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Stress Myocardial Perfusion ImagingAka: Radionuclude Perfusion Imaging, Cardiac Radionuclide Imaging, SPECT Myocardial Perfusion Imaging, Myocardial Single-Photon Emission Computed Tomography, Stress Thallium, Stress Cardiolite

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Background
1. Thallium 201 was originally used for imaging
2. Technetium agents replaced Thallium for higher efficacy
Indications
1. Nondiagnostic Stress EKG, Intermediate CAD likelihood
  1. Resting ST-T Wave abnormalities
  2. Left Bundle Branch Block
  3. Ventricular paced rhythm
  4. Left Ventricular Hypertrophy
  5. Digoxin treatment
2. Suspected Acute Coronary Syndrome, nondiagnostic tests
3. CAD Diagnosis, risk stratification, and therapy
  1. Assess ventricular function
  2. Identify lesions in planning for PTCA intervention
  3. Risk stratification prior to noncardiac surgery
Advantages of Stress thallium
1. High sensitivity for ischemia (>90%)
2. Distinguishes baseline wall motion abnormality from CAD
  1. Severe valvular disease
  2. Severe Hypertension
  3. Idiopathic hypertrophic subaortic stenosis (IHSS)
  4. Left Bundle Branch Block
  5. Severe Left Ventricular Hypertrophy
  6. Atrial Fibrillation
3. In above cases angiography may be needed
Efficacy
1. Overall SPECT: 87% Sensitive, 73% Specific
2. Pharmacologic: 89% Sensitive, 75% Specific
3. Symptomatic: >85% Sensitive, >80% Specific
Prognosis
1. Normal perfusion scan: Cardiac event rate <1% per year
2. Factors suggestive of worse prognosis
  1. Increased numbers of involved vascular territories
  2. Increased severity and extent of defect size
  3. Decreased reversibility
  4. Post-stress ejection fraction <45%
  5. End-systolic volume >70 ml
  6. Transient ischemic dilation

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This page was written by Scott Moses, MD. This page was last revised on 4/26/2008 9:08:23 PM. This page was last published on 4/29/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.