Assessment of jeopardized myocardium in patients with one-vessel disease.

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Abstract
The size of the perfusion defect was assessed from a quantitative analysis of exercise 201Tl images. Quantitative analysis was determined by measuring the area and the perimeter of the perfusion defect and expressing it as a percentage of the total left ventricular area or perimeter in 3 projections. Using this technique, 50 patients with 1-vessel disease of .gtoreq. 50% diameter narrowing were studied. The planimetic and the perimetric methods correlated well (P < 0.001, r = 0.97). Of the 11 patients with < 70% diameter narrowing, only 1 patient had abnormal exercise 201Tl images. Of the remaining 39 patients with .gtoreq. 70% diameter narrowing, 35 had abnormal exercise images. The defects were larger in patients with left anterior descending coronary artery disease (33 .+-. 10%; mean .+-. SD by perimetry) than in patients with left circumflex coronary artery disease (19 .+-. 14%, P < 0.01) or right coronary artery disease (17 .+-. 11%, P < 0.01). There was significant variation in the sizes of the defects in the 3 projections in patients with left circumflex and right coronary artery disease, but not in patients with left anterior descending coronary artery disease. Patients with left anterior descending coronary artery disease with collaterals had smaller defects than their counterparts without collaterals (25 .+-. 6% vs. 40 .+-. 8%, P < 0.001). In patients with 1-vessel disease, the quantitative size of the perfusion defects during exercise apparently is highly variable. Patients with left anterior descending coronary artery disease have larger defects than patients with left circumflex or right coronary artery disease. The significantly lower quantitative Tl scores in patients with left anterior descending coronary artery disease and collaterals suggests that collaterals have a protective role during exercise in these patients.

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