The BSPM display format was as individual and group mean ST segment isointegral contour maps at the various protocol times (Fig 2). Individual (Fig 2 and 3) and group mean (Fig 4 and 5) temporal difference maps also were constructed by subtracting resting maps from maps at cessation of exercise and at 5 min of recovery, respectively. From these subtraction maps the body surface sum of negative change in ST integral values (sum ST decrease) was determined and utilized as the quantitative index of electrocardiographic ischemia for this study (Fig 2 to 5).
Thallium Scintigraphy
In all patients, 1.5 mCi of thallium was injected intravenously at peak exercise and exercise was continued for a further 1 min. Initial thallium scanning was begun within 8 min of cessation of exercise, following removal of the BSPM leads. Images were obtained in the 45° left anterior oblique positiqn, as well as in the anterior and left lateral positions, using an Ohio Nuclear Series 420 scintillation camera and a high sensitivity, parallel hole collimator. Images were continued until 300,000 total counts were recorded in each view. Scanning was repeated in the same fashion 4 h postexercise. buy asthma inhaler

Figure_2

Figure 2. ST segment isointegral maps for the same study subject as illustrated in Figure 1. Each rectangle represents the torso, unrolled. The left half of each map represents the front of the body; the right half, the back. The contour lines join points of equal ST integral value and progress logarithmically. The maxima and minima are numerically identified. In the top four maps, solid lines represent positive ST integral values; dashed lines, negative values. From rest to immediate cessation of exercise, anterior, lateral and inferior ST distributions changed from positive to markedly negative. By 5 min of recovery they had returned toward normal, but there was still an area of ST negatively centered over the precordium. The bottom two maps are temporal subtraction maps in which dashed lines indicate a relative decrease in ST integral values between the respective study times. The torso sum of this decrease in ST integral values was utilized as the quantitative index of electrocardiographic ischemia for this study. In this patient with total occlusion of the left anterior descending coronary artery the sum of ST integral decrease between rest and immediate cessation of exercise was — 9,043 |iV«s, improving to — 6,202 jjlV*s by 5 min of recovery.

Figure_3

Figure 3. Isointegral ST maps of a study subject (patient 35; Tables 1 and 2) with three-vessel CAD.

Figure_4

Figure 4. Croup mean ST isointegral maps for the five study groups (Tables 1 to 3).

Figure_5

Figure 5. Croup mean ST isointegral maps of the component subgroups of CAD patient group 1 (Tables 1 and 2). The maps in the left column are the average ST integral appearances for the 14 patients with isolated left anterior descending CAD; those in the middle column, from four patients with isolated right CAD; and, the maps in the right column, from the five patients with isolated circumflex CAD. There were some spatial differences in ST integral patterns from rest, to exercise, to recovery; however, there was also marked overlap.