RESUMEN
The purpose of this study was to assess the ability of isoproterenol (IPNA) to provoke chest pain, electrocardiographic (ECG) changes and transient defects on thallium 201 myocardial scintigraphy for coronary artery disease (CAD) diagnosis. Thirty patients without prior myocardial infarction who underwent coronary angiography were included. Significant stenosis was found in 15 and absent in the other 15. The most relevant clinical and ECG data were observed in the few minutes that followed IPNA perfusion: 1) angina pectoris occurred in ten patients of whom eight had CAD (sensitivity: 53 p. cent + 13 p. cent; specificity: 87 p. cent + 9 p. cent); 2) ST segment depression was observed in 11 CAD and 3 non-CAD patients (sensitivity: 73 p. cent + 11 p. cent; specificity: 30 p. cent + 10 p. cent); 3) reversible perfusion defects on planar myocardial thallium 201 scintigrams occurred in 16 patients of whom 13 had CAD. Thallium scintigraphy sensitivity was 87 p. cent + 9 p. cent and specificity was 80 p. cent + 10 p. cent. The combined interpretation and stochastic sequential analysis of two or three presumed independent criteria increased significantly the diagnostic value of the test. We conclude that the isoproterenol test is a safe and reliable method to provoke myocardial ischemia with clinical, ECG and myocardial scintigraphic expression. It has an information content nearly identical to exercise stress test for CAD detection. Because it allows a three step sequential probability analysis, the diagnosis is more reliable than with other pharmacological tests which apply only to scintigraphy.
Asunto(s)
Enfermedad Coronaria/diagnóstico , Corazón/diagnóstico por imagen , Isoproterenol , Adulto , Anciano , Angiografía Coronaria , Enfermedad Coronaria/inducido químicamente , Enfermedad Coronaria/diagnóstico por imagen , Electrocardiografía , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Cintigrafía , Radioisótopos de TalioRESUMEN
Isotopic phlebography with microspheres containing 99 mTc aggregated human albumin is a simple and easily reproducible means of controlling the results of venous surgery of the lower limb and ilio-caval confluent. A comparison in 34 cases with the results obtained by conventional contrast phlebography showed close correlation between the two methods. However, since the images are not as sharp as with contrast phlebography, isotopic phlebography cannot be used for planning procedures prior to reconstructive venous surgery and should be reserved to post-operative control.