Left ventricular dilatation and pulmonary thallium uptake after single-photon emission computer tomography using thallium-201 during adenosine-induced coronary hyperemia

      This paper is only available as a PDF. To read, Please Download here.


      This study examined the implications of left ventricular (LV) dilatation and increased pulmonary thallium uptake during adenosine-induced coronary hyperemia. The lung-to-heart thallium ratio in the initial images was significantly higher in patients with coronary artery disease (CAD) than normal subjects; 0.48 ± 0.16 in 3-vessel disease (n = 16), 0.43 ± 0.10 in 2-vessel disease (n = 20), 0.43 ± 0.08 in 1-vessel disease (n = 16) and 0.36 ± 0.05 in normal subjects (n = 7) (p < 0.001, 0.09 and 0.06, respectively). There was a significant correlation between the severity and the extent of the perfusion abnormality (determined from the polar maps) and the lung-to-heart thallium ratio (r = 0.51 and 0.52, respectively, p < 0.0002). There was also a significant correlation between lung thallium washout and lung-to-heart thallium ratio (r = 0.42, p = 0.0009) and peak heart rate (r = -0.49, p < 0.0001). The LV dilatation was mostly due to an increase in cavity dimension (30% increase) and to a lesser extent (6% increase) due to increase in LV size. (The cavity dimensions were measured from the short-axis slices at the midventricular level in the initial and delayed images.) The dilation was seen in patients with CAD but not in the normal subjects. These changes correlated with the extent and severity of the thallium perfusion abnormality. Thus, adenosine-induced coronary hyperemia may cause LV dilation and increased lung thallium uptake on the basis of subendocardial ischemia.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Iskandrian AS
        • Heo J
        • Askenase A
        • Segal BL
        • Auerbach N
        Dipyridamole cardiac imaging.
        Am Heart J. 1988; 115: 432-443
        • Leppo JA
        • Boucher CA
        • Okada RD
        • Newell JB
        • Strauss WH
        • Pohost GM
        Serial thallium-201 myocardial imaging after dipyridamole infusion: diagnostic utility in detecting coronary stenosis and relationship to regional wall motion.
        Circulation. 1982; 66: 649-656
        • Boucher CA
        • Brewster DE
        • 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; 312: 389-394
        • Brown KA
        • O'Meara J
        • Chambers CE
        • Plante DA
        Ability of dipyridamole thallium-201 imaging one to four days after acute myocardial infarction to predict in-hospital and late recurrent myocardial ischemia events.
        Am J Cardiol. 1990; 65: 160-162
      1. Nguyen T, Heo J, Ogilby D, Iskandrian AS. Single-photon emission computed tomography with thallium-201 during adenosine-induced coronary hyperemia: correlation with coronary arteriography, exercise thallium imaging, and two-dimensional echocardiography. J Am Coll Cardiol, in press.

        • Siffring PA
        • Gupta NC
        • Mohiuddin SM
        • Esterbrooks DJ
        • Hilleman DE
        • Cheng SC
        • Sketch MM
        • Frick MP
        Myocardial uptake and clearance of thallium-201 in healthy subjects: comparison of adenosine-induced hyperemia and exercise stress.
        Radiology. 1989; 173: 769-774
        • Homma S
        • Kaul S
        • Boucher CA
        Correlates of lung/heart ratio of thallium-201 in coronary artery disease.
        J Nucl Med. 1987; 28: 1531-1535
        • Kushner FG
        • Okada RD
        • Kirshenbaum HD
        • Boucher CA
        • Strauss HW
        • Pohost GM
        Lung thallium-201 uptake after stress testing in patients with coronary artery disease.
        Circulation. 1981; 63: 341-342
        • Kahn JK
        • Carry MM
        • McGhie I
        • Pippin JJ
        • Akers MS
        • Corbett JR
        Quantitation of post exercise lung thallium-201 uptake during single photon emission computed tomography.
        J Nucl Med. 1989; 30: 288-294
        • Bingham JB
        • McKusick KA
        • Strauss HW
        • Boucher CA
        • Pohost GM
        Influence of coronary artery disease on pulmonary uptake of thallium-201.
        Am J Cardiol. 1980; 46: 821-826
        • Weiss AT
        • Berman DS
        • Lew AS
        • Nielsen J
        • Potkin B
        • Swan HJC
        • Waxman A
        • Maddahi J
        Transient ischemic dilation of the left ventricle on stress thallium-201 scintigraphy: a marker of severe and extensive coronary artery disease.
        J Am Coll Cardiol. 1987; 9: 752-759
        • Iskandrian AS
        • Heo J
        • Kong B
        • Lyons E
        Effects of exercise level on the ability of thallium-201 tomographic imaging in detecting coronary artery disease: analysis of 461 patients.
        J Am Coll Cardiol. 1989; 14: 1477-1486
        • Garcia EV
        • VanTrain K
        • Maddahi V
        • Prigent F
        • Friedman J
        • Areeda J
        • Wasman A
        • Berman DS
        Quantification of rotational thallium-201 myocardial tomography.
        J Nucl Med. 1985; 26: 17-26
        • Iskandrian AS
        • Heo J
        Myocardial ischemia during pharmacologic coronary vasodilation: a concept in search of definition.
        Cath and Cardiovasc Diag. 1989; 18: 65-66
        • Demer L
        • Gould KL
        • Kirkeeide R
        Assessing stenosis severity: coronary flow reserve, collateral, functional, quantitative coronary arteriography, positron imaging, and digital subtraction angiography: a review and analysis.
        Prog Cardiovasc Disease. 1988; 30: 307-322
        • Picano E
        • Simaneti I
        • Carpeggiani C
        • Lattanzi F
        • Macerata A
        • Trivella MG
        • Marzilli M
        • L'Abbate A
        Regional and globular bi-ventricular function during dipyridamole stress testing.
        Am J Cardiol. 1989; 63: 429-432
        • Picano E
        • Parodi O
        • Lattanzi F
        • Sambuceti G
        • Masini M
        • Marrullo P
        • Distante A
        • L'Abbate A
        Comparison of dipyridamole-echocardiography test and exercise thallium-201 scanning for diagnosis of coronary artery disease.
        Am J Noninuas Cardiol. 1989; 3: 85-92
        • Iskandrian AS
        • Hakki AH
        • DePace NL
        • Manno B
        • Segal BL
        Evaluation of left ventricular function by radionuclide angiography during exercise in normal subjects and in patients with coronary artery disease.
        J Am Coll Cardiol. 1973; 1: 1518-1528
        • Nordrehaug JE
        • Danielsen R
        • ViK-Mo H
        Effect of heart rate on myocardial thallium-201 uptake and clearance.
        J Nucl Med. 1989; 30: 1972-1976