TY - JOUR
T1 - Thallium-201 myocardial perfusion imaging in aortic valve stenosis
AU - Bailey, Ian K.
AU - Come, Patricia C.
AU - Kelly, David T.
AU - Burow, Robert D.
AU - Griffith, Lawrence S.C.
AU - Strauss, H. William
AU - PittMD, Bertram
N1 - Funding Information:
From the Cardiovascular Division, Department of Medicine, The Johns Hopkins University and Johns Hopkins Hospital, Baltimore, Maryland. This study was supported by the Specialized Center of Research for Ischemic Heart Disease, Grant P 50 HL 17655-03 with the National Institutes of Health and Department of Health, Education, and Welfare, Bethesda, Maryland . Manuscript received March 4, 1977 ; revised manuscript received June 13, 1977, accepted June 14, 1977 . Clinical Research Fellow supported by Postgraduate Committee in Medicine, University of Sydney, New South Wales, Australia. I Clayton Scholar of The Johns Hopkins University, Baltimore, Maryland . Address for reprints : Bertram Pitt, MD, Department of Medicine, Cardiovascular Division, The University of Michigan School of Medicine, Ann Arbor, Michigan 48109 .
PY - 1977/12
Y1 - 1977/12
N2 - The clinical utility of thallium-201 myocardial perfusion imaging in aortic valve stenosis was evaluated at rest and after exercise in three groups of patients: (1) 20 normal subjects, (2) 11 patients with aortic valve stenosis and coronary artery disease (70 percent or greater narrowing of luminal diameter), 11 patients with aortic valve stenosis without coronary artery disease (30 percent or less narrowing). Seven of the latter 22 patients also had postoperative imaging studies. None of the normal subjects had perfusion abnormalities either at rest or after maximal exercise. Three patients with aortic stenosis and coronary artery disease and one with aortic stenosis alone had focal perfusion defects present at rest suggesting prior myocardial infarction. Five patients with aortic stenosis and coronary artery disease manifested new focal perfusion defects and also a pattern of widespread left ventricular wall "thinning" in the postexercise thallium image suggesting diffuse subendocardial ischemia; three had wall "thinning" alone, and two no change in resting focal defects. Five patients with aortic stenosis without coronary artery disease also manifested focal perfusion defects and wall thinning; one had wall thinning alone, and one a new focal defect alone. Two patients had new resting focal defects after surgery, suggesting perioperative damage, and four patients no longer had either the focal or the diffuse pattern of exercise ischemia seen preoperatively. Thallium-201 imaging is of value in assessing the results of surgery in aortic stenosis. However, the technique does not allow adequate separation of patients with aortic stenosis and coronary artery disease from those with aortic stenosis alone because (1) angiographically significant coronary artery disease may not always produce focal ischemia before diffuse subendocardial ischemia develops, and (2) angiographically insignificant coronary artery disease may become functionally critical in the presence of aortic stenosis and produce focal ischemia.
AB - The clinical utility of thallium-201 myocardial perfusion imaging in aortic valve stenosis was evaluated at rest and after exercise in three groups of patients: (1) 20 normal subjects, (2) 11 patients with aortic valve stenosis and coronary artery disease (70 percent or greater narrowing of luminal diameter), 11 patients with aortic valve stenosis without coronary artery disease (30 percent or less narrowing). Seven of the latter 22 patients also had postoperative imaging studies. None of the normal subjects had perfusion abnormalities either at rest or after maximal exercise. Three patients with aortic stenosis and coronary artery disease and one with aortic stenosis alone had focal perfusion defects present at rest suggesting prior myocardial infarction. Five patients with aortic stenosis and coronary artery disease manifested new focal perfusion defects and also a pattern of widespread left ventricular wall "thinning" in the postexercise thallium image suggesting diffuse subendocardial ischemia; three had wall "thinning" alone, and two no change in resting focal defects. Five patients with aortic stenosis without coronary artery disease also manifested focal perfusion defects and wall thinning; one had wall thinning alone, and one a new focal defect alone. Two patients had new resting focal defects after surgery, suggesting perioperative damage, and four patients no longer had either the focal or the diffuse pattern of exercise ischemia seen preoperatively. Thallium-201 imaging is of value in assessing the results of surgery in aortic stenosis. However, the technique does not allow adequate separation of patients with aortic stenosis and coronary artery disease from those with aortic stenosis alone because (1) angiographically significant coronary artery disease may not always produce focal ischemia before diffuse subendocardial ischemia develops, and (2) angiographically insignificant coronary artery disease may become functionally critical in the presence of aortic stenosis and produce focal ischemia.
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U2 - 10.1016/0002-9149(77)90039-X
DO - 10.1016/0002-9149(77)90039-X
M3 - Article
C2 - 930836
AN - SCOPUS:0017710575
SN - 0002-9149
VL - 40
SP - 889
EP - 899
JO - The American journal of cardiology
JF - The American journal of cardiology
IS - 6
ER -