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Diagnostic value for coronary artery disease of chest pain during dipyridamole-thallium stress testing
1Cardiac Unit, Massachusetts General Hospital, Harvard University School of Medicine, Boston, Massachusetts 02114.
Insights
Chest pain during dipyridamole-thallium testing for coronary artery disease (CAD) has uncertain diagnostic significance. This study found chest pain is not closely related to CAD severity and offers little diagnostic value.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Dipyridamole-thallium imaging is a non-exercise stress test for coronary artery disease (CAD).
- The diagnostic significance of chest pain during this test is not well-established.
Purpose of the Study:
- To evaluate the diagnostic significance of chest pain during dipyridamole-thallium testing in patients with suspected CAD.
Main Methods:
- Retrospective analysis of 90 patients undergoing coronary angiography.
- Forty-five patients with chest pain during dipyridamole-thallium testing were matched with 45 patients without chest pain.
- Comparison of angiographic findings and ischemic ST changes between the two groups.
Main Results:
- No statistically significant differences in the prevalence or severity of CAD between patients with and without chest pain.
- A moderate association was observed between chest pain and ischemic ST changes (p < 0.02).
- Chest pain, even with concurrent ST changes, did not predict CAD distribution or severity.
Conclusions:
- Chest pain during dipyridamole-thallium testing is not a reliable indicator of coronary artery disease severity.
- The diagnostic value of chest pain in this context is limited.
Abstract:
Intravenous dipyridamole with thallium imaging permits stress testing for coronary artery disease (CAD) without exercise. Chest pain may occur with dipyridamole-thallium testing, but its diagnostic significance is uncertain. Forty-five patients who had coronary angiography, no revascularization and chest pain during dipyridamole-thallium testing were identified. These patients were matched blindly by sex and age to 45 patients who had coronary angiography, no revascularization and no chest pain reported during the dipyridamole-thallium test. In the groups with versus without chest pain, 9 versus 24% had no CAD, 16 versus 16% had 1-vessel disease, 38 versus 29% had 2-vessel CAD and 38 versus 29% had 3-vessel CAD. These differences did not achieve statistical significance. Also, there were no evident differences in the severity of angiographic CAD by vessel or by percent of stenosis (p greater than 0.50). There was only a moderate association with ischemic ST changes (40 versus 16%, p less than 0.02). Chest pain with concurrent ischemic ST changes also failed to predict any difference in distribution or severity of angiographic stenoses. We conclude that chest pain during dipyridamole-thallium testing is not closely related to the severity of CAD and has little diagnostic value.