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European Heart Journal 1993 14(8):1079-1087;
Copyright © 1993 by the European Society of Cardiology.
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© 1993 The Europen Society of Cardiology

Diagnostic value of 123I-phenylpentadecanoic acid (IPPA) metabolic and thallium 201 perfusion imaging in stable coronary artery disease

M. WALAMIES, V. TURJANMAA, M. KOSKINEN and A. UUSITALO

Department of Clinical Physiology, Tampere University Hospital Finland

Received 17 October 1992; revised 22 February 1993; .

Correspondence: Markku Walamies, Silmäkkeenkatu 5 E 16, SF-33560 Tampere, Finland

Abstract

The diagnostic value of 123I-phenylpentadecanoic acid (IPPA) metabolic cardiac imaging was studied in a group (n=29) of patients with angiographically confirmed CAD using single photon emission computed tomography (SPECT). A symptom-limited exercise test was first done with IPPA, and 2 days later with thallium. Medications were not withheld during testing. Fourteen healthy control subjects participated in parallel IPPA and 15 in thallium tests.

Data acquisition and output were comparable in the two imaging modalities. By testing various relatively simple criteria for abnormality we found that the semiquantitative interpretation was more accurate than the visual readings. The best compromise of accuracy with the scored criteria consisted of a sensitivity of 86% and a specificity of 86%, obtained with IPPA polar tomograms (mild exercise defect) and a sensitivity of 86% and a specificity of 80% obtained with thallium (regionally decreased washout). With visual interpretation alone, a sensitivity of 83% and a specificity of 71% was detected with IPPA (mild exercise defect) and 72% and 73%, respectively, with thallium (partial reversibility). The sensitivity of the exercise ECG alone was 62%.

The results of this study imply that IPPA imaging could be a rational, uncomplicated clinical method for non-invasive diagnosis of CAD. The diagnostic ability of IPPA is at least as good as that of thallium, and it is possible to use them in succession.

Key Words: IPPA • thallium • nuclear imaging • coronary artery disease • diagnosis


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