[Exercise test coupled with thallium-201 myocardial scintigraphy after a primary posterior wall infarct. Apropos of 123 patients subjected to coronarography].
The following investigations were performed in 123 patients (118 men and 5 women) with an average age of 51 +/- 6 years, between the 3rd and 6 week after primary posterior infarction, a standard exercise stress test on a bicycle ergometer coupled with Thallium 201 myocardial scintigraphy, followed by coronary angiography in the following 15 days. The object of these investigations was to detect severe stenosis (greater than 70%) of the left anterior descending artery and 50% stenosis of the left main stem. Thirteen investigations could not be interpreted because of a submaximal exercise stress test which did not attain 85% of the theoretical maximal heart rate. The sensitivity of exercise stress testing was 73% and that of myocardial scintigraphy 71%. On the other hand, the specificity of scintigraphy was 94% compared to 68% for exercise stress testing. The predictive value of a positive scintigraphy was 88% compared to 47% for stress testing. However, the predictive value of a negative test was similar with both techniques (87% for exercise stress testing, 90% for scintigraphy). When all the positive results were considered, the sensitivity was 93% but the specificity only 66%. The simplest and most rational way of exploiting the information provided by these investigations is to combine the results: when they are concordant they indicate the true diagnosis in 90% of cases. Discordant results pose a more difficult problem with myocardial scintigraphy being the more reliable: its positive predictive value was 71% when exercise stress testing was negative; its negative predictive value was 87% when exercise stress testing was positive.(ABSTRACT TRUNCATED AT 250 WORDS)
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D011446:Prospective Studies; D011868:Radioisotopes; D011877:Radionuclide Imaging; D013793:Thallium
D011868:Radioisotopes; D013793:Thallium
Apport de l'épreuve d'effort couplée à la scintigraphie myocardique au thallium 201 dans les suites d'un primo-infarctus postérieur. A propos de 123 malades coronarographiés.