[Value of thallium-dipyridamole myocardial scintigraphy in coronary patients in non cardiac surgery].
Cardiac assessment is of particular importance in patients with documented or suspected coronary artery disease (CAD) as well as in all those patients undergoing vascular surgery. Use of dipyridamole thallium scintigraphy (DTS) in this population could help to detect significant coronary artery narrowing, together with the location and quantification of the areas of myocardium in jeopardy. Such information might lead to changing the surgical procedure, or to starting other treatment, such as coronary angioplasty or bypass graft surgery, thereby diminishing the morbidity and mortality associated with surgery in these high-risk patients. The ability of DTS to predict acute postoperative ischaemic events has been suggested by several studies. Various shortcomings of DTS used as a preoperative screening test have been pointed out in some recent papers. Therefore it is concluded that: 1) DTS should not be used as a routine preoperative test in vascular surgical patients. DTS is not accurate enough when used in patients without any clinical findings suggestive of CAD, 2) DTS may prove more useful in stratifying patients with an intermediate probability of developing cardiac complications. In such patients, the test will not provide a linear "all or nothing" result, but, when taken together with the clinical findings and the nature of the surgical procedure, a complex stratification, 3) Because of progress in the perioperative management of high-risk patients, positive findings on preoperative DTS may not correlate perfectly with perioperative cardiac events, 4) As several factors influence thallium uptake after dipyridamole, DTS does not have a perfect specificity, thus leading to order an excessive number of coronary angiographies. Some patients will be seen as having a false-positive DTS, 5) Preoperative screening DTS leads to cardiac catheterization and hence to revascularisation, independently of symtomatology. Further studies must be undertaken to determine whether this approach will improve short and long term patient survival.
Puybasset
L
L
Département d'Anesthésie-Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris.
Gosgnach
M
M
Baron
J F
JF
Coriat
P
P
Viars
P
P
D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004176:Dipyridamole; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D009206:Myocardium / Q000378:metabolism; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011877:Radionuclide Imaging; D013514:Surgical Procedures, Operative; D013794:Thallium Radioisotopes
D013794:Thallium Radioisotopes; D004176:Dipyridamole
Intérêt de la scintigraphie myocardique au thallium-dipyridamole chez le coronarien en chirurgie non cardiaque.