title: Preoperative diagnosis of coronary artery disease in patients with valvular heart disease using technetium-99m isonitrile tomographic imaging together with high-dose dipyridamole and handgrip exercise.
abstract: Forty-seven consecutive patients (mean age 61 +/- 8 years) referred for cardiac catheterization due to moderate to severe aortic (n = 30) or mitral (n = 17) valvular heart disease were examined by technetium-99m isonitrile tomography together with a high-dose dipyridamole infusion (0.7 mg/kg) and handgrip stress. Tomography did not identify coronary artery disease (CAD) in 3 of the 21 patients with angiographically proven disease (sensitivity 86%) and suggested false positive results in 5 of the 26 without the disease (specificity 81% and negative predictive accuracy 88%). No patient without angina pectoris and with negative scintigraphy (n = 14) had angiographically significant (greater than or equal to 50% diameter stenosis) CAD. Overall vessel sensitivity was 63%, and specificity was 92%. The frequency of side effects during the dipyridamole-handgrip test was only 7%. No serious complications occurred during stress tests. Thus, technetium-99m isonitrile tomographic imaging, together with high-dose dipyridamole and handgrip exercise, is a useful noninvasive method in excluding significant CAD in patients with valvular heart disease.
authors.affiliation: Department of Medicine, Oulu University Central Hospital, Finland.
authors.forename: R
authors.initials: R
authors.lastname: Kettunen
authors.forename: H V
authors.initials: HV
authors.lastname: Huikuri
authors.forename: J
authors.initials: J
authors.lastname: Heikkilä
authors.forename: J T
authors.initials: JT
authors.lastname: Takkunen
mesh_terms: D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging*; D004176:Dipyridamole / Q000009:adverse effects; D005080:Exercise Test / Q000009:adverse effects; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009570:Nitriles; D015609:Organotechnetium Compounds; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D014055:Tomography, Emission-Computed
chemical_list: D009570:Nitriles; D015609:Organotechnetium Compounds; D004176:Dipyridamole; D017256:Technetium Tc 99m Sestamibi