Assessment of the presence and extent of coronary artery disease in postmenopausal women after an episode of unstable coronary artery disease: incremental value of exercise electrocardiography and thallium-201 SPECT
(English)Manuscript (preprint) (Other academic)
Aims To compare the incremental diagnostic properties of Thallium-201 (201TI) SPECT perfusion imaging with clinical and exercise test variables in a female population with a suspected high prevalence of coronary artery disease.
Methods and Results We prospectively studied 121 postmenopausal women admitted to the coronary care unit with symptoms of unstable coronary artery disease and ECG changes suggestive of ischaemia. Incremental diagnostic logistic algorithms were developed. These included pretest variables (age; body mass index; previous myocardial infarction; myocardial markers at inclusion and type of anginal symptoms); exercise test (maximum workload; occurrence of ST-depression ≥ 0.1mV and peak heart rate); and 201TI scintigram (extent of thallium uptake abnormalities during exercise and presence of reversibility). End points were presence of coronary artery disease (250% diameter stenosis) and extent ('severe coronary artery disease' defined as left main, three vessel disease and two vessel disease involving proximal left anterior descending). Diagnostic accuracy and incremental value were assessed by receiver operating characteristic curve analysis. Incremental curve areas for disease presence were pretest 0.76 ±0.04, post-exercise ECG 0.83 ±0.04 (p<0.02 for the increment), and post-thallium scintigraphy 0.89 ±0.03 (p<0.02) and for disease extent were pretest 0.82 ±0.04, post-exercise ECG 0.89 ±0.03 (p<0.01 for the increment), and post thallium scintigraphy 0.92 ±0.02 (p = ns).
Conclusion In postmenopausal women, stable after an episode of unstable coronary artery disease, there is an incremental value of adding 201TI SPECT to clinical parameters and exercise testing in the determination of coronary artery disease. In women with severe coronary artery disease there was no significant additive value of myocardial scintigraphy.
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-79932OAI: oai:DiVA.org:liu-79932DiVA: diva2:544729