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Atrial Pacing with Two-Dimensional Echocardiography for Evaluation of Chest Pain: Comparison with Thallium 201 Scintigraphy

Department of Cardiology, St. Louis Veterans Administration Medical Center, and St. Louis University, St. Louis, Missouri

Denise L. Janosik

Department of Cardiology, St. Louis Veterans Administration Medical Center, and St. Louis University, St. Louis, Missouri

Leslie E. Mezei

Department of Cardiology, St. Louis Veterans Administration Medical Center, and St. Louis University, St. Louis, Missouri

Alexander L. Mark

Department of Cardiology, St. Louis Veterans Administration Medical Center, and St. Louis University, St. Louis, Missouri

George A. Williams

Department of Cardiology, St. Louis Veterans Administration Medical Center, and St. Louis University, St. Louis, Missouri

Atrial pacing was performed with two-dimensional (2-D) echocardiography and thallium 201 scintigraphy in 40 men with stable chest pain. Coronary an giography showed significant (one or more lesions 50%) coronary artery dis ease (CAD) in 36 patients and no or insignificant CAD in 4. Two dimensional echocardiography showed a left ventricular wall motion abnormality (WMA) either at rest or with pacing in 28 (78%) patients with CAD, with 17 (47%) show ing a new or worsened WMA with pacing. A thallium scan showing abnormali ty (reversible or fixed perfusion defect) was seen in 26 (72%) patients with CAD; 18 (50%) had a reversible defect. In all, 34 of the 36 patients with CAD (94%) had a WMA, a perfusion defect, or both (specificity 50%). Occurrence of both a WMA and a perfusion defect in individual segments ranged from 10 of 25 pa tients with septal abnormalities to 0 of 12 with abnormalities of the lateral seg ment. Sensitivity of 2-D echocardiography for identifying CAD in specific vessels was 81% for the left anterior descending (LAD) artery, 30% for the right coro nary artery, and 20% for the circumflex artery (both p < .001 compared with the LAD artery). Corresponding sensitivities for thallium 201 imaging were 54% (p<.05 compared with 2-D echocardiography), 27%, and 8% (both p<.05 com pared with the LAD artery). When combined with atrial pacing, 2-D echocar diography and thallium 201 perfusion imaging are of similar value for diagnos ing the presence of CAD in patients with stable chest pain. Two-dimensional echocardiography is superior to thallium 201 imaging for identifying the presence of significant CAD in the LAD artery, but both tests are limited in their ability to detect lesions of the right coronary or circumflex arteries

Angiology, Vol. 42, No. 11, 855-865 (1991)
DOI: 10.1177/000331979104201101


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