Author + information
- Received December 28, 1982
- Revision received December 27, 1983
- Accepted January 26, 1984
- Published online July 1, 1984.
- Timothy M. Bateman, MD*,1,
- Jamshid Maddahi, MD1,
- Richard J. Gray, MD, FACC1,
- Franklin L. Murphy, MD1,
- Ernest V. Garcia, PhD1,
- Carolyn M. Conklin, RN1,
- Marjorie J. Raymond, RN1,
- Morgan E. Stewart, MS1,
- H.J.C. Swan, MD, PhD, FACC1 and
- Daniel S. Berman, MD, FACC1
- ↵*Address for reprints: Timothy M. Bateman, MD, Division of Cardiology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Room 6215, Los Angeles, California 90048.
When coronary artery disease is extensive and of relatively uniform severity, regional myocardial hypoperfusion may be balanced during stress, precluding development of spatially relative perfusion defects. Assessment of the washout of thallium-201 from myocardial regions may provide diagnostic assistance in these cases because washout analysis is spatially nonrelative and hypoperfused myocardial regions manifest a slow thallium-201 washout rate. In 1,265 consecutive patients having quantitatively analyzed stress-redistribution scintigraphy, 46 had a diffuse slow washout pattern with no or a maximum of one regional perfusion defect. Thirty-two underwent clinically indicated coronary angiography, and 23 (72%) of these were found to have three vessel or left main disease. Of 30 similar patients without a diffuse slow washout pattern and with no or a maximum of one perfusion defect, only 5 (17%) had extensive coronary disease. An independent relation between diffuse slow washout and extensive coronary disease was demonstrated by a Mantel-Haentzel chi-square analysis of a wide variety of other indexes of extensive disease. A diffuse washout abnormality, even in the absence of other scintigraphic, clinical or electrocardiographic indicators, carries a high predictive value for three vessel or left main coronary artery disease. The predictive value is maintained when the exercise level achieved is sub-maximal. Although an infrequent occurrence (3.6% of tested patients), a diffuse slow washout pattern without other scintigraphic indications of extensive coronary disease should lead to further diagnostic testing.
- Received December 28, 1982.
- Revision received December 27, 1983.
- Accepted January 26, 1984.
- American College of Cardiology Foundation