title: Clinical and angiographic significance of a normal thallium-201 tomographic study in patients with a strongly positive exercise electrocardiogram.
abstract: Among 23,059 patients who underwent exercise myocardial tomography between 1985 and 1994 at our institution, there were 817 (3.5%) with a strongly positive exercise electrocardiogram and normal myocardial tomograms. Among these, 52 patients had no conditions known to be associated with a false-positive exercise electrocardiogram and no previous coronary revascularization, and underwent coronary angiography. Of the 32 patients with significant coronary stenoses, 50% had 1-vessel disease and only 22% had 3-vessel disease (p < 0.05). Among 55 stenosed arteries, 56% were of moderate severity (50 to 74%), whereas only 9% had subtotal or total occlusion (95 to 100%) (p < 0.001). There was a significant gender difference in the prevalence of significant coronary stenoses (80% in male vs 24% in female patients, p < 0.0001). A strongly positive exercise electrocardiogram coupled with normal exercise myocardial tomograms is a rare clinical finding. In women, this finding is usually associated with normal coronary arteries, whereas in men it often denotes coronary artery disease, usually of mild to moderate degree.
authors.affiliation: Section of Cardiology, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: Z X
authors.initials: ZX
authors.lastname: He
authors.forename: H A
authors.initials: HA
authors.lastname: Dakik
authors.forename: P
authors.initials: P
authors.lastname: Vaduganathan
authors.forename: U
authors.initials: U
authors.lastname: Qureshi
authors.forename: J J
authors.initials: JJ
authors.lastname: Mahmarian
authors.forename: M S
authors.initials: MS
authors.lastname: Verani
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D013794:Thallium Radioisotopes