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European Heart Journal 1990 11(8):705-711;
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

Thallium-201 scintigraphy after dipyridamole infusion with low-level exercise. III. Clinical significance and additional diagnostic value of ST segment depression and angina pectoris during the test

G. J. LAARMAN*,, P. W. SERRUYS{dagger}, J. F. VERZULBERGEN{ddagger}, C. A. P. L. ASCOOP{ddagger} and A. J. AZAR{ddagger}

*Department of Cardiology, Onze Lieve Vrouwe Gasthuis Amsterdam, The Netherlands
{dagger}Thoraxcenter, University Hospital Rotterdam-Dijkzigt The Netherlands
{ddagger}Nuclear Cardiology, St. Antonius Hospital Nieuwegein, The Netherlands

Received 19 June 1989; revised 13 September 1989; .

Address for reprints: Dr G. J. Laarman, MD, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, le Oosterparkstraat 179 1091 HA Amsterdam, The Netherlands.

Abstract

Intravenous dipyridamole thallium testing is a useful alternative procedure for assessing coronary artery disease (CAD) in patients who are unable to perform maximal exercise tests. Ischaemic ST segment depression and angina pectoris are frequently observed during the test, in particular when exercise is added to dipyridamole infusion. To establish the clinical significance and additional diagnostic value of these markers of ischaemia during dipyridamole low-level exercise testing (DXT) 57 patients with CAD (group A), 21 patients with normal or near-normal coronary arteries at coronary arteriography (group B), and 20 healthy subjects with low likelihood of CAD (group C) were studied.

During DXT ischaemic ST segment depression was observed in 28 patients (47%) of group A and in two patients (10%) of group B. Angina pectoris was experienced by 35 patients (61%) of group A and by five patients (24%) of group B. The positive predictive value of both ST depression and angina pectoris was high (88 and 93%, respectively), but the negative predictive values were low (42 and 40%, respectively). Combining ST segment analysis with the findings of thallium imaging significantly increased the diagnostic accuracy of the test.

ST segment depression, angina pectoris, and thallium abnormalities were highly specific findings if the study population consisted of asymptomatic subjects with a low likelihood of CAD (group C).

Sensitivity for the detection of the presence of CAD increased with the extent of CAD for all parameters studied. Thus, ST depression and angina pectoris, alone or in combination, during DXT have little diagnostic significance, although sensitivity is increased in patients with triple-vessel CAD. Analysis of the ST segment provides additional information and should therefore be included in the overall interpretation of the test results. A marked difference in the false positive rates for all parameters was observed between asymptomatic subjects and angiographically normal patients with chest pain syndromes, which can be explained by selection bias.

Key Words: Thallium-201 scintigraphy • dipyridamole infusion • angina pectoris • ST segment depression


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