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European Heart Journal 1982 3(2):114-121;
Copyright © 1982 by the European Society of Cardiology.
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© 1982 by The European Society of Cardiology

Segmental analysis of stress thallium201 scintigraphy for the diagnosis and localization of coronary artery disease

V. LEGRAND, P. RIGO, W. BURGUET, J. P. SMEETS, P. COLLIGNON and H. E. KULBERTUS

Division of Cardiology and Division of Nuclear Medicine, University Hospital Liege, Belgium

Received 26 February 1981; revised 9 July 1981; .

Requests for reprints to: H. E. Kulbertus, Associate Professor of Medicine, University Hospital, 66 Bvd de la Constitution, 4020 Liege, Belgium.

Abstract

Ninety-two patients (15 devoid of coronary artery disease, 24 with atherosclerotic coronary lesions but without antecedent myocardial infarction, 20 with prior anterior myocardial infarction, 33 with prior inferior infarction) were submitted to a stress electrocardiogram and thallium201 scan within the three months preceeding or the month following a coronary angiogram. This study first confirmed that by using a segmental analysis of the scans, the localization of the coronary lesion responsible for the appearance of zones of hypofixation can be determined. In general, however, defects appear only in the territory of the most stenosed vessels. For the detection of coronary disease in the absence of antecedent myocardial infarction, the exercise electrocardiogram showed a sensitivity of 54% and a specificity of 67%. The sensitivity (92%) and specificity (93%) of stress myocardial scintigraphy were clearly superior. Stress thallium201 scintigraphy detected 60% of the patients with anterior infarction and multiple vessel disease, but suggested the existence of multiple lesions in three out of five subjects with isolated LAD disease. After inferior infarction, multiple vessel disease was detected by scintigraphy with a sensitivity of 45% and a specificity of 82%. If an apical defect in the anterior view was considered to be the sign of LAD artery stenosis, the sensitivity of stress myocardial scintigraphy for the detection of multiple vessel disease in the presence of inferior myocardial infarction reached 86% and the specificity 54%. Stress thallium201 myocardial scintigraphy appears more sensitive and specific than exercise electrocardiography for the detection of coronary artery disease and residual ischaemia after myocardial infarction.

Key Words: Coronary artery disease • myocardial infarction • stress TI201 myocardial scintigraphy • segmental analysis of thallium201 scans • exercise electrocardiography


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