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January 24, 1986, Vol 255, No. 4 >
ARTICLE | January 24, 1986

Value of Computer Analysis of Exercise Thallium Images in the Noninvasive Detection of Coronary Artery Disease FREE

Sanjiv Kaul, MD; John B. Newell; David A. Chesler, ScD; Gerald M. Pohost, MD; Robert D. Okada, MD; Timothy E. Guiney, MD; Charles A. Boucher, MD
[+] Author Affiliations

Reprint requests to Cardiac Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114 (Dr Boucher).


JAMA. 1986;255(4):508-511. doi:10.1001/jama.1986.03370040082029
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References

WHEN a patient presents with either chest pain or an abnormal electrocardiogram, coronary artery disease (CAD) is suspected. Thallium imaging with exercise is performed frequently at this point to confirm whether CAD is present.1-13 This test provides numerous scintigraphic and nonscintigraphic data, which are usually provided to the physician separately in an unsystematic way. The physician must subjectively integrate the individual results and then decide about the presence of CAD. This decision may be difficult when the data in an individual are discordant regarding the presence or absence of CAD. If the presence of any abnormality is used to diagnose CAD, sensitivity is maximized at the expense of specificity. If the presence of multiple abnormalities is required, specificity is maximized at the expense of sensitivity. To study this problem, we analyzed 196 patients with no previous myocardial infarction who had undergone thallium imaging with exercise and cardiac catheterization. Patients

REFERENCES

1 +
Bruce RA, Hornsten TR:  Exercise stress testing in evaluation of patients with ischemic heart disease . Prog Cardiovasc Dis 1969;;11:371.
2 +
Sheffield LT:  Exercise stress testing , in Braunwald (ed): Heart Disease: A Textbook of Cardiovascular Medicine . Philadelphia, WB Saunders Co, 1983;, pp 258-278.
3 +
Beller GA, Watson DD, Gibson RS:  Assessment of myocardial perfusion , in Come PC (ed): Diagnostic Radiology . New York, JB Lippincott, 1985;, pp 125-149.
4 +
Botnivick EH, Taradesh MR, Shames DM, et al:  Thallium-201 myocardial perfusion scintigraphy for the clinical classification of normal, abnormal, and equivocal electrocardiographic stress tests . Am J Cardiol 1978;;41:41-51.
5 +
Ritchie JL, Zaret BL, Strauss HW, et al:  Myocardial imaging with thallium-201: A multicenter study in patients with angina pectoris or acute myocardial infarction . Am J Cardiol 1978;; 42:341-350.
6 +
Leppo J, Yipintsoi T, Blanstein R, et al:  Thallium-201 myocardial scintigraphy in patients with triple-vessel disease and ischemic exercise stress tests . Circulation 1979;;59:714-721.
7 +
Dash H, Massie BM, Botnivick EH, et al:  The noninvasive identification of left main and three-vessel coronary artery disease by myocardial stress perfusion scintigraphy and treadmill exercise electrocardiography . Circulation 1979;; 60:276-284.
8 +
Okada RD, Boucher CA, Strauss HW, et al:  Exercise radionuclide imaging approaches to coronary artery disease . Am J Cardiol 1980;; 46:1188-1204.
9 +
Iskandrian AS, Segal BL:  Value of exercise thallium-201 imaging in patients with diagnostic and nondiagnostic exercise electrocardiograms . Am J Cardiol 1981;;48:233-238.
10 +
Maddahi J, Garcia EV, Berman DS, et al:  Improved noninvasive assessment of coronary artery disease by quantitative analysis of regional stress myocardial uptake and washout of thallium-201 . Circulation 1981;;64:924-935.
11 +
Berger BB, Watson DD, Taylor GJ, et al:  Quantitative thallium-201 exercise scintigraphy for detection of coronary disease . J Nucl Med 1981;;22:585-593.
12 +
Patterson RE, Horowitz SF, Eng Crudin A, et al:  Can exercise electrocardiography and thallium 201 imaging exclude the diagnosis of coronary artery disease? Bayesian analysis of the clinical limits of exclusion, and indications for coronary angiography . Am J Cardiol 1982;; 49:1127-1135.
13 +
Brown KA, Boucher CA, Okada RD, et al:  Prognostic value of exercise thallium-201 imaging in patients presenting for evaluation of chest pain . J Am Coll Cardiol 1984;;4:994-1001.
14 +
Horan LG, Flowers NC, Johnson JC:  Significance of the diagnostic Q wave in myocardial infarction . Circulation 1971;;43:428-436.
15 +
Helfant R:  Q waves in coronary heart disease: Newer understanding of their clinical implications . Am J Cardiol 1976;;38:662-664.
16 +
Okada RD, Boucher CA, Kirschenbaum HK, et al:  Improved diagnostic accuracy of thallium-201 stress test using multiple observers and criteria derived from interobserver analysis of variance . Am J Cardiol 1980;;46:619-624.
17 +
Brown KA, Boucher CA, Okada RD, et al:  Quantification of pulmonary thallium-201 activity after upright exercise in normal subjects: Importance of peak heart rate and propranolol usage in defining normal values . Am J Cardiol 1984;;53:1678-1682.
18 +
Lim YL, Okada RD, Chesler DA, et al:  A new approach to quantitation of exercise thallium-201 scintigraphy before and after an intervention: Application to define the impact of coronary angioplasty on regional myocardial perfusion . Am Heart J 1984;;108:917-925.
19 +
Okada RD, Lim YL, Boucher CA, et al:  Clinical, angiographic, hemodynamic, perfusional and functional changes after single vessel left anterior descending coronary angioplasty . Am J Cardiol 1985;;55:347-356.
20 +
Kaul S, Kiess M, Liu P, et al:  Comparison of exercise electrocardiography and quantitative thallium imaging for single vessel coronary artery disease . Am J Cardiol 1985;;56:257-261.
21 +
Willerson JT:  Diagnostic methods in the assessment of the patient with chest pain . J Am Coll Cardiol 1984;;4:290-291.
22 +
Burow RD, Pond M, Schafer AW, et al:  'Circumferential profiles': A new method for computer analysis of thallium-201 myocardial perfusion images . J Nucl Med 1979;;20:771-777.
23 +
Massie BM, Hollenberg M, Wisneski JA, et al:  Scintigraphic quantitation of myocardial ischemia: A new approach . Circulation 1983;; 68:747-755.
24 +
Bateman TM, Maddahi J, Gray RJ, et al:  Diffuse slow washout of myocardial thallium201: A new scintigraphic indicator of extensive coronary artery disease . J Am Coll Cardiol 1984;;4:55-64.
25 +
Gibson RS, Watson DD, Craddock GB, et al:  Predicting cardiac events after uncomplicated acute myocardial infarction: A prospective study comparing predischarge exercise thallium201 scintigraphy and coronary angiography . Circulation 1983;;68:321-336.
26 +
Rozanski A, Diamond G, Berman D, et al:  The declining specificity of exercise radionuclide ventriculography . N Engl J Med 1983;;309:518-522.
27 +
Rozanski A, Diamond GA, Forrester JS, et al:  Alternative referent standards for cardiac normality: Implications for diagnostic testing . Ann Intern Med 1984;;101:164-170.
28 +
Brown KA, Osbakken M, Boucher CA, et al:  Positive exercise thallium-201 test responses in patients with less than 50% maximal coronary stenosis: Angiographic and clinical predictors . Am J Cardiol 1985;;55:54-57.

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1 +
Bruce RA, Hornsten TR:  Exercise stress testing in evaluation of patients with ischemic heart disease . Prog Cardiovasc Dis 1969;;11:371.
2 +
Sheffield LT:  Exercise stress testing , in Braunwald (ed): Heart Disease: A Textbook of Cardiovascular Medicine . Philadelphia, WB Saunders Co, 1983;, pp 258-278.
3 +
Beller GA, Watson DD, Gibson RS:  Assessment of myocardial perfusion , in Come PC (ed): Diagnostic Radiology . New York, JB Lippincott, 1985;, pp 125-149.
4 +
Botnivick EH, Taradesh MR, Shames DM, et al:  Thallium-201 myocardial perfusion scintigraphy for the clinical classification of normal, abnormal, and equivocal electrocardiographic stress tests . Am J Cardiol 1978;;41:41-51.
5 +
Ritchie JL, Zaret BL, Strauss HW, et al:  Myocardial imaging with thallium-201: A multicenter study in patients with angina pectoris or acute myocardial infarction . Am J Cardiol 1978;; 42:341-350.
6 +
Leppo J, Yipintsoi T, Blanstein R, et al:  Thallium-201 myocardial scintigraphy in patients with triple-vessel disease and ischemic exercise stress tests . Circulation 1979;;59:714-721.
7 +
Dash H, Massie BM, Botnivick EH, et al:  The noninvasive identification of left main and three-vessel coronary artery disease by myocardial stress perfusion scintigraphy and treadmill exercise electrocardiography . Circulation 1979;; 60:276-284.
8 +
Okada RD, Boucher CA, Strauss HW, et al:  Exercise radionuclide imaging approaches to coronary artery disease . Am J Cardiol 1980;; 46:1188-1204.
9 +
Iskandrian AS, Segal BL:  Value of exercise thallium-201 imaging in patients with diagnostic and nondiagnostic exercise electrocardiograms . Am J Cardiol 1981;;48:233-238.
10 +
Maddahi J, Garcia EV, Berman DS, et al:  Improved noninvasive assessment of coronary artery disease by quantitative analysis of regional stress myocardial uptake and washout of thallium-201 . Circulation 1981;;64:924-935.
11 +
Berger BB, Watson DD, Taylor GJ, et al:  Quantitative thallium-201 exercise scintigraphy for detection of coronary disease . J Nucl Med 1981;;22:585-593.
12 +
Patterson RE, Horowitz SF, Eng Crudin A, et al:  Can exercise electrocardiography and thallium 201 imaging exclude the diagnosis of coronary artery disease? Bayesian analysis of the clinical limits of exclusion, and indications for coronary angiography . Am J Cardiol 1982;; 49:1127-1135.
13 +
Brown KA, Boucher CA, Okada RD, et al:  Prognostic value of exercise thallium-201 imaging in patients presenting for evaluation of chest pain . J Am Coll Cardiol 1984;;4:994-1001.
14 +
Horan LG, Flowers NC, Johnson JC:  Significance of the diagnostic Q wave in myocardial infarction . Circulation 1971;;43:428-436.
15 +
Helfant R:  Q waves in coronary heart disease: Newer understanding of their clinical implications . Am J Cardiol 1976;;38:662-664.
16 +
Okada RD, Boucher CA, Kirschenbaum HK, et al:  Improved diagnostic accuracy of thallium-201 stress test using multiple observers and criteria derived from interobserver analysis of variance . Am J Cardiol 1980;;46:619-624.
17 +
Brown KA, Boucher CA, Okada RD, et al:  Quantification of pulmonary thallium-201 activity after upright exercise in normal subjects: Importance of peak heart rate and propranolol usage in defining normal values . Am J Cardiol 1984;;53:1678-1682.
18 +
Lim YL, Okada RD, Chesler DA, et al:  A new approach to quantitation of exercise thallium-201 scintigraphy before and after an intervention: Application to define the impact of coronary angioplasty on regional myocardial perfusion . Am Heart J 1984;;108:917-925.
19 +
Okada RD, Lim YL, Boucher CA, et al:  Clinical, angiographic, hemodynamic, perfusional and functional changes after single vessel left anterior descending coronary angioplasty . Am J Cardiol 1985;;55:347-356.
20 +
Kaul S, Kiess M, Liu P, et al:  Comparison of exercise electrocardiography and quantitative thallium imaging for single vessel coronary artery disease . Am J Cardiol 1985;;56:257-261.
21 +
Willerson JT:  Diagnostic methods in the assessment of the patient with chest pain . J Am Coll Cardiol 1984;;4:290-291.
22 +
Burow RD, Pond M, Schafer AW, et al:  'Circumferential profiles': A new method for computer analysis of thallium-201 myocardial perfusion images . J Nucl Med 1979;;20:771-777.
23 +
Massie BM, Hollenberg M, Wisneski JA, et al:  Scintigraphic quantitation of myocardial ischemia: A new approach . Circulation 1983;; 68:747-755.
24 +
Bateman TM, Maddahi J, Gray RJ, et al:  Diffuse slow washout of myocardial thallium201: A new scintigraphic indicator of extensive coronary artery disease . J Am Coll Cardiol 1984;;4:55-64.
25 +
Gibson RS, Watson DD, Craddock GB, et al:  Predicting cardiac events after uncomplicated acute myocardial infarction: A prospective study comparing predischarge exercise thallium201 scintigraphy and coronary angiography . Circulation 1983;;68:321-336.
26 +
Rozanski A, Diamond G, Berman D, et al:  The declining specificity of exercise radionuclide ventriculography . N Engl J Med 1983;;309:518-522.
27 +
Rozanski A, Diamond GA, Forrester JS, et al:  Alternative referent standards for cardiac normality: Implications for diagnostic testing . Ann Intern Med 1984;;101:164-170.
28 +
Brown KA, Osbakken M, Boucher CA, et al:  Positive exercise thallium-201 test responses in patients with less than 50% maximal coronary stenosis: Angiographic and clinical predictors . Am J Cardiol 1985;;55:54-57.

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