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Thallium-201 myocardial scintigraphy during dipyridamole-induced coronary hyperaemia. First experiences with a new
P V Madsen1, O Munck, H Kelbaek
1Surgical Department H, Gentofte Hospital, Denmark.
Insights
Preoperative thallium-201 dipyridamole myocardial scintigraphy detected significant coronary artery disease in all patients with severe peripheral atherosclerosis undergoing surgery. This noninvasive imaging is crucial for identifying silent ischemic heart disease.
Area of Science:
- Cardiology
- Nuclear Medicine
- Vascular Surgery
Background:
- Severe peripheral vascular atherosclerosis often coexists with coronary artery disease.
- Patients undergoing abdominal aortic surgery may have undiagnosed ischemic heart disease.
- Standard exercise tests are often not feasible in this patient population.
Purpose of the Study:
- To evaluate the utility of thallium-201 dipyridamole myocardial scintigraphy in detecting coronary artery disease in patients with severe peripheral vascular atherosclerosis.
- To assess the prevalence of silent ischemic heart disease in patients scheduled for abdominal aortic surgery.
Main Methods:
- Eight patients with severe peripheral vascular atherosclerosis awaiting abdominal aortic surgery were prospectively studied.
- Preoperative noninvasive assessment using thallium-201 dipyridamole myocardial scintigraphy was performed.
- Serum cardiac biomarkers (creatine kinase, aspartate aminotransferase, lactate dehydrogenase) were monitored postoperatively.
Main Results:
- All eight patients exhibited abnormal preoperative myocardial scintigraphy, indicating myocardial scar and/or ischemia.
- Postoperative elevation of creatine kinase occurred in seven patients.
- Two patients showed elevated aspartate aminotransferase and lactate dehydrogenase levels.
- No patient presented with clinical or electrocardiographical evidence of acute myocardial infarction.
Conclusions:
- Thallium-201 dipyridamole myocardial scintigraphy is a valuable noninvasive tool for detecting ischemic heart disease in patients with severe peripheral atherosclerosis.
- This imaging modality is particularly useful for patients unable to undergo exercise stress testing.
- The precise determination of regional washout in myocardial scintigraphy aids in identifying ischemia, especially with low washout values.
Abstract:
Eight patients with severe peripheral vascular atherosclerosis scheduled for abdominal aortic surgery were investigated to detect coexisting coronary artery disease. None of the patients had a history of angina pectoris or previous myocardial infarction. Preoperative computerised thallium-201 dipyridamole myocardial scintigraphy was abnormal in all patients, showing either myocardial scar tissue and/or ischaemia with redistribution and/or low washout. In all but one patient, the serum level of creatin kinase was elevated during the first postoperative days. In two patients, the serum concentrations of aspartate aminotransferase and lactate dehydrogenase were elevated. None of the patients showed clinical or electrocardiographical signs of acute myocardial infarction. Thallium-201 dipyridamole myocardial imaging is a new noninvasive method for detection of ischaemic heart disease in patients with severe peripheral atherosclerosis who are unable to perform a bicycle exercise test. The new programme for determination of regional washout appeared to be very precise and may be especially applicable in the case of low washout values.