Open AccessDiagnostic value of atrial pacing and thallium‐201 scintigraphy for the assessment of patients with chest pain
Author(s) -
Stratmann H. G.,
Mark A. L.,
Walter K. E.,
Williams G. A.
Publication year - 1989
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960120404
Subject(s) - medicine , coronary artery disease , scintigraphy , chest pain , thallium , perfusion , angina , cardiology , st depression , depression (economics) , cardiac catheterization , infarction , ischemia , myocardial infarction , radiology , inorganic chemistry , chemistry , economics , macroeconomics
Atrial pacing was performed either alone (n = 23) or in combination with thallium‐201 scintigraphy (n = 113) in 136 patients referred for evaluation of chest pain. The presence of coronary artery disease (CAD) was excluded by cardiac catheterization in 12 patients and confirmed in 124. Both pacing‐induced ST depression and angina had sensitivities of 48% for CAD; specificities were 75% and 83%, respectively. An abnormal thallium‐201 scan (one or more reversible and/or fixed perfusion defects) was seen in 72% of patients with CAD (specificity 83%), and fixed defects in 36% (specificity 100%). Pacing was associated with either ST depression or an abnormal perfusion scan in 81% of patients (specificity 67%). There were no significant differences in the results of atria pacing or thallium‐201 scintigraphy in patients with or without a history of myocardial infarction, or in those with or without previous coronary artery bypass surgery. Pacing‐induced ST depression, or both ST depression and a reversible perfusion defect occurred significantly less frequently in patients with peripheral vascular disease than in those without this diagnosis (p <.05). With only one exception, there were no significant differences in the sensitivities of any indicators of ischemia (ST depression, angina, or perfusion scans), either individually or in combination, as the peak pacing rate or double product achieved increased. Patients paced to maximum double products in excess of 26,000 beats‐mmHg/min had a significantly increased incidence of ischemic ST depression compared to those paced to lower double products (p <.05). We conclude that atrial pacing and thallium‐201 scintigraphy, when used together, are useful for evaluating selected patients with chest pain for the presence of CAD.