Reversible ischaemia of right ventricle detected by exercise thallium-201 scintigraphy

Exercise and redistribution thallium-201 imaging is commonly used for the detection and evaluation of left ventricular ischaemia and infarction. The right ventricle is frequently visualised after stress and sometimes on redistribution images. The visualisation of the right ventricle at rest is thought to be abnormal and is suggestive of pressure or volume overload of the right ventricle, either a result of pulmonary hypertension or secondary to left ventricular dysfunction. Using stress and delayed 201Tl imaging we have shown reversible left and right ventricular ischaemia and fixed left ventricular perfusion defects in two patients with multivessel coronary artery disease and left ventricular dyskinesia caused by prior myocardial infarction. Judging by the rarity of this finding as well as taking into consideration 201Tl kinetics, it is suggested that reversible right ventricular ischaemia after exercise may only be detected in patients with coronary artery disease who have severely compromised ventricular function. This finding may have therapeutic and prognostic significance.