title: Exclusion of coronary artery disease by exercise thallium-201 tomography in patients with aortic valve stenosis.
abstract: In many patients with valvular aortic stenosis (AS), management decisions may be possible without invasive studies if coexistent coronary artery disease (CAD) can be ruled out noninvasively. The use of thallium-201 single-photon emission computed tomography to the exclusion of CAD was studied in 44 patients aged 41 to 78 years with AS. In addition to cardiac catheterization and selective coronary angiography, patients underwent a cardiac ultrasound study and thallium-201 myocardial perfusion imaging at rest and after bicycle ergometer exercise. Two thirds of the patients had critical AS (valve area index less than or equal to 0.5 cm2/m2) but none had left ventricular systolic dysfunction. Twenty-one patients had angiographically significant CAD (greater than or equal to 50% diameter stenosis in greater than or equal to 1 coronary artery), whereas 23 had either a fully normal angiogram (n = 17) or mild (less than 50%) stenoses (n = 6). Each patient with significant CAD had an abnormal thallium-201 tomogram, either a strictly segmental perfusion defect (n = 19), or a patchy nonsegmental abnormality (n = 2); however, 10 of 23 patients free of significant CAD had similar results. Thus, the sensitivity and specificity of an abnormal scintigram were 100 and 57%, respectively. If only segmental perfusion defects typical of CAD had been considered abnormal, then the sensitivity of the test would have been 90% and the specificity 70%. Patients with false abnormal scintigrams had more severe AS and more angiographically nonsignificant CAD than those with true normal findings.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: First Department of Medicine, Helsinki University Central Hospital, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Kupari
authors.forename: K S
authors.initials: KS
authors.lastname: Virtanen
authors.forename: H
authors.initials: H
authors.lastname: Turto
authors.forename: M
authors.initials: M
authors.lastname: Viitasalo
authors.forename: M
authors.initials: M
authors.lastname: Mänttäri
authors.forename: M
authors.initials: M
authors.lastname: Lindroos
authors.forename: E
authors.initials: E
authors.lastname: Koskela
authors.forename: H
authors.initials: H
authors.lastname: Leinonen
authors.forename: S
authors.initials: S
authors.lastname: Pohjola-Sintonen
authors.forename: J
authors.initials: J
authors.lastname: Heikkilä
mesh_terms: D001024:Aortic Valve Stenosis / Q000150:complications*; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D013794:Thallium Radioisotopes