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Diffuse slow washout of myocardial thallium-201: A new scintigraphic indicator of extensive coronary artery disease
When coronary artery disease is extensive and of relatively uniform severity, regional myocardial hypoperfusion may be balanced during stress, precluding development of spatially relative perfusion defects. Assessment of the washout of thallium-201 from myocardial regions may provide diagnostic assi...
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Published in: | Journal of the American College of Cardiology 1984-07, Vol.4 (1), p.55-64 |
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creator | Bateman, Timothy M. Maddahi, Jamshid Gray, Richard J. Murphy, Franklin L. Garcia, Ernest V. Conklin, Carolyn M. Raymond, Marjorie J. Stewart, Morgan E. Swan, H.J.C. Berman, Daniel S. |
description | When coronary artery disease is extensive and of relatively uniform severity, regional myocardial hypoperfusion may be balanced during stress, precluding development of spatially relative perfusion defects. Assessment of the washout of thallium-201 from myocardial regions may provide diagnostic assistance in these cases because washout analysis is spatially nonrelative and hypoperfused myocardial regions manifest a slow thallium-201 washout rate. In 1,265 consecutive patients having quantitatively analyzed stress-redistribution scintigraphy, 46 had a diffuse slow washout pattern with no or a maximum of one regional perfusion defect. Thirty-two underwent clinically indicated coronary angiography, and 23 (72%) of these were found to have three vessel or left main disease. Of 30 similar patients without a diffuse slow washout pattern and with no or a maximum of one perfusion defect, only 5 (17%) had extensive coronary disease. An independent relation between diffuse slow washout and extensive coronary disease was demonstrated by a Mantel-Haentzel chi-square analysis of a wide variety of other indexes of extensive disease. A diffuse washout abnormality, even in the absence of other scintigraphic, clinical or electrocardiographic indicators, carries a high predictive value for three vessel or left main coronary artery disease. The predictive value is maintained when the exercise level achieved is sub-maximal. Although an infrequent occurrence (3.6% of tested patients), a diffuse slow washout pattern without other scintigraphic indications of extensive coronary disease should lead to further diagnostic testing. |
doi_str_mv | 10.1016/S0735-1097(84)80319-8 |
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Assessment of the washout of thallium-201 from myocardial regions may provide diagnostic assistance in these cases because washout analysis is spatially nonrelative and hypoperfused myocardial regions manifest a slow thallium-201 washout rate. In 1,265 consecutive patients having quantitatively analyzed stress-redistribution scintigraphy, 46 had a diffuse slow washout pattern with no or a maximum of one regional perfusion defect. Thirty-two underwent clinically indicated coronary angiography, and 23 (72%) of these were found to have three vessel or left main disease. Of 30 similar patients without a diffuse slow washout pattern and with no or a maximum of one perfusion defect, only 5 (17%) had extensive coronary disease. An independent relation between diffuse slow washout and extensive coronary disease was demonstrated by a Mantel-Haentzel chi-square analysis of a wide variety of other indexes of extensive disease. A diffuse washout abnormality, even in the absence of other scintigraphic, clinical or electrocardiographic indicators, carries a high predictive value for three vessel or left main coronary artery disease. The predictive value is maintained when the exercise level achieved is sub-maximal. Although an infrequent occurrence (3.6% of tested patients), a diffuse slow washout pattern without other scintigraphic indications of extensive coronary disease should lead to further diagnostic testing.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/S0735-1097(84)80319-8</identifier><identifier>PMID: 6736455</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Biological and medical sciences ; Cardiology. Vascular system ; Coronary Angiography ; Coronary Circulation ; Coronary Disease - diagnostic imaging ; Coronary Disease - physiopathology ; Coronary heart disease ; Electrocardiography ; Exercise Test ; Female ; Heart ; Heart - diagnostic imaging ; Humans ; Male ; Medical sciences ; Middle Aged ; Radioisotopes ; Radionuclide Imaging ; Thallium</subject><ispartof>Journal of the American College of Cardiology, 1984-07, Vol.4 (1), p.55-64</ispartof><rights>1984 American College of Cardiology Foundation</rights><rights>1985 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4768-ec05fff7b3277fe10b24759765254c6c6776af42d4707e9e66204cca858c52513</citedby><cites>FETCH-LOGICAL-c4768-ec05fff7b3277fe10b24759765254c6c6776af42d4707e9e66204cca858c52513</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=8849398$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/6736455$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bateman, Timothy M.</creatorcontrib><creatorcontrib>Maddahi, Jamshid</creatorcontrib><creatorcontrib>Gray, Richard J.</creatorcontrib><creatorcontrib>Murphy, Franklin L.</creatorcontrib><creatorcontrib>Garcia, Ernest V.</creatorcontrib><creatorcontrib>Conklin, Carolyn M.</creatorcontrib><creatorcontrib>Raymond, Marjorie J.</creatorcontrib><creatorcontrib>Stewart, Morgan E.</creatorcontrib><creatorcontrib>Swan, H.J.C.</creatorcontrib><creatorcontrib>Berman, Daniel S.</creatorcontrib><title>Diffuse slow washout of myocardial thallium-201: A new scintigraphic indicator of extensive coronary artery disease</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>When coronary artery disease is extensive and of relatively uniform severity, regional myocardial hypoperfusion may be balanced during stress, precluding development of spatially relative perfusion defects. Assessment of the washout of thallium-201 from myocardial regions may provide diagnostic assistance in these cases because washout analysis is spatially nonrelative and hypoperfused myocardial regions manifest a slow thallium-201 washout rate. In 1,265 consecutive patients having quantitatively analyzed stress-redistribution scintigraphy, 46 had a diffuse slow washout pattern with no or a maximum of one regional perfusion defect. Thirty-two underwent clinically indicated coronary angiography, and 23 (72%) of these were found to have three vessel or left main disease. Of 30 similar patients without a diffuse slow washout pattern and with no or a maximum of one perfusion defect, only 5 (17%) had extensive coronary disease. An independent relation between diffuse slow washout and extensive coronary disease was demonstrated by a Mantel-Haentzel chi-square analysis of a wide variety of other indexes of extensive disease. A diffuse washout abnormality, even in the absence of other scintigraphic, clinical or electrocardiographic indicators, carries a high predictive value for three vessel or left main coronary artery disease. The predictive value is maintained when the exercise level achieved is sub-maximal. Although an infrequent occurrence (3.6% of tested patients), a diffuse slow washout pattern without other scintigraphic indications of extensive coronary disease should lead to further diagnostic testing.</description><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Coronary Angiography</subject><subject>Coronary Circulation</subject><subject>Coronary Disease - diagnostic imaging</subject><subject>Coronary Disease - physiopathology</subject><subject>Coronary heart disease</subject><subject>Electrocardiography</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Heart</subject><subject>Heart - diagnostic imaging</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Radioisotopes</subject><subject>Radionuclide Imaging</subject><subject>Thallium</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1984</creationdate><recordtype>article</recordtype><recordid>eNqFkE1v1DAQhi0EKtvCT6jkA0JwCNiJv8Klqkr5kCpxAM6WdzJmjZJ48SRd-u_Jdld75TSHed75eBi7lOKdFNK8_y5soyspWvvGqbdONLKt3BO2klq7qtGtfcpWJ-Q5Oyf6LYQwTrZn7MzYxiitV4w-phhnQk593vFdoE2eJ54jHx4yhNKl0PNpE_o-zUNVC_mBX_MRd5wgjVP6VcJ2k4CnsUsQplz2Sfw74UjpHjnkksdQHngoEy6lS4SB8AV7FkNP-PJYL9jPT7c_br5Ud98-f725vqtAWeMqBKFjjHbd1NZGlGJdK7v8ZXStFRgw1poQVd0pKyy2aEwtFEBw2sGCyOaCvT7M3Zb8Z0aa_JAIsO_DiHkm76SsTa31AuoDCCUTFYx-W9KwHO6l8HvZ_lG235v0TvlH2d4tucvjgnk9YHdKHe0u_VfHfiAIfSxhhEQnzDnVNu1-zNUBw0XGfcLiF7s4AnapIEy-y-k_h_wDZo2cBg</recordid><startdate>198407</startdate><enddate>198407</enddate><creator>Bateman, Timothy M.</creator><creator>Maddahi, Jamshid</creator><creator>Gray, Richard J.</creator><creator>Murphy, Franklin L.</creator><creator>Garcia, Ernest V.</creator><creator>Conklin, Carolyn M.</creator><creator>Raymond, Marjorie J.</creator><creator>Stewart, Morgan E.</creator><creator>Swan, H.J.C.</creator><creator>Berman, Daniel S.</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>198407</creationdate><title>Diffuse slow washout of myocardial thallium-201: A new scintigraphic indicator of extensive coronary artery disease</title><author>Bateman, Timothy M. ; Maddahi, Jamshid ; Gray, Richard J. ; Murphy, Franklin L. ; Garcia, Ernest V. ; Conklin, Carolyn M. ; Raymond, Marjorie J. ; Stewart, Morgan E. ; Swan, H.J.C. ; Berman, Daniel S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4768-ec05fff7b3277fe10b24759765254c6c6776af42d4707e9e66204cca858c52513</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1984</creationdate><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Coronary Angiography</topic><topic>Coronary Circulation</topic><topic>Coronary Disease - diagnostic imaging</topic><topic>Coronary Disease - physiopathology</topic><topic>Coronary heart disease</topic><topic>Electrocardiography</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Heart</topic><topic>Heart - diagnostic imaging</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Radioisotopes</topic><topic>Radionuclide Imaging</topic><topic>Thallium</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bateman, Timothy M.</creatorcontrib><creatorcontrib>Maddahi, Jamshid</creatorcontrib><creatorcontrib>Gray, Richard J.</creatorcontrib><creatorcontrib>Murphy, Franklin L.</creatorcontrib><creatorcontrib>Garcia, Ernest V.</creatorcontrib><creatorcontrib>Conklin, Carolyn M.</creatorcontrib><creatorcontrib>Raymond, Marjorie J.</creatorcontrib><creatorcontrib>Stewart, Morgan E.</creatorcontrib><creatorcontrib>Swan, H.J.C.</creatorcontrib><creatorcontrib>Berman, Daniel S.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bateman, Timothy M.</au><au>Maddahi, Jamshid</au><au>Gray, Richard J.</au><au>Murphy, Franklin L.</au><au>Garcia, Ernest V.</au><au>Conklin, Carolyn M.</au><au>Raymond, Marjorie J.</au><au>Stewart, Morgan E.</au><au>Swan, H.J.C.</au><au>Berman, Daniel S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diffuse slow washout of myocardial thallium-201: A new scintigraphic indicator of extensive coronary artery disease</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>1984-07</date><risdate>1984</risdate><volume>4</volume><issue>1</issue><spage>55</spage><epage>64</epage><pages>55-64</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>When coronary artery disease is extensive and of relatively uniform severity, regional myocardial hypoperfusion may be balanced during stress, precluding development of spatially relative perfusion defects. Assessment of the washout of thallium-201 from myocardial regions may provide diagnostic assistance in these cases because washout analysis is spatially nonrelative and hypoperfused myocardial regions manifest a slow thallium-201 washout rate. In 1,265 consecutive patients having quantitatively analyzed stress-redistribution scintigraphy, 46 had a diffuse slow washout pattern with no or a maximum of one regional perfusion defect. Thirty-two underwent clinically indicated coronary angiography, and 23 (72%) of these were found to have three vessel or left main disease. Of 30 similar patients without a diffuse slow washout pattern and with no or a maximum of one perfusion defect, only 5 (17%) had extensive coronary disease. An independent relation between diffuse slow washout and extensive coronary disease was demonstrated by a Mantel-Haentzel chi-square analysis of a wide variety of other indexes of extensive disease. A diffuse washout abnormality, even in the absence of other scintigraphic, clinical or electrocardiographic indicators, carries a high predictive value for three vessel or left main coronary artery disease. The predictive value is maintained when the exercise level achieved is sub-maximal. Although an infrequent occurrence (3.6% of tested patients), a diffuse slow washout pattern without other scintigraphic indications of extensive coronary disease should lead to further diagnostic testing.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>6736455</pmid><doi>10.1016/S0735-1097(84)80319-8</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Biological and medical sciences Cardiology. Vascular system Coronary Angiography Coronary Circulation Coronary Disease - diagnostic imaging Coronary Disease - physiopathology Coronary heart disease Electrocardiography Exercise Test Female Heart Heart - diagnostic imaging Humans Male Medical sciences Middle Aged Radioisotopes Radionuclide Imaging Thallium |
title | Diffuse slow washout of myocardial thallium-201: A new scintigraphic indicator of extensive coronary artery disease |
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