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Effect of Exercise Position During Stress Testing on Cardiac and Pulmonary Thallium Kinetics and Accuracy in Evaluating Coronary Artery Disease

Department of Radiology, Stanford University; and Nuclear Medicine Service, V.A. Medical Center, Palo Alto, California

Correspondence: For reprints contact: James L. Lear, MD, Nuclear Medicine (115), V.A. Medical Center, 3801 Miranda Ave., Palo Alto, CA 94304.

ABSTRACT

We compared the effects of symptom-limited upright and supine exercise on ²⁰¹TI distribution and kinetics in the heart and lungs of 100 consecutive patients. Our analysis was based on data obtained with a digital gamma camera in the 45° left anterior oblique position at 5, 40, 240, and 275 min postadministration of [²⁰¹TI]chloride. We found significant differences in the results at the 5- and 40-min intervals; viz, (a) higher cardiac and (b) lower pulmonary thallium activity after upright exercise in 94 subjects at both intervals, and (c) greater variability in total and regional cardiac thallium kinetics after supine exercise. With supine exercise, the relatively low initial cardiac activity, relatively high lung activity, and the greater variability in thallium kinetics combined to make interpretation of quantitative data and cardiac images difficult and less accurate with respect to detection of coronary artery disease. These observations have important implications for the interpreting physician when thallium stress tests are performed in the supine position.