title: Safety and diagnostic accuracy of adenosine thallium-201 scintigraphy in patients unable to exercise and those with left bundle branch block.
abstract: Three hundred forty consecutive patients (mean age 69 +/- 9 years) were evaluated with adenosine tomographic thallium-201 scintigraphy for suspected coronary artery disease. Minor side effects occurred in 91% of patients. Out of 28 patients (8%) with potentially serious side effects, 28 had significant atrioventricular (AV) block (second-degree, 24 patients; third-degree, four patients; syncope occurred in two patients). Acute bronchospasm and severe refractory angina pectoris occurred in one patient each. All side effects were transient and without sequelae. One hundred twenty-one patients underwent coronary angiography within 9 days of adenosine thallium imaging. The predictive accuracies of adenosine thallium imaging for identifying and localizing ischemia to a specific coronary distribution were: left anterior descending = 88%, left circumflex = 84%, right coronary = 88%. The predictive accuracy of adenosine thallium imaging in patients with left bundle branch block was 91%, and was higher than the 71% predictive accuracy noted in 39 patients who underwent exercise thallium testing (p = 0.04). It is concluded that adenosine thallium-201 myocardial scintigraphy was (1) highly accurate for the detection and localization of significant coronary artery disease; (2) it was more accurate at detecting ischemia in patients with left bundle branch block than exercise thallium testing, and (3) subjective side effects were common and were of no diagnostic importance; transient AV block occurred occasionally.
authors.affiliation: Cardiovascular Consultants, Inc., Kansas City, MO 64111.
authors.forename: J H
authors.initials: JH
authors.lastname: O'Keefe
authors.forename: T M
authors.initials: TM
authors.lastname: Bateman
authors.forename: R
authors.initials: R
authors.lastname: Silvestri
authors.forename: C
authors.initials: C
authors.lastname: Barnhart
mesh_terms: D000241:Adenosine / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000139:chemically induced; D001986:Bronchial Spasm / Q000139:chemically induced; D002037:Bundle-Branch Block / Q000150:complications*; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006327:Heart Block / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes; D014665:Vasodilator Agents / Q000009:adverse effects
chemical_list: D013794:Thallium Radioisotopes; D014665:Vasodilator Agents; D000241:Adenosine