Author + information
- Received January 14, 1985
- Revision received July 30, 1985
- Accepted August 12, 1985
- Published online January 1, 1986.
- Jamshid Maddahi, MD, FACCa,
- Alnoor Abdulla, MD, FACC,
- Ernest V. Garcia, PhD1,
- H.J.C. Swan, MD, PhD, FACC and
- Daniel S. Berman, MD, FACC
- ↵aAddress for reprints: Jamshid Maddahi, MD, Cardiology/Nuclear Medicine, Cedars-Sinai Medical Center, PO Box 48750, Los Angeles, California 90048.
The capabilities of visual and quantitative analysis of stress redistribution thallium-201 scintigrams, exercise electrocardiography and exercise blood pressure response were compared for correct identification of extensive coronary disease, defined as left main or triple vessel coronary artery disease, or both (50% or more luminal diameter coronary narrowing), in 105 consecutive patients with suspected coronary artery disease. Extensive disease was present in 56 patients and the remaining 49 had either less extensive coronary artery disease (n = 34) or normal coronary arteriograms (n = 15).
Although exercise blood pressure response, exercise electrocardiography and visual thallium-201 analysis were highly specific (98, 88 and 96%, respectively), they were insensitive for identification of patients with extensive disease (14, 45 and 16%, respectively). Quantitative thallium-201 analysis significantly improved the sensitivity of visual thallium-201 analysis for identification of patients with extensive disease (from 16 to 63%, p < 0.001) without a significant loss of specificity (96 versus 86%, p = NS). Eighteen (64%) of the 28 patients who were misclassified by visual analysis as having less extensive disease were correctly classified as having extensive disease by virtue of quantitative analysis of regional myocardial thallium-201 washout. When the results of quantitative thallium-201 analysis were combined with those of blood pressure and electrocardiographic response to exercise, the sensitivity and specificity for identification of patients with extensive disease was 86 and 76%, respectively, and the highest overall accuracy (0.82) was obtained.
In conclusion, the quantitative analysis of myocardial thallium-201 stress distribution and washout markedly increases the suboptimal sensitivity of visual thallium201 analysis for correct identification of patients with triple vessel or left main coronary disease, or both. Such identification is enhanced by combining the results of quantitative thallium-201 analysis with those of blood pressure and electrocardiographic response to exercise.
↵1 Dr. Garcia's present address is the Department of Nuclear Medicine, Emory University, Atlanta, Georgia.
This study was supported in part by Grant HL-17651 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland; Grant 732G2-2 from the American Heart Association, Greater Los Angeles Affiliate, Los Angeles, California and an individual grant to Dr. Abdulla from the Aga Khan Foundation, Geneva, Switzerland.
- Received January 14, 1985.
- Revision received July 30, 1985.
- Accepted August 12, 1985.
- American College of Cardiology Foundation