Feldman M D, Warren S E, Gervino E V, Aroesty J M, Royal H D, Parker J A, Silverman K J, Kolodny G M, Zoll P M, McKay R G
Department of Internal Medicine, Charles A. Dana Research Institute, Boston, Massachusetts.
Am J Physiol Imaging. 1988;3(4):172-7.
Improvements in noninvasive external cardiac pacing have led to a technique with reliable electrical capture and tolerable patient discomfort. To assess the use of this modality of pacing in combination with thallium scintigraphy as a noninvasive pacing stress test, we applied simultaneous noninvasive cardiac pacing, hemodynamic monitoring, and thallium-201 scintigraphy in 14 patients undergoing cardiac catheterization for chest pain syndromes. Two patients had normal coronary arteries, while the remaining 12 had significant coronary artery disease. Thallium scintigraphic responses to pacing were compared to routine exercise thallium stress testing in nine of these 14 patients. All patients were noninvasively paced to more than 85% of the age-predicted maximum heart rate. Twelve patients demonstrated reversible thallium defects, which corresponded in 11 cases to significant lesions seen on coronary angiography. Of nine patients who underwent both pacing and exercise thallium stress tests, comparable maximal rate-pressure products were achieved. Moreover, thallium imaging at peak pacing and during delayed views did not differ significantly from exercise thallium scintigraphy. A limiting factor associated with the technique was local patient discomfort, which occurred to some degree in all patients. We conclude that noninvasive external cardiac pacing together with thallium scintigraphy is capable of detecting significant coronary artery disease and may be comparable to routine exercise thallium stress testing. This new modality of stress testing could be useful in patients unable to undergo the exercise required for standard exercise tolerance testing, particularly if improvements in the technology can be found to reduce further the local discomfort.
无创体外心脏起搏技术的改进带来了一种能实现可靠电捕获且患者不适可耐受的技术。为评估这种起搏方式与铊闪烁扫描术联合用于无创起搏负荷试验的情况，我们对14例因胸痛综合征接受心导管检查的患者同时进行了无创心脏起搏、血流动力学监测及铊 - 201闪烁扫描术。2例患者冠状动脉正常，其余12例有明显冠状动脉疾病。在这14例患者中的9例里，将起搏时的铊闪烁扫描反应与常规运动铊负荷试验进行了比较。所有患者均通过无创方式起搏至超过年龄预测最大心率的85%。12例患者显示出可逆性铊缺损，其中11例与冠状动脉造影所见的明显病变相符。在9例同时接受起搏和运动铊负荷试验的患者中，达到了相当的最大心率 - 血压乘积。此外，起搏峰值时及延迟显像时的铊显像与运动铊闪烁扫描术相比无显著差异。与该技术相关的一个限制因素是局部患者不适，所有患者均有不同程度的发生。我们得出结论，无创体外心脏起搏与铊闪烁扫描术联合能够检测出明显的冠状动脉疾病，且可能与常规运动铊负荷试验相当。这种新的负荷试验方式对于无法进行标准运动耐量试验所需运动的患者可能有用，特别是如果能在技术上有所改进以进一步减轻局部不适的话。
