Author + information
- Received October 9, 1984
- Revision received February 20, 1985
- Accepted April 22, 1985
- Published online September 1, 1985.
- Behxhet Canhasi, MD,
- Michael Dae, MD,
- Elias Botvinick, MD, FACCa,
- Peter Lanzer, MD,
- Norberto Schechtmann, MD,
- Donald Faulkner, NMT,
- William O'connell, BS and
- Nelson Schiller, MD, FACC
- ↵aAddress for reprints: Elias H. Botvinick, MD, Cardiovascular Division, 1186-M, University of California, Medical Center, San Francisco, California 94143.
Lung uptake, ventricular cavitary dilation and basal myocardial uptake represent abnormalities that have been associated with myocardial ischemia on stress thallium-201 images, but that are supplementary to the conventional assessment of perfusion distribution. These “supplementary” indicators of ischemia were related to the coronary distribution of perfusion abnormalities, the results of electrocardiographic stress testing and to the findings on coronary angiography in 73 patients. Forty patients had multivessel coronary disease; 19 of these had three vessel disease. Perfusion abnormalities were seen in 39 of these 40 patients but were indicative of multivessel coronary disease in only 28 and of three vessel disease in only 6. However, supplementary indicators were present in 33 of 40 patients with multivessel disease and in 15 of 19 with three vessel disease. Furthermore, they were seen in 16 of 22 patients with multivessel disease in whom conventional perfusion abnormalities underestimated the extent of disease, but in only 4 of 12 patients in whom the extent of disease was overestimated. The presence of either perfusion abnormalities in a multivessel distribution or supplementary indicators identified 38 (95%) of 40 patients with multivessel disease.
A markedly positive electrocardiographic treadmill test was a less sensitive indicator of multivessel disease, appearing in only 15 of 40 patients. However, it was present in only 4 of 33 patients without multivessel coronary disease and was more specific for that diagnosis than were supplementary scintigraphic indicators (88 versus 67%, p < 0.05). All 13 patients with both a markedly positive treadmill test and supplementary indicators had coronary artery disease; 12 had multivessel disease and 7 had three vessel disease, a predictive value of 93% for multivessel disease. Conversely, among 17 patients with a normal treadmill test without supplementary indicators, only 1 had multivessel disease, a negative predictive value of 97% for multivessel coronary disease exclusion. The utilization of scintigraphic supplementary indicators in the routine assessment of thallium scintigrams, applied in association with the electrocardiographic treadmill result, significantly improves diagnostic accuracy in detecting multivessel coronary disease.
This work was supported in part by a grant from the Fannie Ripple Foundation, Madison, New Jersey and Grant 2-44496772961 from The National Institute, of Health, Bethesda, Maryland. Dr. Canhasi participated in this work while supported by the Fogarty International Research Fellowship 1-F05-TW03151-01 from the Fogarty Institute, Washington, D.C. He is now Associate Professor of Nuclear Medicine at the University of Pristina, Pristina. Yugoslavia. Dr. Botvinick is a recipient of an Established Investigator Award of the American Heart Association with funds contributed by local heart associations and is supported in part by a grant from the George D. Smith Foundation, San Francisco, California. Dr. Lanzer participated in this work while supported in part by a grant from the Deutsche Forschungsgemeinschaft, Bonn, West Germany. Dr. Schechtmann participated in this work while he was a Visiting Research Fellow at the University of California, San Francisco, California.
- Received October 9, 1984.
- Revision received February 20, 1985.
- Accepted April 22, 1985.
- American College of Cardiology Foundation