High reproducibility of myocardial perfusion defects in patients undergoing serial exercise thallium-201 tomography

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Abstract

The purpose of this study was to define the reproducibility of sequential quantitative exercise thallium-201 tomography. This was an ancillary study of a randomized, double-blind, placebo-controlled trial evaluating the shortterm efficacy of transdermal nitroglycerin patches in stable patients with angiographic coronary artery disease and no prior myocardial infarction. All 18 patients had a baseline tomographic perfusion defect involving ≥ 5% of the left ventricle after treadmill exercise. At a minimum of 3 days (mean 6.1 ± 1.8) after double-blind randomization to placebo, exercise thallium-201 tomography was repeated (study 2) using the same exercise protocol as in the baseline study (study 1). No significant differences in exercise parameters were observed from studies 1 to 2. Seventeen of 18 patients (94%) had an abnormal repeat exercise perfusion scan and 96% of initially abnormal vascular territories remained abnormal. The mean tomographic perfusion defect size was not significantly different from studies 1 (17.4 ± 13.3%) to 2 (16.6 ± 15.3%), nor were the components defined as scar and ischemia. A ≥ 10% change in total perfusion defect size in an individual patient defined the 95% confidence interval for exceeding the variability of the tomographic technique. Quantitative exercise thallium-201 tomography is highly reproducible and can be used to accurately interpret temporal changes in myocardial perfusion in individual patients.

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    Citation Excerpt :

    Because of the inherent method of creating these scores from a 17-segment anatomic model, significant variability is inevitable. With quantitative analysis, the variability associated with investigator visual interpretation is removed, making these techniques more reproducible (6) and therefore better suited for assessing serial changes after administration of differing tracers and/or stressors or after treatment with anti-ischemic therapies (7). A recent editorial underscored the limitations of visual assessments and the potential benefit of quantification to add objectivity when serially analyzing imaging studies (21).

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This study was presented in part at the 66th Annual Scientific Sessions of the American Heart Association, Atlanta, Georgia, November 1993.

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