Report an error   

HERDIN Record #: PCHRD13080111274389 Submitted: 01 August 2013 Modified: 01 August 2013

Myocardial perfusion scintigraphy: utilization patterns and impact on patient management at the Philippine Heart Center.

JM Obaldo,
JF Torres,
AO Martinez,
TM Bolotaulo-Sadava

See More

The clinical use of SPECT myocardial perfusion scintigraphy in 101 patients referred to the nuclear medicine department of a tertiary care hospital was evaluated. The most common indications for requesting the test were for assessment of myocardial viability after infarction, determination of the size of the infarcted or ischemic area, and confirmation of the presence or absence of suspected coronary artery diseases (CAD). Using the chest symptoms and demographic data to calculate pretest likelihood for CAD, it was determined that 10 had high probability, 34 had intermediate probability and 8 had low probability for the disease. The rest (49 patients) had proven CAD. The test result contributed to a modest degree of stratification into the extreme of CAD likelihood. There was a change in the decision to catheterize in 17 of 101 patients, planned catheterization being reduced by 25% (16/64) as a result of the scan findings. A normal scan had greater impact however, with the perceived need for catheterization going down by 80%. A change in whether to proceed with surgical procedures (angioplasty or bypass) or not was also noted in 17 patients. Finally, the results contributed to a change in medical management in 29 patients. Our data indicate that perfusion scanning is usde more often for the functional information it gives, rather than simply for CAD detection, and has substantial impact on subsequent clinical decision - making.

Publication Type
Publication Sub Type
Journal Article, Original
The Nucleus: Journal of the Radioisotope Society of the Philippines
Publication Date
LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Box No. 77 Fulltext Print Format
1. Bailey, IK , Griffith, LSC , Rouleau, J . "Thallium-201 myocardial perfusion imaging at rest and during exercise. Comparative sensitivity to electrocardiography in coronary artery disease" Circulation 55, 79-87, 1977
2. Botvinick, EH , Taradash, MR , Shames, DM . "Thallium-201 myocardial perfusion scintigraphy for the clinical clarification of normal, abnormal and equivocal electrocardiographic stress tests" Am J Cardiol 41, 43-51, 1978
3. Come, RA , Gotsman, MS , Weiss, A . "Thallium-201 scintigraphy in diagnosis of coronary stenosis" Br Heart J 41, 575-83, 1979
4. Diamond, GA . "A clinically relevant classificationof chest discomfort" J Am Coll Cardiol 1(2): 574-5, 1983
5. Diamond, GA , Forrester, JS . "Analysis of probability as an aid in the clinical diagnosis of coronary artery disease" N Engl J Med 300, 1350-58, 1979
6. Diamond, GA , Forrester, JS . "Probability of CAD" Circulation 65, 641-2, 1982
7. Diamond, GA , Forrester, JS , Hirsch, M . "Application of conditional probability analysis to the clinical diagnosis of coronary artery disease" J Clin Invest 65, 1210-21, 1980
8. Garcia, EV , Van Train, K , Maddahi, J . "Quantification of rotational thallium-201 myocardial tomography" J Nucl Med 26, 17-26, 1985
9. Gitler, BM , Fishbach, M , Steingart, RM . "Use of electrocardiographic-thallium exercise testing in clinical practice" J Am Coll Cardiol 3, 262-7, 1980
10. Goldman, L , Feinstein, AR , Batsford, WP . "Ordering patterns and clinical impact of cardiovascular nuclear medicine procedure" 62, 680-7, 1980
11. Gould, KL , Westcott, RJ , Albro, PC . "Noninvasive assessments of coronary stenosis by myocardial imaging during pharmacologic vasodilatation: II. Clinical methodology and feasibility" Am J Cardiol 41, 279-287, 1978
12. Lebowitz, E , Green, MW , Fairchild, R . "Thallium-201 for medical use I." J Nucl Med 16, 151-5, 1975
13. Leppo, JA . "Dipyridamole-thallium imaging: The lazy man's tress test" J Nucl Med 30, 281-7, 1989
14. Maddahi, J , Garcia, EV , Berman, DS . "Improved noninvasive assessment of coronary artery disease by quantitative analysis of regional stress myocardial distribution and washout of thallium-201" Circulation 64, 924-35, 1981
15. Van Train, K , Maddahi, J , Prigent, F . "Quantification of T1-20 myocardial single-photon emission computerized rotation tomography: development, validation and prospective application of an optimized computerized method" J Nucl Med 27, 899, 1986
16. Mahmarian, JJ , Boyce, TM , Goldberg, RK . "Quantitative exercise thallium-201 single photon emission computed tomography for the enhanced diagnosis of ischemic heart disease" J Am Coll Cardiol 15, 319-29, 1990
17. McCarthy, DM , Blood, DK , Sciaca, RR . "Single dose myocardial perfusion imaging with thallium-20: Application in patienst nondiagnostic electrocardiographic stress tests" Am J cardiol 43, 899-906, 1979
18. Ritchies, JL , Zaret, BL , Strauss, HW . "Myocardial imaging with thallium-201: A multicenter study in patients with angina pectoris or acute myocardial infarction" Am J Cardiol 42, 345, 1978
19. Ritchie, JL , Trobaugh, GB , Hamilton, GW . "Myocardial imaging with thallium-201 at rest and during exercise: Comparison with coronary arteriography and resting and stress electrocardiography" Circulation 56, 66-71, 1977
20. Rocco, RP , Dilsizian, V , Strauss, HW . "Technetium 99m-isonitrile myocardial uptake at rest. II Relation to clinical markers of potnetial viability" J Am Coll Cardiol 14, 1678-84, 1989
21. "Siemens Grammasonics, Inc. Operating Instructions: Cedars-Sinai Quantitative Tomographic Thallium-201 Analysis for MicroDELTA" , 1989
22. Steinberg, EP , Klag, MH , Bakal, CW . "Exercise thallium scans: Patterns of use and impact on management of patients with known or suspected coronary disease" Am J Cardiol 59, 50-55, 1987
23. Steingart, RM , Wassertheil-Smoller, S , Tobin, JN . "Nuclear exercise testing and the management of coronary artery disease" J Nucl Med 32, 753-758, 1991
24. Strauss, WM , Pitt, B . "Evaluation of cardiac function and structure with radioactive tracer techniques" Circulation 57, 645-52, 1978
25. Wassertheil-Smoller, S , Steingart, RM , Wexler, JP . "Nuclear Scans: A clinical decision making tool that reduces the need for cardiac catheterization" J Chronic Dis 40, 385-397,