[Transient ischemic dilatation of the left ventricle observed on dipyridamole-stressed thallium-201 scintigraphy].
Takuji ToyamaB CanerNobuharu TamakiKazuki YamamotoTetsuo NakashimaT OdoriNaoko TakahashiJunichiro MifuneM OhnakaTakayuki Tanaka
6
Citation
0
Reference
10
Related Paper
Abstract:
To assess clinical significance of transient ischemic dilatation of the left ventricle (TID) on dipyridamole-stressed 201Tl myocardial scintigraphy, 110 patients suspected with coronary artery disease, including 13 with normal coronary, 48 with single vessel disease, 30 with 2 vessel disease, and 19 with 3 vessel disease were analyzed. TID was visually and quantitatively assessed calculating the ratio of the area within the left ventricular region on the initial and delayed image (TID ratio). TID was observed in 3 of 1 vessel disease (6%), 5 of 2 vessel disease (17%), and 8 of 3 vessel disease (42%). None of normal coronary artery showed TID. In patients with multivessel disease (MVD), TID was observed more frequently (27%) than in patients with 1 vessel disease (6%) (p < 0.025). Furthermore, the TID ratio tended to be higher (1.15 +/- 0.11) than those with single vessel disease (1.03 +/- 0.03). To identify patients with MVD, TID had a sensitivity of 27% and a specificity of 95%. ECG changes were observed more often in patients with TID than those without TID. Five patients showing TID underwent coronary artery bypass graft surgery, TID disappeared postoperatively in each patient. In conclusion, TID on dipyridamole 201Tl scan seems to be a specific although not sensitive marker for detecting MVD.Keywords:
Dipyridamole
Thallium
Cite
To assess clinical significance of transient ischemic dilatation of the left ventricle (TID) on dipyridamole-stressed 201Tl myocardial scintigraphy, 110 patients suspected with coronary artery disease, including 13 with normal coronary, 48 with single vessel disease, 30 with 2 vessel disease, and 19 with 3 vessel disease were analyzed. TID was visually and quantitatively assessed calculating the ratio of the area within the left ventricular region on the initial and delayed image (TID ratio). TID was observed in 3 of 1 vessel disease (6%), 5 of 2 vessel disease (17%), and 8 of 3 vessel disease (42%). None of normal coronary artery showed TID. In patients with multivessel disease (MVD), TID was observed more frequently (27%) than in patients with 1 vessel disease (6%) (p < 0.025). Furthermore, the TID ratio tended to be higher (1.15 +/- 0.11) than those with single vessel disease (1.03 +/- 0.03). To identify patients with MVD, TID had a sensitivity of 27% and a specificity of 95%. ECG changes were observed more often in patients with TID than those without TID. Five patients showing TID underwent coronary artery bypass graft surgery, TID disappeared postoperatively in each patient. In conclusion, TID on dipyridamole 201Tl scan seems to be a specific although not sensitive marker for detecting MVD.
Dipyridamole
Thallium
Cite
Citations (6)
Fourier amplitude image circumferential profile analysis in the evaluation of the dipyridamole test.
The aim of this study was to evaluate a circumferential profile method of analysis (CPA) of the Fourier image of amplitude (FA), obtained by equilibrium gated radionuclide angiocardiography (EGRA) in the assessment of the response to the dipyridamole (DIP) test in patients with previous myocardial infarction. The changes in regional wall motion (RWM) induced by DIP in a group of 29 patients with previous MI were compared with those of a ten-patient control group. On the basis of SPECT thallium-201 standard stress-rest scintigraphy the infarcted patients were divided into 9 patients with fixed perfusion defects at four hours and 20 patients with both fixed and reversible perfusion defects. The quantitative CPA was carried out on the FA image normalized by the mean amplitude calculated for the left ventricle (LV) area. A circular ROI was drawn around the FA left ventricle image and two curves (basal and post-DIP) with 60 points were obtained. We compared this method with a five-sector method of analysis applied to the same FA images. An increase of 2 or more SD in the basal post-DIP ratio curve, compared with the average of the ratios in the control group, was found in 16 of 20 patients with reversible perfusion defects (sensitivity: 80%) and an increase in the same ratio was found in 2 of 9 MI patients with fixed perfusion defects (specificity: 78%). A sensitivity and specificity of 60% and 78% respectively were found using sectorial analysis.
Dipyridamole
Thallium
Cite
Citations (0)
Objective To assess the value of myocardial thallium-201( 201Tl)washout rate (WR) after dipyradamole infusion in screening coronary artery disease.Methods 34 patients with coronary artery disease (CAD) demonstrated by angiogram were enrolled. 23 patients who had atypical chest pain with mild coronary artery stenosis(50%) were taken as the control group. Regional myocardial WR of 201Tl was measured from early and delayed bull's eye images of dipyridamole 201Tl SPECT. Around 2 weeks before or after 201Tl myocardial scintigraphy, angiograms were performed.Results The myocardial 201Tl WR after dipyridamole infusion in patients with CAD was significantly less than that in the controls [anterior wall (26.89±4.39)% vs (43.54±9.08)%; inferior wall (16.81±6.13)% vs (45.04±9.66)%; lateral wall (27.76±9.01)% vs (43.87±9.17)%, P 0.001]. There was a poor correlation between the WR of 201Tl in anterior wall and the stenotic degree of LAD, as well as between lateral wall and LCx (r=-0.469, P=0.05; r=-0.394, P=0.164). But the correlation between the WR in inferior wall and the stenotic degree of RCA was better shown (r=-0.661, P=0.005).Conclusion In CAD patients, the regional WR of 201Tl in ischemic area was less than that in the controls. But the correlation between the WR and the degree of coronary stenosis needs further study.
Dipyridamole
Thallium
Myocardial imaging
Cite
Citations (0)
Dipyridamole
Thallium
Cite
Citations (27)
A decline is usually observed in the myocardial uptake of thallium-201 in delayed imaging compared with initial imaging. In patients with severe coronary artery disease (CAD), the uptake is sometimes higher in the delayed than in the initial imaging, which is expressed as negative washout rate. To evaluate the diagnostic implications of this negative washout rate the findings of dipyridamole thallium scintigraphy in 582 patients with coronary artery disease were evaluated. The negative washout rate was present in 201 of 582 patients (35%). It had a significant association with high grade coronary artery narrowing of > or = 90%. Sensitivity in detecting patients with this high grade narrowing by negative washout rate was 48%, its specificity was 93%, and its positive predictive value was 94%. Sensitivity to detect individual coronary artery narrowing of > or = 90% did not decrease according to the extent of CAD, with the highest detection in the left anterior descending coronary artery and the lowest in the left circumflex coronary artery. Since patients with high grade coronary narrowing often require coronary intervention, the results of this study suggest the diagnostic importance of negative washout rate in the identification of the particular subset of patients with CAD.
Thallium
Dipyridamole
Washout
Circumflex
Cite
Citations (10)
Clinical role of myocardial scintigraphy in the diagnosis of coronary artery disease (CAD) is now well accepted, however, the role of it in the identification of viable myocardium in patients with chronic CAD has not yet been clarified. To determine the usefulness of rest-injected scan as a marker of myocardial viability, the regional uptake of this agent at rest was compared with that of on reinjection and 24 hours after reinjection images. Subject patients were 13 chronic CAD patients who showed irreversible perfusion defect(s) on standard pharmacologic (dipyridamole) stress-redistribution images. Immediately after the redistribution images were obtained, 37 MBq thallium was injected at rest, and images were reacquired at 10 minutes and 24 hours after reinjection. After then 740 MBq was injected, and 1 hour later rest MIBI myocardial imaging was performed. Five sets of imagestress, redistribution, reinjection, delayed images of thallium, and rest image of MIBI) were then analyzed qualitatively and quantitatively. Left ventricle was arbitrarily divided into 9 segments (apex, basal and apical portions of anterior, septal, inferior, and lateral walls). Seven patients and 30 regions showed a fixed perfusion defect on the stress-redistribution images. Among 30 regions, 15 showed positive uptakes and 6 showed negative uptakes on both reinjection/delayed images and rest images. Five regions showed only thallium uptake and were regarded as viable clinically. Of four regions which showed only uptake, two were regarded as viable, while the other two were regarded as a nonviable scar tissue clinically. In conclusion, reinjection technique was more reliable in the identification of viable myocardium. However, the role of in identification of viable myocardium was still remained to be clarified because 2 of 9 regions showed only uptake and were regarded as viable tissues.
Thallium
Dipyridamole
Rest (music)
Basal (medicine)
Cite
Citations (0)
This report describes the different clinical and instrumental manifestations of coronary ischemia in a patient with left main coronary artery atresia. Exercise test and thallium-201 perfusion scintigraphy during isometric exercise test were negative for angina and electrocardiographic changes. Conversely, dipyridamole infusion caused severe angina, marked ST-segment changes and diffuse thallium-201 uptake abnormalities. This peculiar anatomical condition offers the opportunity of high-lighting the role played by the microcirculation in determining myocardial ischemia.
Dipyridamole
Thallium
Left coronary artery
Cite
Citations (2)
Thallium
Dipyridamole
Cite
Citations (2)
The increase in mortality from cardiovascular disease in the presence of electrocardiographic signs of left ventricular hypertrophy (LVH) has been ascribed to ischaemic changes in the hypertrophied left ventricle even in the absence of overt coronary artery disease. To test this hypothesis and to investigate the usefulness in the detection of LVH myocardial perfusion scintigraphy with thallium-201 and echocardiography was performed in thirty-three hypertensive patients. Sixteen had had electrocardiographic signs of left ventricular hypertrophy. Twelve patients had symptoms of cardiovascular disease. In twenty-six subjects the scintigraphic procedure consisted of a combined rest--exercise study, in the other seven only resting images were obtained. Measurement of septal wall thickness on the scintiscans correlated fairly well with echographic dimensions and allowed separation of a group of patients with LVH from a group without. In individual patients, however, the perfusion scan was not a reliable tool to affirm the presence of LVH. A total of eight patients, six with LVH on the echocardiogram, had an abnormal rest--exercise perfusion scan, either with a new perfusion defect after exercise and/or with a resting defect alone. In nine other patients with echocardiographic LVH, on the other hand, no abnormal perfusion was found. Thus, perfusion abnormalities did not correlate with the presence of LVH. The presence of such abnormalities in relation to increasing age and symptomatic cardiovascular disease could well be the expression of anatomic coronary artery disease and cannot be differentiated from the possible ischaemia of the hypertrophied left ventricle.
Thallium
Cite
Citations (2)
Asynergy
Thallium
Treadmill
Cardiac catheterization
Dipyridamole
Cite
Citations (172)