(Circulation. 1996;93:915-923.)
© 1996 American Heart Association, Inc.
Articles |
Exercise Thallium Tomography Predicts Future Clinically Manifest Coronary Heart Disease in a High-Risk Asymptomatic Population
From the Divisions of Cardiology (R.S.B., L.C.B.) and Internal Medicine (J.C.), Department of Medicine and the Center for Health Promotion (D.M.B., T.F.M., L.B.W.), Johns Hopkins University School of Medicine, Baltimore, Md.
Background Exercise testing, even when combined with radionuclide perfusion imaging, does not accurately predict future clinical coronary heart disease (CHD) in low-risk asymptomatic populations. We hypothesized that these tests would perform better in a higher-risk population with a high prevalence of occult CHD. Siblings of persons with premature CHD represent such a group in whom it would be advantageous to identify affected individuals before the occurrence of clinically manifest CHD.
Methods and Results Exercise thallium
scintigraphy was performed in 264
asymptomatic individuals less than 60 years of age who
had a sibling with documented CHD before age 60. Despite an average age
of only 46 years at the time of screening, 19 of the 264 siblings
developed clinical CHD (sudden death in 1, myocardial infarction in 10,
coronary revascularization in 8) over a
mean of 6.2 years (range, 1 to 9 years) of follow-up. Abnormal
thallium scans were observed in 29% of men and 9% of women, while
abnormal exercise ECGs occurred in 12% and 5%, respectively. Of men
45 years of age, 45% had an abnormal exercise ECG, thallium scan, or
both. In contrast, only 3% of women <45 years of age had an abnormal
test result. Although abnormal exercise ECGs and thallium scans were
both predictive of future clinical CHD, the thallium scan was
associated with a higher relative risk. After adjustment for age, sex,
and exercise ECG results, the relative risk of developing clinical CHD
was 4.7 for an abnormal scan. Siblings with a concordant abnormal
exercise ECG and thallium scan had a relative risk of 14.5. These
siblings were all men >45 years of age at the time of screening and
had a strikingly high incidence of clinical CHD (6 of 12, 50%).
Conclusions Exercise thallium scintigraphy appears to be useful in the risk assessment of asymptomatic siblings of patients with premature CHD, particularly in male siblings who are 45 years of age or older.
Key Words: exercise • tests • scintigraphy • coronary disease
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