Evaluation of thallium-201 exercise scintigraphy in coronary heart disease.

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Abstract
201Tl myocardial imaging is a non-invasive technique to study patients with suspected coronary heart disease. 201Tl scintigraphy was evaluated in predicting the presence or absence of coronary heart disease in 50 patients presenting with chest pain. 201Tl scintiscans were obtained in 4 projections at rest and on symptom-limited maximal exercise. The presence or absence of regional perfusion abnormality was determined by semiquantitative computer analysis. The results were compared with resting and exercise ECG and the final diagnosis established by coronary arteriography. In 33 patients with significant coronary artery disease perfusion defects were present at rest in 13 (39%) and on exercise in 30 (91%). Exercise 201Tl scintigraphy was significantly more sensitive in detecting the presence of coronary artery disease than resting scintigraphy. In 17 patients with normal coronary vessels 201Tl scans were normal in 15 at rest and 14 on exercise. In 33 patients with coronary artery disease the ECG at rest and/or exercise was abnormal in 25 (76%). The combination of exercise 201Tl scintigraphy and exercise ECG identified all 33 patients subsequently shown to have significant coronary artery disease. In 33 patients 71 vessels were diseased. All regions with relative perfusion abnormality were supplied by diseased vessels. Of 71 diseased vessels, 21 (31%) were not associated with perfusion defects which occurred only in patients with .gtoreq. 2 vessel disease. Apparently computer analyzed 201Tl exercise scintigraphy is a valuable technique for identifying patients with significant coronary artery disease. 201Tl image data were highly sensitive for detecting the presence of coronary artery disease though accuracy in predicting the extent of disease was limited in patients with multiple vessel disease, and justifies the use of exercise 201Tl scintigraphy especially in conjunction with exercise ECG in the study of patients with chest pain.