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ADENOSINE THALLIUM‐201 SCANS IN PATIENTS UNDERGOING ELECTIVE NON‐CARDIAC SURGERY
Author(s) -
Ahluwalia Uday,
Larcos George,
Gruenewald Simon M.,
Farlow David C.,
Fletcher John P.
Publication year - 1995
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1111/j.1445-2197.1995.tb00559.x
Subject(s) - medicine , adenosine , dipyridamole , coronary artery disease , thallium , scintigraphy , revascularization , cardiology , vascular surgery , radiology , nuclear medicine , cardiac surgery , myocardial infarction , inorganic chemistry , chemistry
Dipyridamole Thallium‐201 ( 201 Tl) scintigraphy has been used widely for assessment of patients prior to vascular surgery. Recently, Adenosine has been reported to be a safe and useful alternative to Dipyridamole. The purposes of this study were to evaluate the safety and feasibility of the use of Adenosine, to evaluate the correlation of Adenosine 201 Tl scans with coronary angiograms (when available) and to evaluate the effect of scan results on clinician management style. Fifty adults with abdominal aortic aneurysm or other vascular disease underwent an intravenous infusion of Adenosine in conjunction with initial and delayed planar 201 Tl scans. Images were interpreted qualitatively and quantitatively by the consensus of two or more experienced observers with patients showing transient left ventricular dilatation or redistribution in one or more myocardial segments reported as being at high risk of peri‐operative cardiac events. Of the 50 subjects studied, 49 tolerated the maximum infusion dose with 60% experiencing minor transient symptoms. Low ( n = 30) and high risk ( n = 20) patients were defined according to Adenosine 201 Tl scans. Age, gender and clinical characteristics were similar in both groups. Thirteen (65%) high risk subjects had coronary angiography compared with only three (10%) low risk patients. Patients with high‐risk 201 TI scans were also more likely to proceed to coronary revascularization prior to non‐cardiac surgery [5/20 (25%) vs 1/30 (3%)]. The positive predictive value of high risk 201 Tl scans for coronary artery disease was 85%. Thus, Adenosine is considered a useful and safe alternative to Dipyridamole. In conjunction with 201 Tl scintigraphy Adenosine has the potential to modify management of patients prior to elective non‐cardiac surgery and may reduce adverse peri‐operative cardiac events.