Abnormal thallium-201 scans in patients with chest pain and angiographically normal coronary arteries

• Published in: The American journal of cardiology Vol. 52; no. 3; pp. 365 - 370
• Main Authors: Berger, Bruce C., Abramowitz, Richard, Park, Chan H., Desai, Anil G., Madsen, Mark T., Chung, Edward K., Brest, Albert N.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.1983
• Subjects: Coronary Disease - diagnostic imaging; False Positive Reactions; Humans; Pain - diagnostic imaging; Physical Exertion; Radionuclide Imaging; Thallium; Thorax - diagnostic imaging
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(83)90140-6

We reviewed the exercise thallium-201 (Tl-201) scans arid clinical data of 41 patients with chest pain and normal coronary arteries to identify clinical factors associated with “false-positive” studies. Exercise Tl-201 studies were performed before angiography and often precipitated referral. Sex, beta-blocker therapy, anginal pattern, and results of exercise electrocardiography were evaluated and compared with Tl-201 imaging. A negative Tl-201 study was the most common finding (p < 0.005). Of the 41 patients, 11 (27%) had abnormal exercise Tl-201 scans. No clinical factor was significantly associated with a false-positive Tl-201 scans. Of the 11 patients with abnormal scans, 9 had ≥1 cardiac abnormality: right bundle branch block in 2, mitral Valve prolapse in 3, paroxysmal atrial fibrillation in 2, abnormal left ventricular diastolic pressure in 3, and left bundle branch block in 1. Thus, (1) when results of exercise Tl-201 imaging are used to refer patients for angiography, “false-positive” Tl-201 studies are common; (2) sex, beta blockade, anginal pattern, and results of exercise electrocardiogram are not useful predictors of a false-positive Tl-201 study; and (3) patients with chest pain, normal coronary arteries, and abnormal Tl-201 scans frequently have other cardiac abnormalities.