Clinical usefulness of thallium-201 scintigraphy in the study of coronary artery disease: a comparison of two exercise systems

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Exercise-related thallium-201 (201T1) scintigraphy has become an established diagnostic technique in the study of coronary artery disease.1–4 Its predictive value, like that of stress electrocardiography or any other diagnostic test, varies according to the likelihood of the disease in any given population,5 but in the study of symptomatic patients, or those identified as at risk, it often provides information about the extent as well as the presence of disease. A recent review by Okada et al,1 which combines the results of many studies (1817 patients), gives an overall sensitivity of 87% and specificity of 91%. This paper will review the experience at the Cleveland Clinic with thallium testing in daily clinical practice and compare the results from two test protocols.

Materials and methods

The patients involved in the study were referred to the Cleveland Clinic for evaluation of a chest pain syndrome, possibly representing coronary insufficiency, or for study following documented myocardial infarction. The records of patients from two, separate, 3-month periods who underwent exercise and equilibrium myocardial imaging with 201T1 were reviewed; those who had undergone coronary angiography within 6 weeks of the procedure were included in the analysis. Patients who had undergone myocardial revascularization procedures were excluded.

The two exercise systems are shown in Table 1. These differed in terms of type of exercise, dose of 201T1 and interval between exercise and imaging. An abnormal electrocardiographic response was considered to be an ST-segment depression ≥ 1 mm, either horizontal or downsloping in quality. A diagnostic test either showed . . .



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