[ST segment elevation during exercise test and perfusion scintigraphy in patients without infarction].
BACKGROUND
The features of perfusion scintigraphy in patients who show exercise-induced ST-segment elevation in the absence of previous infarction have been assessed in only a few reports. Therefore, we have evaluated our experience in a wide review of exercise 201-thallium scintigraphies.


METHODS
16,620 exercise 201-thallium scintigraphies, carried out between 1986 and 1993, have been retrospectively reviewed. Fourteen patients (0.8/1000) without previous infarction who were evaluated for chest pain showed ST-segment elevation. In all patients coronary arteriography was also available.


RESULTS
Five patients were free from significant coronary artery stenoses, 6 had one-vessel disease, 2 had two-vessel disease, and the remaining patient had three-vessel disease. In 8 patients ST-segment elevation (up to 3-24 mm) was inferior, in 5 anterior and in 1 lateral. The radionuclide was injected during ST-segment elevation in 10 cases and before such elevation (which developed in the postexercise phase) in 4. In 3 out of these 4, which had angiographically normal coronary arteries, the scintigraphy was negative. In all cases where thallium-201 was injected during ST elevation, severe perfusion defects were detected corresponding to the localization of ST elevation. In the 4 patients with critical coronary stenoses, thallium-201 redistribution after 3 hours was partial.


CONCLUSIONS
In patients without previous infarction and with exercise-induced ST-segment elevation, very severe perfusion defects are detected when the radionuclide has been injected during the crisis. Thallium-201 redistribution after 3 hours was not total in patients with fixed critical stenoses. When radionuclide injection preceded the crisis, the result of the scintigraphy was in agreement with the coronary anatomy.
Candell Riera
J
J
Servicio de Cardiología, Hospital General Universitari Vall d'Hebron, Barcelona.
Castell
J
J
Rius
A
A
Buxeda
M
M
Moragas
G
G
Palet
J
J
Bernaus
F
F
Ortega
D
D
Soler Soler
J
J
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging
Elevación del segmento ST en la prueba de esfuerzo y gammagrafía de perfusión en pacientes sin infarto.