QRS score versus ST-segment changes in patients undergoing Tl-201 scintigraphy using dipyridamole infusion.
BACKGROUND
ST-segment changes after dipyridamole infusion followed by handgrip isometric stress lack diagnostic value, because of the low sensitivity for the detection of coronary artery disease (CAD). In addition, an abnormal QRS score during exercise had a greater diagnostic ability than ST-segment changes to detect CAD. This study was undertaken to compare QRS score values with ST-segment changes during thallium 201 scintigraphy via dipyridamole infusion.


RESULTS
In this study 128 patients (101 men and 27 women), aged 53 to 72 years (mean, 59 +/- 8 years), underwent Tl-201 scintigraphy after dipyridamole infusion and handgrip isometric stress, as well as coronary angiography. QRS score values and ST-segment changes after dipyridamole infusion and handgrip isometric stress were also estimated. CAD was detected in 96 patients (75%), whereas normal coronary arteries were found in 32 (25%). According to scintigraphic data, 48 patients (37%) had no reversible perfusion defects whereas 80 (63%) had at least 1 reversible perfusion defect. Sensitivities for an abnormal QRS score and ST-segment deviation were 68% versus 18% ( P < .01) for detection of CAD and 75% versus 19% for detection of myocardial ischemia ( P < .01), respectively. Similar specificities were found ( P = not significant).


CONCLUSIONS
An abnormal QRS score significantly improves the low sensitivity of ST-segment changes for the detection of myocardial ischemia and CAD by use of Tl-201 scintigraphy with dipyridamole infusion and handgrip isometric stress.
Michaelides
Andreas P
AP
A' Department of Cardiology, Medical School of Athens University, Hippokration Hospital, 66 Thermopylon Street, 15235 Vrilissia, Athens, Greece.
Fourlas
Christos A
CA
Andrikopoulos
George K
GK
Dilaveris
Polychronis E
PE
Paspaliaris
Andreas V
AV
Stefanadis
Christodoulos I
CI
D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D004176:Dipyridamole; D004562:Electrocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D018737:Hand Strength; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013793:Thallium; D014665:Vasodilator Agents
D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; C027549:thallium chloride; D004176:Dipyridamole; D013793:Thallium