A comparison of maximal exercise and dipyridamole thallium-201 planar gated scintigraphy

Abstract

Both symptom-limited maximal exercise and intravenously given dipyridamole stress (0.56 mg/kg over 4 min with a 2 min walk) gated thallium scans were performed in 22 patients undergoing coronary arteriography for the assessment of chest pain. All scans were acquired gated to the electrocardiogram in 3 projections and were reported for the presence and extent of defects in 5 myocardial segments in each view. In addition, left and right ventricular myocardial uptake and estimates of right and left lung and liver to left ventricular uptake were assessed relative to the injected dose of thallium-201. Overall, 190/310 segments were abnormal with exercise compared with 169/310 with dipyridamole. Segments were scored greater in extent in 90/310 cases with exercise, compared with 46/310 in which the defect was more extensive with dipyridamole (P less than 0.0005). Non-attenuation corrected percentage myocardial thallium uptakes were similar for both stresses: anterior percentage uptakes, 0.785% +/- 0.230% with exercise versus 0.870% +/- 0.217% with dipyridamole (NSD). Left and right lung and liver to left ventricle ratios were all significantly higher with dipyridamole than with exercise (1.587 +/- 0.408 versus 1.446 +/- 0.518, P less than 0.02; 1.78 +/- 0.479 versus 1.46 +/- 0.502, P less than 0.002; 2.598 +/- 0.788 versus 1.265 +/- 0.386, P less than 0.001, respectively). High right and left lung uptakes with dipyridamole were strongly correlated with high exercise values (r = 0.756, P less than 0.001; r = 0.809, P less than 0.001). The liver uptake was weakly correlated between the 2 different stress tests (r = 0.483, P less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)