Quantitative thallium imaging findings in patients with normal coronary angiographic findings and in clinically normal subjects

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Abstract

Computer-quantified exercise thallium images in 45 clinically normal subjects (group I) and in 44 patients with chest pain and no significant coronary artery disease by angiography (group II) were compared. Group II patients were older and more frequently female, had ST-segment depression by electrocardiography, and included 8 with subcritical (0 to 49%) stenoses. When normality was defined by the range of thallium imaging values in the clinically normal subjects, and after correcting clearance for peak exercise heart rate, 20 of 44 patients (45%) in group II had “abnormal” findings. The only difference between the 20 patients with abnormal findings and the 24 with normal findings in group II was a greater frequency of subcritical (less than 50%) coronary stenoses in the abnormal group, 7 (35%) vs 1 (4%) (p < 0.05). However, this does not explain most of the abnormalities of thallium imaging in group II. Thus, abnormal thallium findings in subjects with normal angiographic findings are frequently seen and are partially related to the presence of subcritical coronary stenoses, suggesting an underestimation of coronary obstruction. Furthermore, clinically and angiographically normal subjects may differ substantially, and both sets of normal subjects should be considered when establishing criteria for abnormality in exercise thallium imaging.

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This study was supported in part by Grants HL 26215, 32953 and 07416 from the U.S. Public Health Service, National Institutes of Health, Bethesda, Maryland.

1

Dr. Pohost is now the Director of the Division of Cardiovascular Diseases at the University of Alabama Medical Center at Birmingham, Alabama.

2

Dr. Okada is an Established Investigator of the American Heart Association.

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