Detection of multivessel disease in patients with sustained myocardial infarction by thallium 201 myocardial scintigraphy: no additional value of quantitative analysis.

Abstract

This study was performed to determine the value of visual and quantitative thallium 201 scintigraphy for the detection of multivessel disease in 67 patients with a sustained transmural myocardial infarction. Also the viability of the myocardial regions corresponding to pathologic Q-waves was evaluated. Of the 67 patients, 51 patients had multivessel coronary artery disease (76%). The sensitivity of the exercise test was 53%, of thallium scintigraphy 69%, when interpreted visually, and 67%, when analysed quantitatively. The specificity of these methods was 69%, 56%, and 50%, respectively. Sixty-two infarct-related flow regions were detected by visual analysis of the thallium scans, total redistribution was observed in 11/62 (18%) of patients, partial redistribution in 26/62 (42%), and no redistribution in 25/62 (40%) of patients. The infarct-related areas with total redistribution on the thallium scintigrams were more likely to be associated with normal or hypokinetic wall motion (7/11: 64%) than the areas with a persistent defect (7/25:28%) (P = 0.05), which were more related with akinetic or dyskinetic wall motion. Based on our results, it is concluded that 1) both visual and quantitative analysis of thallium exercise scintigraphy have limited value to predict the presence or absence of multivessel coronary artery disease in patients with sustained myocardial infarction, and 2) exercise-induced thallium redistribution may occur within the infarct zone, suggesting the presence of viable but jeopardized myocardium in presumed fibrotic myocardial areas.