Transesophageal Atrial Pacing during Scintigraphic Tomography Exams

Value of thallium 201 myocardial scintigraphy under transesophageal atrial stimulation for the diagnosis of coronary disease.

Le Feuvre C; Vacheron A; Metzger JP; Berdah J; Etienne D; Albarede P; De Vernejoul P. Ann Med Interne (Paris) (France), 1991, 142(5) p325-9. Fifty patients hospitalized for chest pain underwent coronary angiography, and thallium-201 myocardial scintigraphy after exercise (TE) and under transesophageal atrial stimulation (TST). The double product mean during exercise was 2,223 +/- 579 beats x cmHg/min and 2,313 +/- 420 beats x cmHg/min under TST (NS). The criterion of positivity was early hypofixation. Thallium redistribution 4 hours after administration is indicative of reversible ischemia. Thirty-six patients had more than 50% narrowing in at least one of the three principle coronary arteries. The predictive sensitivity for coronary stenosis was 83% for TE and 94% for TST. The respective specificities were 71 and 78%. The comparison of segmental hypoperfusion after exercise and under TST gave similar results in 230 of the 250 segments studied (92%). Thus, TST provides and alternative diagnostic method to TE for the detection of coronary artery disease and can be performed in patients for whom the usual stress test is not possible, most particularly when dipyridamole is counter indicated because of a bronchospastic factor.

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