Effect of the degree of effort on the sensitivity of the exercise thallium-201 stress test in symptomatic coronary artery disease

Lidiette Esquivel, Stewart G. Pollock, George A. Beller, Robert S. Gibson, Denny D. Watson, Sanjiv Kaul

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

The sensitivity of ST-segment depression on the electrocardiogram during exercise is influenced by the level of effort. Whether such is the case with thallium-201 imaging (initial defect or redistribution) has not been established. Accordingly, the prevalence of these parameters was evaluated in 288 patients (age 59 ± 10 years, 88% men) with coronary artery disease who underwent both exercise thallium-201 imaging and coronary anglography within 3 months of each other: 159 had a prior myocardial infarction, 72 had 1-vessel, and 216 had multivessel disease. The degree of effort was evaluated by 3 criteria: (1) percentage of maximal predicted heart rate (≤ 65, > 65 to 85, > 85%); (2) workload during exercise (≤ 4, > 4 to 8, > 8 METs); and (3) duration of exercise (≤ 3, > 3 to 6, > 6 minutes). The prevalence of defects on initial images was higher than both redistribution on delayed images and ST-segment depression on the electrocardiogram (p <0.01). The overall prevalence of initial defects remained the same for all levels of effort and was not influenced by the presence or absence of a prior infarction. However, it decreased in patients with 1-vessel disease who exercised to higher workloads. The prevalence of redistribution on delayed thallium-201 images was higher than that of ST-segment depression on the electrocardiogram (p <0.01), except at higher levels of effort where they were similar. This decrease in the prevalence of redistribution at high levels of effort occurred predominantly in patients with a prior infarction or those with 1-vessel disease. It was concluded that the overall prevalence of abnormal findings on thallium-201 imaging (initial defect and redistribution) is not significantly affected by the degree of effort in patients undergoing symptom-limited exercise testing. Because of the higher yield of these findings compared with ST-segment depression in most patients, thallium-201 imaging should be added to routine exercise stress testing for the detection of coronary artery disease,.

Original languageEnglish (US)
Pages (from-to)160-165
Number of pages6
JournalThe American Journal of Cardiology
Volume63
Issue number3
DOIs
StatePublished - Jan 15 1989
Externally publishedYes

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Thallium
Exercise Test
Coronary Artery Disease
Exercise
Electrocardiography
Workload
Infarction
Heart Rate
Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of the degree of effort on the sensitivity of the exercise thallium-201 stress test in symptomatic coronary artery disease. / Esquivel, Lidiette; Pollock, Stewart G.; Beller, George A.; Gibson, Robert S.; Watson, Denny D.; Kaul, Sanjiv.

In: The American Journal of Cardiology, Vol. 63, No. 3, 15.01.1989, p. 160-165.

Research output: Contribution to journalArticle

Esquivel, Lidiette ; Pollock, Stewart G. ; Beller, George A. ; Gibson, Robert S. ; Watson, Denny D. ; Kaul, Sanjiv. / Effect of the degree of effort on the sensitivity of the exercise thallium-201 stress test in symptomatic coronary artery disease. In: The American Journal of Cardiology. 1989 ; Vol. 63, No. 3. pp. 160-165.
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abstract = "The sensitivity of ST-segment depression on the electrocardiogram during exercise is influenced by the level of effort. Whether such is the case with thallium-201 imaging (initial defect or redistribution) has not been established. Accordingly, the prevalence of these parameters was evaluated in 288 patients (age 59 ± 10 years, 88{\%} men) with coronary artery disease who underwent both exercise thallium-201 imaging and coronary anglography within 3 months of each other: 159 had a prior myocardial infarction, 72 had 1-vessel, and 216 had multivessel disease. The degree of effort was evaluated by 3 criteria: (1) percentage of maximal predicted heart rate (≤ 65, > 65 to 85, > 85{\%}); (2) workload during exercise (≤ 4, > 4 to 8, > 8 METs); and (3) duration of exercise (≤ 3, > 3 to 6, > 6 minutes). The prevalence of defects on initial images was higher than both redistribution on delayed images and ST-segment depression on the electrocardiogram (p <0.01). The overall prevalence of initial defects remained the same for all levels of effort and was not influenced by the presence or absence of a prior infarction. However, it decreased in patients with 1-vessel disease who exercised to higher workloads. The prevalence of redistribution on delayed thallium-201 images was higher than that of ST-segment depression on the electrocardiogram (p <0.01), except at higher levels of effort where they were similar. This decrease in the prevalence of redistribution at high levels of effort occurred predominantly in patients with a prior infarction or those with 1-vessel disease. It was concluded that the overall prevalence of abnormal findings on thallium-201 imaging (initial defect and redistribution) is not significantly affected by the degree of effort in patients undergoing symptom-limited exercise testing. Because of the higher yield of these findings compared with ST-segment depression in most patients, thallium-201 imaging should be added to routine exercise stress testing for the detection of coronary artery disease,.",
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