31 Oct

New Exercise Parameter for the Identification of Severe Coronary Artery Disease: Discussion

New Exercise Parameter for the Identification of Severe Coronary Artery Disease: DiscussionThe heart was tomographically imaged under an orbitor gamma scintillation camera within 10 minutes after exercise and three hours later to obtain the redistribution images. The thallium 201 scintigrams revealed reversible filling defects indicative of ischemia in the anterior, inferior, and septal regions of the heart (Fig 3).
Discussion
This case demonstrates the usefulness of a new exercise parameter, SBP-RR, in the diagnosis of severe coronary artery disease. The patient did not have any of the previously described exercise criteria for significant multivessel or left main coronary artery disease including exertional hypotension, angina at low level of exercise, ST-segment depression, or exercise limited to stage 1 of Bruce protocol. However, he did have an abnormal recovery period, blood pressure response (| SBP-RR) with the ratios increasing from minutes 1 to 2 and 2 to 3 in the recovery period. The presence of significant reversible thallium 201 defects confirms the presence of myocardial ischemia. so
Previously, we have demonstrated both in a retrospective as well as a prospective manner that an | SBP-RR is highly predictive (100 percent) of an abnormal exercise thallium 201 scintigram. In the prospective study, an f SBP-RR was also found to be more sensitive than diagnostic ST segment depression ^0.1 millivolts (38 percent vs 15 percent) or angina (38 percent vs 26 percent) in identifying patients with multivessel coronary artery disease receiving antian-ginal medications. Also, the f SBP-RR was more predictive than ST depression (86 percent vs 57 percent) but similar to angina (86 percent vs 88 percent) in identifying patients with scintigraphic evidence of multivessel coronary artery disease in this study. Although hypertension is known to falsely elevate the SBP-RR, we recently described that a history of hypertension does not alter the diagnostic value of an f SBP-RR.

Figure 3. Thallium 201 scintigraphic findings immediately postexercise (exercise) and three hours posttesting (rest) to evaluate for redistribution. Reversible filling defects due to myocardial ischemia are seen in the anterior, apical and inferior regions of the heart.

Figure 3. Thallium 201 scintigraphic findings immediately postexercise (exercise) and three hours posttesting (rest) to evaluate for redistribution. Reversible filling defects due to myocardial ischemia are seen in the anterior, apical and inferior regions of the heart.

Categories: Coronary Artery
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