Routine exercise stress testing and stress radionuclide angiography are not reliably predictive of ischemia in hypertensive patients, whereas thallium-201 imaging or PET may prove valuable.
Does noninvasive thallium-201 myocardial perfusion imaging accurately diagnose ischemia from obstructive epicardial coronary artery disease in hypertensive patients?
Routine exercise stress testing and stress radionuclide angiography are unreliable for diagnosing ischemia in hypertensive patients, highlighting the need for prospective studies on thallium-201 imaging and PET.
Chest pain is a common complaint among hypertensive patients. Hypertension and coronary heart disease each may present with symptoms and signs that are clinically indistinguishable. Noninvasive testing by routine exercise stress testing and stress radionuclide angiography are not reliably predictive of ischemia resulting from obstructive epicardial coronary artery disease and should be abandoned for that diagnostic purpose. Noninvasive thallium-201 myocardial perfusion imaging for this purpose may prove to be a valuable tool, avoiding the risk and expense of coronary arteriography. However, carefully performed prospective studies are not available. Because of the high prevalence of both diseases, a high priority must be given to obtaining these data and evaluating other noninvasive methods (especially positron emission tomography) if they appear promising.
Prisant et al. (Sun,) conducted a review in Coronary heart disease in hypertensive patients. Noninvasive diagnostic testing (thallium-201 imaging, PET) vs. Routine exercise stress testing and stress radionuclide angiography was evaluated. Routine exercise stress testing and stress radionuclide angiography are not reliably predictive of ischemia in hypertensive patients, whereas thallium-201 imaging or PET may prove valuable.