Diagnostic value for coronary artery disease of chest pain during dipyridamole-thallium stress testing

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      Intravenous dipyridamole with thallium imaging permits stress testing for coronary artery disease (CAD) without exercise. Chest pain may occur with dipyridamole-thallium testing, but its diagnostic significance is uncertain. Forty-five patients who had coronary angiography, no revascularization and chest pain during dipyridamole-thallium testing were identified. These patients were matched blindly by sex and age to 45 patients who had coronary angiography, no revascularization and no chest pain reported during the dipyridamole-thallium test. In the groups with versus without chest pain, 9 versus 24% had no CAD, 16 versus 16% had 1-vessel disease, 38 versus 29% had 2-vessel CAD and 38 versus 29% had 3-vessel CAD. These differences did not achieve statistical significance. Also, there were no evident differences in the severity of angiographie CAD by vessel or by percent of stenosis (p > 0.50). There was only a moderate association with ischemic ST changes (40 versus 16%, p < 0.02). Chest pain with concurrent ischemic ST changes also failed to predict any difference in distribution or severity of angiographic stenoses. We conclude that chest pain during dipyridamole-thallium testing is not closely related to the severity of CAD and has little diagnostic value.
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        • Bartel AG
        • Behar VS
        • Peter RH
        • Orgain ES
        • Kong Y
        Graded exercise stress tests in angiographically documented coronary artery disease.
        Circulation. 1974; 49: 348-353
        • Ascoop CA
        • Simoons ML
        • Egmond WG
        • Bruschke AUG
        Exercise test, history, and serum lipid levels in patients with chest pain and normal electrocardiogram at rest: Comparison to findings at coronary arteriography.
        Am Heart J. 1971; 82: 609-617
        • Blackburn H
        The exercise electrocardiogram in diagnosis.
        Cardiology. 1977; 62: 190-205
        • Young DZ
        • Guiney TE
        • McKusick KA
        • Okada RD
        • Strauss W
        • Boucher CA
        Unmasking potential myocardial ischemia with dipyridamole thallium imaging in patients with normal submaximal exercise thallium tests.
        Am J Noninvasive Cardiol. 1987; 1: 11-14
        • Gould KL
        Noninvasive assessment of coronary stenoses by myocardial perfusion imaging during pharmacologie coronary vasodilation I. Physiologic basis and experimental validation.
        Am J Cardiol. 1978; 41: 267-276
        • Gould KL
        Noninvasive assessment of coronary stenoses by myocardial perfusion imaging during pharmacologic coronary vasodilation II. Clinical methodology and feasibility.
        Am J Cardiol. 1978; 41: 279-287
        • Josephson MA
        • Brown BG
        • Hecht HS
        • Hopkins J
        • Pierce CD
        • Petersen RB
        Noninvasive detection and localization of coronary stenoses in patients: comparison of resting dipyridamole and exercise thallium-201 myocardial perfusion imaging.
        Am Heart J. 1982; 102: 1008-1018
        • Leppo J
        • Boucher CA
        • Okada RD
        • Newell JB
        • Strauss HW
        • Pohost GM
        Serial thallium-201 myocardial imaging after dipyridamole infusion: diagnostic utility in detecting coronary stenoses and relationship to regional wall motion.
        Circulation. 1982; 66: 649-657
        • Leppo JA
        • O'Brian J
        • Rothendler JA
        • Getchell JD
        • Lee VW
        Dipyridamole-thallium-201 scintigraphy in the prediction of future cardiac events after acute myocardial infarction.
        N Engl J Med. 1985; 310: 1014-1018
        • Boucher CA
        • Brewster DC
        • Darling RC
        • Okada RD
        • Strauss HW
        • Pohost GM
        Determination of cardiac risk by dipyridamole-thallium imaging before peripheral vascular surgery.
        N Engl J Med. 1985; 12: 389-394
        • Homma S
        • Gilliland Y
        • Guiney TE
        • Strauss HW
        • Boucher CA
        Safety of intravenous dipyridamole for stress testing with thallium imaging.
        Am J Cardiol. 1987; 59: 152-154
        • Diamond GA
        • Forrester JS
        Analysis of probability as an aid in the clinical diagnosis of coronary artery disease.
        N Engl J Med. 1979; 300: 1350-1358
        • Cole JP
        • Ellestad MH
        Significance of chest pain during treadmill exercise: correlation with coronary events.
        Am J Cardiol. 1978; 41: 227-232
        • Peisman S
        • Berman DS
        • Maddahi J
        • Swan HJC
        Silent myocardial ischemia during treadmill exercise: thallium scintgraphic and angiographic correlates (abstr).
        JACC. 1985; 5: 406
        • Ouyang P
        • Shaprio EP
        • Chandra NC
        • Gottlieb SH
        • Chew PH
        • Gottlieb SO
        An angiographic and functional comparison of patients with silent and symptomatic treadmill ischemia early after myocardial infraction.
        Am J Cardiol. 1987; 59: 730-734
        • Weiner DA
        • Ryan TJ
        • McCabe CH
        • Luk S
        • Chaitman BR
        • Sheffield LT
        • Tristani F
        • Fisher LD
        Significance of silent myocardial ischemia during exercise testing in patients with coronary artery disease.
        Am J Cardiol. 1987; 59: 725-729
        • Cohn PF
        Silent myocardial ischemia in patients with a defective anginal warning system.
        Am J Cardiol. 1980; 45: 697-702
        • Droste C
        • Roskamm H
        Experimental pain measurements in patients with asymptomatic ischemia.
        JACC. 1983; 1: 950-955