[Noninvasive identification of left main and triple vessel coronary artery disease using dipyridamole thallium...

The diagnostic value of dipyridamole thallium scintigraphy for the noninvasive identification of left main (LM) and triple vessel (TV) coronary artery disease (CAD) was evaluated in 615 consecutive patients with known or suspected CAD. One hundred thirty-nine patients had LM or TVCAD; the remaining 476 patients had limited CAD (double vessel CAD in 112, single vessel CAD in 235, insignificant lesions in 129). Patients with LM or TVCAD, compared to those with limited CAD, had a higher incidence of diffuse slow washout (58 vs 20%, p < 0.0001), extensive fixed defects (21 vs 6%, p < 0.0001) and extensive reversible defects (32 vs 8%, p < 0.0001). During dipyridamole loading, the incidence of chest pain was higher (65 vs 41%, p < 0.0001), and the magnitude of ST depression was greater (0.16 +/- 0.14 vs 0.04 +/- 0.07 mV, p < 0.001) in patients with LM or TVCAD than in those with limited CAD. Stepwise discriminant analysis using scintigraphic imaging achieved a sensitivity of 69%, a specificity of 79%, and an accuracy of 77% for diagnosing patients with LM or TVCAD. After including clinical markers of ischemia during dipyridamole loading, multivariate analysis revealed an improved diagnosis with a sensitivity of 71%, a specificity of 85%, and an accuracy of 82%. These results clearly show the usefulness of scintigraphic imaging as well as the significance of careful assessment of clinical markers of ischemia during dipyridamole loading for the noninvasive identification of LM and TVCAD.