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PubMed1989

Myocardial imaging using thallium 201 scintigraphy after dipyridamole infusion: a case history.

Coronary artery disease frequently occurs in combination with peripheral vascular disorders and is an important cause of morbidity and mortality during or after peripheral vascular surgery. However, the detection of coronary artery disease in patients with peripheral vascular disease may be complicated, since most of these patients are unable to perform conventional exercise testing. The authors report a sixty-two-year-old man with an infrarenally located aneurysm of the abdominal aorta who underwent thallium 201 scintigraphy combined with dipyridamole infusion as an alternative exercise test. The subsequent thallium 201 images showed perfusion defects indicative of severe coronary artery disease. Coronary angiography showed an occluded right coronary artery and a significant proximal stenosis in the left anterior descending coronary artery. The patient underwent successful aortocoronary bypass surgery, and two months later, the aortic aneurysm was operated on without complications. As a result, dipyridamole thallium 201 scintigraphy should be considered as a valuable diagnostic test to detect coronary artery disease in patients with peripheral vascular disorders.

Aortic Aneurysm↗
PubMed1991

Comparison of coronary angiographic features and oral dipyridamole thallium 201 tomography.

Coronary angiography and left ventriculography is commonly used to identify those patients with incomplete infarctions and therefore, a need for revascularization. The authors compared coronary angiography and left ventriculography with thallium 201 tomography using oral dipyridamole to identify patients with potential ischemia in the infarct zone indicating viable tissue. Forty-five patients (37 men, 8 women) with acute myocardial infarctions (29 anterior, 16 inferior) who received intravenous thrombolytic therapy were studied. On the basis of the left ventriculograms, only 16 patients were judged to have residual function in the infarct zone. Six of these patients had no thallium redistribution in the infarct zone, indicating lack of residual ischemia. Of the 29 patients with no residual function in the infarct zone, 18 had redistribution in the infarct zone, suggesting residual ischemic myocardium and thus viable tissue. Among the 32 patients with open infarct vessels, 15 had no redistribution in the infarct zone, but of the remaining 13 patients with occluded infarct vessels, 9 had redistribution in the infarct zone indicating residual ischemia and thus viable tissue. The authors' data suggest that neither wall motion analysis by left ventriculography nor the angiographic status of the infarct vessel identifies those patients with residual ischemia as evidenced by thallium tomography using oral dipyridamole.

Adult↗
PubMed1992

A comparison of dipyridamole thallium 201 scintigraphy and clinical examination in the determination of cardiac risk before arterial reconstruction.

Preoperative clinical examination, including a 12-lead resting ECG, and planar dipyridamole thallium imaging (DTI) were compared in a prospective study of 65 vascular surgical patients in regard to their value for predicting postoperative cardiac complications. Fifty-three patients underwent abdominal vascular procedures and 12 were operated on for peripheral artery disease. Thirty-six patients had ischemic heart disease (IHD) and/or abnormal findings from 12-lead resting ECG. Of these 36 patients, 11 had nonfatal cardiac complications. The remaining 29 patients were free of IHD and had normal results from ECG. No complications occurred among these 29 patients. There was no postoperative death. Thallium imaging results were abnormal in 45 patients, showing either redistribution and/or scar tissue or low washout. In 18 of these patients major changes with redistribution were present in all projections. Among these patients, 9 had a nonfatal cardiac complication. In the 27 patients with abnormalities in only one or two projections, only 2 had a cardiac event postoperatively. No cardiac complications occurred in patients with normal thallium scintigraphy findings. The patients were operated on irrespective of the results of the scans, and all recovered from any cardiac complications that occurred. In vascular surgical patients with previous IHD and/or abnormal findings from resting ECGs further risk stratification is achieved with DTI.

Adult↗
PubMed1998

Whole-body exercise thallium imaging in smokers.

Whole-body exercise thallium imaging (WBEI) can show abnormalities of leg muscle perfusion in patients with symptomatic peripheral artery disease (PAD). This study compared the exercise distribution of thallium-201 at different levels of the legs in asymptomatic smokers and non-smokers who performed a maximal graded treadmill test. A group of 74 smokers (more than 20 pack-years) with (n = 51) or without coronary artery disease (CAD) (n = 23) were included in group 1 and 64 non-smokers with a low probability of PAD and CAD in group 2. Patients in group 1 were older than the patients in group 2 (58 +/- 9 versus 48 +/- 12 years, p < 0.0001). Indexes of asymmetry were significantly higher in group 1, at each level of the legs, both in anterior and posterior views (0.001 < p < 0.05), except at thigh level in anterior view. Fractional uptake indexes of thallium-201 were significantly lower in group 1 than in group 2 at calf level (p = 0.0001 in anterior and posterior views) and buttocks (p = 0.006 and p = 0.009 in anterior view only). Interextremity asymmetry was four to six times more frequent at calf level in smokers than in non-smokers. These WBEI abnormalities in smokers are highly suggestive of silent PAD or at least decreased vascular reactivity in clinically uninvolved vessels.

Adult↗
PubMed1984

Assessment of viable myocardium within infarct zone by exercise thallium-201 scintigraphy.

The viability of the myocardial regions corresponding to pathologic Q waves was evaluated. Thirty-four patients with prior myocardial infarction underwent serial thallium-201 scintigraphy during treadmill exercise testing. On the delayed images, 8 of the initial 85 segmental defects (8 patients, 9%) showed total redistribution (RD) and 11 (6 patients, 13%) showed partial RD. In contrast, 66 segments showed persistent defect. The segments with total RD were more likely to be associated with normal or hypokinetic wall motion than the segments with persistent defect (p less than 0.05). Six of the 38 segments (13%) with collateral vessels showed total RD and 10 (21%) showed partial RD. However, 35 of 38 segments (92%) without collateral vessels showed persistent defect. There was a significant difference (p = 0.02) in myocardial thallium uptake patterns when the segments with and without collateral vessels were compared. It is concluded that (1) exercise-induced thallium RD may occur in patients with prior myocardial infarction, and myocardial infarct regions with total RD are highly associated with good contractility; these suggest the presence of viable but jeopardized myocardium within the infarct zone, and (2) collateral vessels may play a role in limiting infarct size.

Adult↗
PubMed1985

Reversible asymmetric septal hypertrophy in acute myocarditis. Serial findings of two-dimensional echocardiogram and thallium-201 scintigram.

Serial two-dimensional echocardiographic and thallium-201 scintigraphic findings are described in a patient with acute myocarditis diagnosed by endomyocardial biopsy. On the 4th day of illness, just before the onset of congestive heart failure, the echocardiogram showed asymmetric septal hypertrophy (IVS/PW = 16 mm/10 mm = 1.6) and thallium-201 scintigram showed the ventricular septal thickening. On the 8th day of illness, when severe congestive heart failure was seen, asymmetric septal hypertrophy disappeared (IVS/PW = 8 mm/8 mm = 1.0), the left ventricle dilated markedly (LVDd = 63 mm), and the wall motion became poor (EF = 0.24). After one month, when congestive heart failure and clinical inflammatory findings disappeared, the contractility somewhat improved (EF = 0.43), although marked left ventricular dilatation remained. Thallium-201 scintigram showed some scattered persistent perfusion defects, thinning of the ventricular septal thickening, and dilatation of the left ventricle. The right ventricular endomyocardial biopsy revealed the histologic findings of the late stage of acute myocarditis. It is concluded that transient thickening of the ventricular wall may represent early changes in acute myocarditis.

Acute Disease↗
PubMed1990

Persistent elevation of cardiac enzymes in a patient with hypertrophic cardiomyopathy--with special reference to electrocardiographic, echocardiographic and 201-thallium myocardial scintigraphic findings.

A 17-year-old female patient with hypertrophic cardiomyopathy whose serum cardiac enzymes (creatine phosphokinase = CPK, lactic dehydrogenase = LDH) showed persistent elevation was presented. Percent of CPK-MB and LDH1 in 6-year-follow-up period ranged from 3.2% to 8.5%, and 58.0% to 63.2%, respectively. This finding strongly suggests the existence of a small amount of continuous myocardial necrosis for a long time. The influence of cardiac enzyme release on the heart was assessed by serial checks of electrocardiogram, echocardiogram and 201-thallium myocardial scintigram. In serial checks of electrocardiograms, markedly decreased R wave amplitude ranging between 31% and 47% was observed in II, III, aVF and V3-6. On echocardiograms, asymmetric septal hypertrophy and a narrow left ventricular cavity were observed in all echocardiograms through the follow-up period. But, in most recent apical two-dimensional echocardiograms, hourglass appearance of the left ventricle due to a distinct cavity-formation at the apex was observed. In 201-thallium single photon emission computed tomogram, hypoperfusion area markedly extended in anterior and lateral parts. These changes in electrocardiograms, echocardiograms and 201-thallium myocardial scintigrams seemed to reflect myocardial necrosis. Our case points to a mechanism for hypertrophic cardiomyopathy to change, over time, to dilated cardiomyopathy-like features.

Adolescent↗
PubMed1993

Coronary stenosis and steal phenomenon in coronary-pulmonary fistula--assessment with stress thallium tomography after coronary angioplasty and fistulectomy.

We present a 46-year-old male with unstable angina and bilateral coronary-to-pulmonary artery fistulae in whom reversible myocardial ischemia was detected by exercise-stress thallium-201 single-photon emission computed tomography (SPECT). Coronary angiography revealed a 99% stenosis at the proximal site of the left descending coronary artery and bilateral coronary-to-pulmonary artery fistulae with a saccular aneurysm. Percutaneous transluminal coronary angioplasty abolished chest pain and electrocardiographic changes. However, definitely improved, but still present, stress-induced perfusion abnormalities were demonstrated by an exercise-stress thallium-201 SPECT study. Myocardial ischemia was the only serious complication related to the coronary fistulae, and after they were surgically resected, the reversible perfusion abnormality was no longer observed. These findings suggest that coronary-to-pulmonary artery fistulae potentiated the myocardial ischemia in patient with coronary stenosis leading to unstable angina and prolonged the presence of coronary perfusion abnormality on stress thallium scans probably through a coronary steal phenomenon.

Angina, Unstable↗
PubMed1994

Assessment of quantitative exercise thallium-201 emission computed tomography in patients with vasospastic angina--value of washout rate analysis.

This study was performed to assess the value of washout rate analysis of quantitative exercise thallium-201 emission computed tomography in vasospastic angina patients without significant coronary stenosis. Quantitative analysis of both thallium-201 perfusion and washout rate before and after drug treatment was performed in 48 patients with vasospastic angina and no significant coronary artery stenosis. All of the patients attained more than 90% of their age-predicted heart rate during each exercise test. Before drug treatment, 26 patients exhibited exercise-induced ischemia (perfusion defects on stress polar map), 17 did not exhibit exercise-induced ischemia (normal stress and washout rate polar maps), and the remaining 5 patients showed no perfusion defects, but did show extensive abnormal washout rates. On coronary angiography, multivessel coronary spasm was documented in 12 of the 26 patients with exercise-induced ischemia, in 7 of the 17 patients without exercise-induced ischemia and in 4 patients with an extensive abnormal washout rate and a normal stress polar map. In the 17 patients without exercise-induced ischemia, the mean washout rate was significantly decreased (p < 0.05) in association with a significant decrease in the double product (p < 0.05) after drug treatment. Of the 26 patients with exercise-induced ischemia, 18 (group 1) showed an increase in the mean washout rate with improved perfusion defect after drug treatment. The remaining 8 patients (group 2) showed a decrease in the mean washout rate with improved perfusion defect after drug treatment, which increased significantly on repeat exercise test performed after additional increased doses of antianginal drugs were administered (p < 0.01). The number of patients with multivessel coronary spasm was significantly high in group 2 (p < 0.01). Thirteen patients showed an extensive abnormal washout rate before drug treatment, including 8 patients with exercise-induced ischemia and 5 patients with no perfusion defects, who showed an increased mean washout rate after drug treatment (p < 0.05). These findings indicate that washout rate analysis aids in the diagnosis in vasospastic angina patients with exercise-induced ischemia. Some patients with exercise-induced ischemia can not be detected by thallium-201 perfusion analysis alone, especially those with multivessel coronary spasm and when this procedure is performed after drug treatment. In addition, a high frequency of abnormal washout rate in vasospastic angina may result not only from exercise-induced ischemia due to main epicardial coronary artery spasm, but also from microspasm, or impairment of microcirculation or myocyte.

Aged↗
PubMed1999

Functional recovery after coronary artery bypass grafting in patients with severe left ventricular dysfunction and preserved myocardial viability in the left anterior descending arterial territory as assessed by thallium-201 myocardial perfusion imaging.

To evaluate the functional recovery after coronary bypass surgery in patients with severe left ventricular (LV) dysfunction (ejection fraction (EF) < or = 35%), 100 consecutive patients with viable myocardium in the territory supplied by the left anterior descending artery (LAD) underwent coronary bypass grafting. In addition, cardiac catheterization and single-photon emission computed tomography (SPECT) perfusion imaging with thallium-201 were repeated 1-year postoperatively. Although 12 patients with severe LV dysfunction were preoperatively in a worse New York Heart Association functional class (3.1+/-0.7 vs 2.4+/-0.8; p<0.01), had a higher incidence of heart failure (10/12 vs 14/88; p<0.001) and had a worse LVEF (29+/-5 vs 61+/-14%; p<0.001) compared with 88 patients without severe LV dysfunction, the operative mortality was similar in the 2 groups (1/12 vs 2/88; p=NS). The postoperative NYHA functional class in the patients with severe LV dysfunction was similar to that in the patients without such dysfunction (1.6+/-0.7 vs 1.3+/-0.6; p=NS). In addition, the 1-year postoperative study revealed a significant improvement in the thallium defect score in both the LAD territory (1.7+/-1.2 to 0.7+/-1.0, p=0.01) and all the territories (5.2+/-2.2 to 3.2+/-1.9, p=0.002) in patients with severe LV dysfunction, whereas no improvement in defect score was found in either of these territories in those without severe LV dysfunction (LAD: 0.6+/-1.4 to 0.4+/-1.2, p=NS; All: 1.9+/-2.2 to 1.8+/-2.0, p=NS). Furthermore, a marked 1-year postoperative improvement (15-24%; 95% confidence interval) in LVEF (29+/-5 to 48+/-10%, p<0.001) was demonstrated in patients with severe LV dysfunction, but not in those without such dysfunction (60+/-13 to 61+/-11%, p=NS). These results indicate that myocardial viability in the LAD territory, as demonstrated by thallium-201 SPECT perfusion imaging, predicts a significant improvement in functional class and LVEF of at least 10% or more after coronary artery bypass grafting in patients with severe LV dysfunction.

Adult↗
PubMed1993

Exercise-induced silent myocardial ischemia in single vessel coronary artery disease associated with Q wave infarction. Assessment by thallium 201 single-photon emission computed tomography.

PURPOSE: To examine the relationship between the symptom of ischemia and the amount of abnormally perfused myocardium, coronary arteriography and exercise and redistribution thallium 201 single-photon emission computed tomography (SPECT) were analyzed. MATERIALS AND METHODS: The study group consisted of 153 patients with single-vessel coronary artery disease; 53 patients had no pathologic Q waves (group 1) and 100 patients had pathologic Q waves consistent with the area supplied by the diseased vessel (group 2). Twenty normal subjects were used as control subjects. The apical, mid, and basal left ventricular levels of the short-axis view and apical portion of the long-axis view were divided into 20 segments, and segmental images were scored blindly on a 0 (normal) to 4 (severely reduced uptake) scale. The redistribution score was defined as the thallium 201 defect score of exercise subtracted from that of the redistribution image and was used as a measure of the amount of ischemic myocardium. RESULTS: The redistribution score in 20 control subjects was 0.20 +/- 2.06, and the upper limit of normal redistribution score was defined as mean + 2 x SD (4.32). In group 1, 40 of 53 patients had a redistribution score above the normal range. In group 2, 34 of 100 patients had a redistribution score above the normal range. Of 40 patients in group 1, angina during exercise was observed in 22 patients (55 percent). Twenty-two patients who had angina had a redistribution score of 15.2 +/- 6.7, while those who did not have angina had a score of 13.7 +/- 5.2 (p = NS). Of 34 patients in group 2, angina was observed in 10 patients (29 percent) during exercise. Ten patients with angina had a redistribution score of 10.1 +/- 4.4, and those without angina had a score of 9.9 +/- 3.4 (p = NS). CONCLUSION: Thus, the incidence of silent ischemia without the Q wave infarct zone was found to be higher than that within the ischemic zone without Q wave. Patients with silent and symptomatic ischemia during exercise have similar amounts of ischemic myocardium demonstrated by tomographic thallium 201 imaging; this was found in patients who had Q wave infarction and in those who did not.

Angina Pectoris↗
PubMed1994

Symptoms of patients with silent ischemia as detected by thallium stress testing.

This study was undertaken to determine whether patients with silent ischemia (SI) (a positive thallium stress test without chest pain) have nonchest-pain symptoms that might serve as "anginal equivalents." Two hundred ninety-four individuals on completing a stress test were requested to score ten symptoms on a questionnaire (0 absent; 3 severe). Forty-three with a positive test had pains (chest, back, arm, and/or jaw) (no SI), whereas 93 with a positive test did not (SI). Patients with SI and patients without SI did not differ as to age, gender, or clinical features (including presence of diabetes or a history of myocardial infarction), but patients with SI were less likely to report a history of effort-related chest pains. Patients with SI exercised longer and had a higher peak heart rate. Patients were comparable with respect to myocardial ischemia (ST segment depression, double product, thallium lung uptake, and positive thallium scintigrams) and severity of coronary disease. Patients with SI complained less of weakness (p < 0.02) and tended to have lower overall symptom scores (4.2 +/- 0.3 vs 5.4 +/- 0.6), but breathlessness was comparable for both groups. On multivariate analysis, no nonanginal symptom was associated with SI. Only absence of a history of chest pain with activity and longer exercise time were related to SI. Patients with SI have similar clinical features as those with angina but tend to be less symptomatic with myocardial ischemia even for symptoms other than chest pain.

Exercise Test↗
PubMed1994

Exercise echocardiographic correlates of transient dilatation of the left ventricular cavity on exercise thallium-201 SPECT imaging.

Transient dilatation of the left ventricular cavity on exercise thallium perfusion imaging is recognized as a marker of significant coronary disease, but the mechanisms that produce this finding are not fully understood. We studied 32 patients who underwent exercise thallium imaging and exercise echocardiography to determine the changes in left ventricular cavity size that underlie transient dilatation. Left ventricular area from the apical four-chamber view was used to approximate left ventricular cavity size. There were 24 patients who did not have transient dilatation (group 1) and 8 patients who did have transient dilatation (group 2) on thallium imaging. Systolic area decreased from rest to exercise in group 1 patients but not in group 2 patients. There was no significant change in diastolic area from rest to exercise in either group 1 or group 2 patients. Thus, exercise-induced systolic dysfunction, manifested as a failure to decrease left ventricular systolic cavity size in exercise, may be an important mechanism in producing scintigraphic transient dilatation.

Echocardiography↗
PubMed1982

Thallium-201 scintigraphy after surgical repair of hemodynamically significant primary coronary artery anomalies.

Nine patients with hemodynamically significant congenital coronary artery anomalies underwent surgical repair at our institution during the period 1960 to 1979. Four received diagnoses of anomalous left coronary artery arising from the pulmonary artery, while five patients had coronary artery fistulae. Stress 201Tl scintigraphy was performed on these patients 0.5 to 18 years after surgical correction as a means of assessing the adequacy of myocardial perfusion. No perfusion defects were visualized on any of the thallium studies. The surgical procedure used did not appear to influence the results of 201Tl stress imaging. Thus, these nine patients with surgically corrected primary coronary artery anomalies had no evidence of ischemia as assessed by stress thallium scintigraphy. Serial preoperative and postoperative thallium studies are now indicated to determine the role of this procedure in the management of hemodynamically significant congenital coronary artery anomalies.

Adolescent↗
PubMed1983

Discordance of exercise thallium testing with coronary arteriography in patients with atypical presentations.

Eighty-one patients with diagnostically difficult clinical presentations suggesting coronary disease underwent symptom-limited maximal-exercise treadmill testing (ETT) and exercise radionuclide scanning with thallium-201. Results of these tests were in agreement in only 47 percent of the cases. Either exercise thallium or ETT was positive in 94 percent of patients with disease. Among a population with a disease prevalence of 67 percent, agreement between exercise thallium an ETT predicted disease in 92 percent of instances or excluded disease in 82 percent of instances. Frequent discordance between these two tests in 53 percent of the cases unfortunately limits this usefulness.

Adult↗
PubMed1985

Evaluation of response to dopamine in idiopathic dilated cardiomyopathy by echocardiography and thallium-201 myocardial scintigraphy.

Twenty-six patients with idiopathic dilated cardiomyopathy (DCM) underwent thallium-201 myocardial scintigraphy. Nine patients (group A) showed a perfusion defect in the interventricular septum (IVS) and 7 patients (group B) showed a defect in the left ventricular posterior wall (LVPW). Hemodynamic responses and catecholamine levels were compared between 16 patients (DCM group) and 6 control subjects (control group) following dopamine infusion (6 micrograms/Kg/min). The end-diastolic thickness of the IVS and LVPW, and the percentage wall thickening were assessed by echocardiography. Plasma dopamine and norepinephrine concentrations in the DCM group were not different from those of the control group at rest. During the dopamine infusion, however, norepinephrine increased only in the control group. There were significant differences in the thickness of the IVS among the 3 groups [7.3 +/- 1.4 mm for group A (p less than 0.001 vs control and p less than 0.05 vs group B), 8.9 +/- 1.5 mm for group B (p less than 0.01 vs control), 10.2 +/- 1.5 mm for the control group]. The percentage thickening of the IVS increased during the dopamine infusion in group B only and the thickening of the LVPW increased in group A only. Thus, in the myocardium of DCM patients with thallium perfusion defects, the degree of thickening did not change during dopamine infusion, but in the myocardium of DCM patients with normal thallium uptake the percentage thickening increased more than in the control group.

Adult↗
PubMed1987

Left ventricular responses to dopamine in dilated cardiomyopathy as assessed by two-dimensional echocardiography and compared with findings of thallium-201 scintigraphy.

The effects of dopamine on the left ventricular regional wall motion were studied in 11 patients with dilated cardiomyopathy by use of two-dimentional echocardiography and compared with the findings on the uptake of thallium-201. There were no significant changes in heart rate after dopamine infusion (6 micrograms/kg/min). However, the administration of dopamine significantly reduced PEP/ET and increased the systolic blood pressure, fractional shortening, ejection fraction and mVcf. The percentage of segments with reduced thallium-uptake area was significantly higher in abnormal wall motion segments than in normal wall segments both before and after dopamine administration. The percentage of segments with reduced thallium-uptake area was significantly higher in abnormal wall motion segments after loading than in normal wall segments before loading or in dopamine responding segments. However, in reduced uptake area, the asynergy of the left ventricle was improved significantly after dopamine administration. These results demonstrated that the abnormality of Tl-uptake was correlated roughly to the asynergy of the left ventricle, but that the state of remaining myocardium was not necessarily evaluated correctly by Tl-uptake. Dopamine loading seemed to be useful for more accurate evaluation of myocardial residual function.

Cardiomyopathy, Dilated↗
PubMedDate not supplied

Poisoning by thallium. A study of five cases.

Thallium poisoning seldom occurs in Spain. This article reports 5 cases of thallium poisoning, of which 4 of the patients belonged to the same family. The cases occurred in or near Granada between 1985 and 1987. The symptoms were initially gastrointestinal (vomiting, abdominal pain, gastrointestinal haemorrhage, etc.) in the case of the family poisoning, and a sensitive-motor polyneuritis in the fifth case. The diagnosis was established by analysis carried out in the authors' laboratory; urinary thallium concentrations were determined by atomic absorption spectrophotometry with graphite furnace and monovalent hollow cathode lamp. Each case was followed up to confirm the efficacy of the treatment; recovery from the poisoning was complete in all cases after 3 to 9 weeks.

Adult↗