Author + information
- Received May 17, 1983
- Revision received December 13, 1983
- Accepted December 24, 1983
- Published online May 1, 1984.
- Gary V. Heller, MD, PhD*,1,
- Julian M. Aroesty, MD, FACC1,
- J. Anthony Parker, MD, PhD1,2,
- Raymond G. McKay, MD1,
- Kenneth J. Silverman, MD, FACC1,
- Ann V. Als, MD1,
- Patricia C. Come, MD1,
- Gerald M. Kolodny, MD1 and
- William Grossman, MD, FACC1
- ↵*Address for reprints: Gary V. Heller, MD, Cardiovascular Division, Memorial Hospital, Pawtucket, Rhode Island 02860.
Many patients suspected of having coronary artery disease are unable to undergo adequate exercise testing. An alternate stress, pacing tachycardia, has been shown to produce electrocardiographic changes that are as sensitive and specific as those observed during exercise testing. To compare thallium-201 imaging after atrial pacing stress with thallium imaging after exercise stress, 22 patients undergoing cardiac catheterization were studied with both standard exercise thallium imaging and pacing thallium imaging.
Positive ischemic electrocardiographic changes (> 1 mm ST segment depression) were noted in 11 of 16 patients with coronary artery disease during exercise, and in 15 of the 16 patients during atrial pacing. One of six patients with normal or trivial coronary artery disease had a positive electrocardiogram with each test. Exercise thallium imaging was positive in 13 of 16 patients with coronary artery disease compared with 15 of 16 patients during atrial pacing. Three of six patients without coronary artery disease had a positive scan with exercise testing, and two of these same patients developed a positive scan with atrial pacing. Of those patients with coronary artery disease and an abnormal scan, 85% showed redistribution with exercise testing compared with 87% during atrial pacing. Segment by segment comparison of thallium imaging after either atrial pacing or exercise showed that there was a good correlation of the location and severity of the thallium defects (r = 0.83, p = 0.0001, Spearman rank correlation).
It is concluded that the location and presence of both fixed and transient thallium defects after atrial pacing are closely correlated with the findings after exercise testing. Thus, atrial pacing may be used as a stress for myocardial perfusion scintigraphy in patients unable to complete a satisfactory exercise test.
- Received May 17, 1983.
- Revision received December 13, 1983.
- Accepted December 24, 1983.
- American College of Cardiology Foundation