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European Heart Journal 1993 14(9):1195-1199;
Copyright © 1993 by the European Society of Cardiology.
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© 1993 The Europen Society of Cardiology

Prognostic value of thallium-201 myocardial scintigraphy after atrial transoesophageal pacing in patients with suspected coronary artery disease

C. LE FEUVRE, A. VACHERON, J. PH. METZGER, J. L. GEORGES, D. ETTIENNE, P. ALBAREDE and P. DEVERNEJOUL

Department of Cardiology, Necker Hospital 149, rue de Sèvres—75015 Paris, France

Received 28 September 1992; revised 10 March 1993; .

Correspondence: A. Vacheron, clinique cardiologique Hôpital Necker: 149, rue de Sèvres—75015 Paris, France

Abstract

Fifty-five patients with suspected coronary artery disease underwent planar thallium-201 myocardial scintigraphy after atrial transoesophageal pacing. Coronary angiography was carried out in all patients. Eighteen patients had no myocardial infarction, but a greater than 50% narrowing of at least one main vessel: initial hypoperfusion with redistribution at 4 h occurred in 16 patients (sensitivity 89%). Twenty-one patients had had a previous myocardial infarction: a reversible thallium defect was observed in 12 patients and an irreversible defect in the nine remaining patients. Sixteen patients had normal coronary arteries: a reversible thallium defect was observed in three patients (specflcity 81%). After a mean follow-up of 22±13 months (range 6 to 40), 23 cardiac events occurred: cardiac death in one patient, unstable angina in three, and revascularization procedures for recurrent angina despite medical therapy in 19 (coronary artery bypass surgery in 7 and coronary angioplasty in 12). By univariate analysis, the predictors of future cardiac events were a history of previous myocardial infarction (odds ratio 55, P<0.02) multivessel coronary artery disease (odds ratio 9.6, P<0.0002), angina during atrial pacing (odds ratio 5.1, P<0.05), abnormal scintigraphy (odds ratio 17.1, P<0.001) and reversible perfusion defect after pacing (odds ratio 7.9, P<0.002). By multivariate analysis, multivessel disease (P<0.004) and reversible perfusion defect after pacing (P<0.02) were the only independent predictors of future cardiac events.

In conclusion, thallium-201 myocardial scintigraphy after transoesophageal atrial pacing is accurate for the diagnosis and prognosis of patients with suspected coronary artery disease, and may be undertaken in patients unable to perform exercise stress testing.

Key Words: Thallium-201 myocardial scintigraphy • transoesophageal atrial pacing • long-term coronary events


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