Ong Y S, Quaife M A, Dzindzio B S, Emery J F, Kotlyarov E V, Forker A D
Am J Med. 1980 Jul;69(1):31-8. doi: 10.1016/0002-9343(80)90496-9.
Fifty patients were prospectively evaluated for myocardial ischemia utilizing treadmill testing and thallium-201 imaging. By coronary angiography, 43 had significant coronary stenosis and seven were normal. The sensitivity, specificity, accuracy and predictive value of treadmill testing alone (81 per cent, 71 per cent, 80 per cent and 95 per cent) did not statistically differ from that of thallium-201 imaging (70 per cent, 86 per cent, 72 per cent and 97 per cent). Combined treadmill testing and thallium-201 imaging (84 per cent, 71 per cent, 80 per cent and 98 per cent) did not significantly affect the results of treadmill testing alone. Thallium-201 imaging failed to identify a number of patients with high risk lesions. The high prevalence of disease, the presentation of typical angina, preselection bias, multiple lead monitoring and exclusion of patients with abnormalities on the resting electrocardiogram probably accounted for failure of thallium-201 imaging to improve the results obtained with treadmill testing. The use of thallium-201 imaging in certain subsets of patient (resting electrocardiographic abnormalities, nondiagnostic treadmill testing, atypical chest pain or asymptomatic patients with abnormalities on treadmill testing) may be of value. However, the use of thallium-201 imaging as a routine screening procedure for myocardial ischemia in patients with typical angina, without due consideration of the prevalence of the disease in the population, is not justified.
对50例患者进行了前瞻性评估，采用运动平板试验和铊-201心肌显像来检测心肌缺血情况。通过冠状动脉造影检查，43例患者有明显的冠状动脉狭窄，7例正常。单独运动平板试验的敏感性、特异性、准确性和预测价值（分别为81%、71%、80%和95%）与铊-201心肌显像（分别为70%、86%、72%和97%）在统计学上无显著差异。运动平板试验与铊-201心肌显像联合使用（分别为84%、71%、80%和98%）对单独运动平板试验的结果没有显著影响。铊-201心肌显像未能识别出一些有高危病变的患者。疾病的高患病率、典型心绞痛的表现、预选择偏倚、多导联监测以及对静息心电图异常患者的排除可能是铊-201心肌显像未能改善运动平板试验结果的原因。在某些患者亚组（静息心电图异常、运动平板试验结果不确定、非典型胸痛或运动平板试验异常的无症状患者）中使用铊-201心肌显像可能有价值。然而，在没有充分考虑人群中疾病患病率的情况下，将铊-201心肌显像作为典型心绞痛患者心肌缺血的常规筛查方法是不合理的。
