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Thallium-201 myocardial perfusion scintigraphy for the clinical clarification of normal, abnormal and equivocal electrocardiographic stress tests

  • Elias H. Botvinick
    Correspondence
    Address for reprints: Elias H. Botvinick, MD, Department of Medicine, 1186 Moffitt Hospital, University of California, San Francisco, California 94143.
    Footnotes
    Affiliations
    From the Cardiovascular Division of the Department of Medicine and the Nuclear Medicine Division of the Department of Radiology, and the Cardiovascular Research Institute, University of California, San Francisco, California USA
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  • Michael R. Taradash
    Affiliations
    From the Cardiovascular Division of the Department of Medicine and the Nuclear Medicine Division of the Department of Radiology, and the Cardiovascular Research Institute, University of California, San Francisco, California USA
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  • David M. Shames
    Footnotes
    Affiliations
    From the Cardiovascular Division of the Department of Medicine and the Nuclear Medicine Division of the Department of Radiology, and the Cardiovascular Research Institute, University of California, San Francisco, California USA
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  • William W. Parmley
    Affiliations
    From the Cardiovascular Division of the Department of Medicine and the Nuclear Medicine Division of the Department of Radiology, and the Cardiovascular Research Institute, University of California, San Francisco, California USA
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  • Author Footnotes
    ∗ Recipient of a Grant-in-Aid from the Bay Area Heart Research Committee, San Francisco, California and a Grant-in-Aid from Smith Capital Management, San Francisco, California.
    † Recipient of a Research Career Development Award (GM-70304) from the National Institute of General Medical Science, National Institutes of Health, Bethesda, Maryland.
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      Abstract

      Sixty-five patients were studied with stress electrocardiography and thallium-201 relative myocardial perfusion scintigraphy. Results were correlated with selective coronary angiography. Scintigraphy was more sensitive (85 versus 67 percent), more specific (89 versus 63 percent) and significantly more accurate (87 versus 65 percent) than stress electrocardiography for the diagnosis of significant coronary arterial lesions in patients with isoelectric S-T segments at rest. Stress scintigraphy helped clarify the equivocal stress test due to left bundle branch block, left ventricular hypertrophy, drugs, hyperventilation and other conditions and was more accurate than the stress electrocardiogram (89 versus 53 percent) even in the presence of a depressed S-T segment at rest. Thallium-201 scintigraphy is a safe and simple noninvasive method for identifying abnormal myocardial perfusion, stress-induced ischemia and, indirectly, significant coronary arterial lesions.
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