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Noninvasive ergonovine maleate provocative testing for coronary artery spasm: the need for routine thallium-201
Insights
Thallium-201 imaging combined with electrocardiographic monitoring safely detects coronary artery spasm. This combined approach offers higher sensitivity for diagnosing reversible ischemia than ECG alone.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Coronary artery spasm is a significant cause of myocardial ischemia.
- Accurate, noninvasive diagnostic methods are crucial for identifying coronary artery spasm.
Abstract:
We administered ergonovine and used both electrocardiographic monitoring and thallium-201 [201Tl] imaging to detect reversible ischemia in 100 patients. Patients already established as having coronary artery spasm and those with nonbypassed, proximal, high-grade coronary artery stenosis were excluded. No complication occurred in any patient. The use of thallium imaging in addition to electrocardiographic monitoring resulted in a higher degree of sensitivity than did ECG monitoring alone. Fourteen patients demonstrated evidence of coronary artery spasm as documented by 201Tl imaging but of the 14, significant ECG changes occurred in only 50%, and classic ST segment elevation in 21%. Thus, in carefully selected patients the noninvasive provocation of coronary spasm can be accomplished safely, but ECG monitoring must be combined with thallium-201 imaging to achieve an acceptable degree of sensitivity.