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CLINICAL STUDIES

Comparison of pulmonary uptake with transient cavity dilation after exercise thallium-201 perfusion imaging

^a Section of Cardiology, Temple University Hospital, Philadelphia, Pennsylvania, USA

Manuscript received August 11, 1998; revised manuscript received November 5, 1998, accepted December 23, 1998.

Reprint requests and correspondence: Dr. Christopher L. Hansen, Section of Cardiology, Temple University Hospital, 3401 North Broad Street, Philadelphia, Pennsylvania 19140

OBJECTIVES

The purpose of the study was to evaluate the relationship between elevated lung/heart ratio (LHR) and transient ischemic dilation (TID) after stress thallium-201 myocardial perfusion imaging and to provide further insight into the mechanism of cavity dilation.

BACKGROUND

Because both LHR and TID have been identified as adjunctive markers of severe coronary disease they should be found in the same patients. Although the mechanism of LHR has been defined, that of transient dilation has not.

METHODS

We identified 4,618 consecutive patients undergoing maximal exercise perfusion imaging with thallium-201. Lung/heart ratio and a dilation index were derived and compared to each other and to relevant clinical parameters.

RESULTS

There was a very weak relationship between the LHR and dilation index (r = 0.15, p < 0.001). Defining a dilation index 1.10 and LHR 50% as abnormal revealed that 322 of the patients (7%) had TID only, 351 (7.8%) had LHR only and 40 (0.9%) had both. When compared to patients without these findings both TID and LHR had higher thallium stress defect and redistribution scores. When comparing subjects who had elevated LHR uptake to those who had TID, it was found that those with LHR were more likely to have had prior myocardial infarction (MI) (29% vs. 9%), coronary artery bypass grafting (22% vs. 8%), lower ejection fraction (34 ± 17% vs. 55 ± 11%) and had more evidence of ischemia based on thallium stress defect and redistribution scores. However, patients with cavity dilation had a higher frequency of positive electrocardiographic response (31% vs. 19%) despite lower scintigraphic markers.

CONCLUSIONS

Although pulmonary uptake and transient cavity dilation have both been associated with severe coronary disease, they have a very weak correlation, which, in combination with the different clinical parameters associated with each, suggests that they represent different pathophysiologic responses to exercise-induced ischemia. Our data support the hypothesis that TID represents transient subendocardial ischemia rather than physical dilation from increased end-diastolic pressure.

Abbreviations and Acronyms   ANOVA = analysis of variance   CABG = coronary artery bypass grafting   CAD = coronary artery disease   CK = creatine kinase   ECG = electrocardiogram   LHR = lung/heart ratio   MI = myocardial infarction   SPECT = single-photon emission computed tomography   TID = transient ischemic dilation   Tl-201 = thallium-201

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