Thallium-201 myocardial perfusion imaging in aortic valve stenosis

Ian K. Bailey, Patricia C. Come, David T. Kelly, Robert D. Burow, Lawrence S.C. Griffith, H. William Strauss, Bertram PittMD

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Abstract

The clinical utility of thallium-201 myocardial perfusion imaging in aortic valve stenosis was evaluated at rest and after exercise in three groups of patients: (1) 20 normal subjects, (2) 11 patients with aortic valve stenosis and coronary artery disease (70 percent or greater narrowing of luminal diameter), 11 patients with aortic valve stenosis without coronary artery disease (30 percent or less narrowing). Seven of the latter 22 patients also had postoperative imaging studies. None of the normal subjects had perfusion abnormalities either at rest or after maximal exercise. Three patients with aortic stenosis and coronary artery disease and one with aortic stenosis alone had focal perfusion defects present at rest suggesting prior myocardial infarction. Five patients with aortic stenosis and coronary artery disease manifested new focal perfusion defects and also a pattern of widespread left ventricular wall "thinning" in the postexercise thallium image suggesting diffuse subendocardial ischemia; three had wall "thinning" alone, and two no change in resting focal defects. Five patients with aortic stenosis without coronary artery disease also manifested focal perfusion defects and wall thinning; one had wall thinning alone, and one a new focal defect alone. Two patients had new resting focal defects after surgery, suggesting perioperative damage, and four patients no longer had either the focal or the diffuse pattern of exercise ischemia seen preoperatively. Thallium-201 imaging is of value in assessing the results of surgery in aortic stenosis. However, the technique does not allow adequate separation of patients with aortic stenosis and coronary artery disease from those with aortic stenosis alone because (1) angiographically significant coronary artery disease may not always produce focal ischemia before diffuse subendocardial ischemia develops, and (2) angiographically insignificant coronary artery disease may become functionally critical in the presence of aortic stenosis and produce focal ischemia.

Original languageEnglish
Pages (from-to)889-899
Number of pages11
JournalAmerican Journal of Cardiology
Volume40
Issue number6
DOIs
StatePublished - Dec 1977
Externally publishedYes

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