark, K E Walter
1Department of Cardiology, St. Louis Veterans Administration Medical Center, Missouri 63125.
Insights
Thallium-201 scintigraphy effectively identifies cardiac event risk in stable chest pain patients. Abnormal and reversible perfusion defects predict future cardiac events, especially unstable angina and cardiac death.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Assessing cardiac event risk in patients with stable chest pain is crucial for guiding treatment.
- Previous myocardial infarction, hypertension, and diabetes are known risk factors, but their predictive value alongside diagnostic tests needs further evaluation.
Purpose of the Study:
- To evaluate the predictive value of atrial pacing and thallium-201 scintigraphy for subsequent cardiac events in stable chest pain patients.
- To determine if specific scintigraphic findings correlate with different types of cardiac events, including unstable angina and cardiac death.
Main Methods:
- A cohort of 210 patients with stable chest pain underwent atrial pacing and thallium-201 scintigraphy.
- Follow-up data was collected for 195 patients over a mean of 19 months to record cardiac events.
- Statistical analysis compared scintigraphic findings and patient history with the occurrence of cardiac events.
Main Results:
- Cardiac events occurred in 38 patients, including unstable angina (20), nonfatal myocardial infarction (6), and cardiac death (12).
- History of congestive heart failure was associated with increased cardiac events (p < 0.05).
- Reversible perfusion defects (p < 0.01) and abnormal scans (p < 0.01) were significantly more frequent in patients with cardiac events. Fixed defects were associated with cardiac death (p < 0.05).
Conclusions:
- Thallium-201 scintigraphy, particularly the presence of reversible defects, is a valuable tool for predicting subsequent cardiac events in stable chest pain patients.
- Abnormal scintigraphic findings, including fixed defects, are associated with increased risk of cardiac death.
- While traditional risk factors like hypertension were not significant predictors in this cohort, scintigraphy provides crucial prognostic information.
Abstract:
The value of atrial pacing and thallium-201 scintigraphy for assessing risk of subsequent cardiac events was examined in 210 patients with stable chest pain. Follow-up information was complete in 195 patients (mean age 61 years). Over an average follow-up of 19 months, cardiac events occurred in 38 patients--unstable angina in 20, nonfatal acute myocardial infarction in 6 and death from cardiac causes in 12. A history of previous myocardial infarction, diabetes mellitus, systemic hypertension or peripheral vascular disease at the time of pacing was not associated with an increased frequency of subsequent cardiac events. Six of 38 patients with later cardiac events had a history of congestive heart failure, compared with 8 of 157 without cardiac events (p less than 0.05). Neither pacing-induced angina, ST depression, nor the presence of a fixed perfusion defect was significantly more frequent in patients with cardiac events as a whole compared with patients without such events. Reversible defects and abnormal scans (reversible or fixed defects) were present, respectively, in 19 and 31 of 38 patients with cardiac events, compared with 42 and 79 patients, respectively, of the 157 patients without cardiac events (both p less than 0.01). In patients who developed unstable angina, a reversible defect was seen in 13 and an abnormal scan in 16 (both p less than 0.01 compared with patients without cardiac events). In 12 patients who died from a primary cardiac event, fixed defects were present in 8 and an abnormal scan in 11 (p less than 0.05 and p less than 0.01, respectively, compared with patients without cardiac events).(ABSTRACT TRUNCATED AT 250 WORDS)