Stress echo vs thallium stress test 
Author Message
 Stress echo vs thallium stress test

I understand the actual differences in these tests, but what are the
diagnostic differences? What does one tell you that the other doesn't
and vice versa?


Thu, 15 Mar 2001 03:00:00 GMT
 Stress echo vs thallium stress test

Quote:

> I understand the actual differences in these tests, but what are the
> diagnostic differences? What does one tell you that the other doesn't
> and vice versa?

Well, to make the story simple, the stress echo can determine if any parts of
the heart structures, esp valves and ventricular walls, are functioning
normally/abnormally in the face of physical exercise...sometimes heart
function will be normal at rest but may differ greatly with exercise, which
can help to explain a patient's symptoms (such as breathlessness with walking,
for instance).

the thallium TST is done using a radioisotope which is distributed to the
heart muscle via the coronary arteries and then *tags* the muscle.  Under the
scanner, any areas of heart muscle which did not receive the isotope (ie,
places which did not get sufficient {*filter*} supply due to blockages in coronary
arteries) will show up as *cold* spots on the scan.  

It is entirely conceivable that a person could have a significant blockage on
the thallium test, and still have normal heart function on the echo, and also
conceivable that a person could have impaired exercise function of a valve or
ventricular wall in the face of NO coronary blockages, so each test has its
own particular value.

--
Alvena Ferreira

http://www.***.com/
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Thu, 15 Mar 2001 03:00:00 GMT
 Stress echo vs thallium stress test

Quote:

> I understand the actual differences in these tests, but what are the
> diagnostic differences? What does one tell you that the other doesn't
> and vice versa?

==============

These are religious-wars questions.

There are good studies and meta-studies showing that one or the other
is slightly superior in diagnosing CAD.? It's hard to get an unbiased
opinion, since those who specialize in either technique usually see
the merits of that approach more clearly.?

There have been several comparisons published this year. One in JACC a
couple of months ago favored stress echo; another in a nuclear med
journal clearly showed the superiority of radionuclide scanning.

Stress echo is more operator-dependent, in my opinion.? I believe a
very good stress echo team can produce results equivalent to
thallium/sestamibi scanning. However run-of-the-mill stress echo is
probably less sensitive (more missed cases).?

On the other hand stress echo is cheaper, faster, & possibly less
'invasive' (no needles if exercise alone).?

You get information about left ventricular contractility from stress
echo that you may not get from standard thallium, but with the
addition of gating techniques you obtain good information about LV
function from the latter too.?

As a consumer of tests, I prefer thallium scanning because I get nice
pictures that I can understand and even interpret myself, and can
readily relate the tracer uptake pattern to the apparent anatomic
defects demonstrated on angiogram.? Stress echo as a third party test
is more esoteric -- I just have to rely on the typed report.

David Rollo
Cardiologist, Melbourne Australia



Fri, 16 Mar 2001 03:00:00 GMT
 Stress echo vs thallium stress test
I had an echo-cardiogram post bypass that showed my ejection fraction at 45%
and 55%. A month later, a thallium stress test showed a problem and a
subsequent cath showed an ejection fraction of 20%. Today I'm waiting for a
transplant. I wouldn't trust an echo because it is dependent on the operator
and the reader and the reader's eyeball. From my experience,  the echo isn't
worth the  money except for quick diagnosis in an ER setting.
Quote:

>I understand the actual differences in these tests, but what are the
>diagnostic differences? What does one tell you that the other doesn't
>and vice versa?



Sat, 24 Mar 2001 03:00:00 GMT
 Stress echo vs thallium stress test

Quote:

>I had an echo-cardiogram post bypass that showed my ejection fraction at 45%
>and 55%. A month later, a thallium stress test showed a problem and a
>subsequent cath showed an ejection fraction of 20%. Today I'm waiting for a
>transplant. I wouldn't trust an echo because it is dependent on the operator
>and the reader and the reader's eyeball. From my experience,  the echo isn't
>worth the  money except for quick diagnosis in an ER setting.

Hmm...I never seem to get any definitive information about Ejection
Fraction values drom echo tests either from local cardiologists or from
cardiologists on this newsgroup.

There are usually two values given in an echo test report...something like
12% and 36%. When I press the cardiologist for a single figure he usually
says something like..."Oh, let's say 20%". Go figure.

I have also asked more than once for something definitive about Ejection
Fractions but to no avail so I conclude that EF is not very meaningful
but raher is a very variable indicator of heart function. Total output
volume over a specified period of heart action seems to be a better
indicator than Ejection Fractions.

Bye,



Mon, 26 Mar 2001 03:00:00 GMT
 Stress echo vs thallium stress test
As I understand it and I'm not a doctor, the ejection fraction is the
percentage of emptying of the left ventricle which is a good measure of
overall heart function. 55% or better is normal, but you can lose a lot of
heart function and continue a normal life. Below 25% is generally considered
a transplant or other treatment candidate. I'm not sure what numbers you are
talking about because the test does involve several others.
Quote:
>Hmm...I never seem to get any definitive information about Ejection
>Fraction values drom echo tests either from local cardiologists or from
>cardiologists on this newsgroup.

>There are usually two values given in an echo test report...something like
>12% and 36%. When I press the cardiologist for a single figure he usually
>says something like..."Oh, let's say 20%". Go figure.

>I have also asked more than once for something definitive about Ejection
>Fractions but to no avail so I conclude that EF is not very meaningful
>but raher is a very variable indicator of heart function. Total output
>volume over a specified period of heart action seems to be a better
>indicator than Ejection Fractions.

>Bye,



Sun, 08 Apr 2001 03:00:00 GMT
 Stress echo vs thallium stress test
Quote:

> As I understand it and I'm not a doctor, the ejection fraction is the
> percentage of emptying of the left ventricle which is a good measure of
> overall heart function. 55% or better is normal, but you can lose a lot of
> heart function and continue a normal life. Below 25% is generally considered
> a transplant or other treatment candidate. I'm not sure what numbers you are
> talking about because the test does involve several others.

Normal ejection fraction, I have been told, is around 67%.  This is not
to say that you can live very decently with less, by the way.  In his
infinite wisdom, God gave us more heart muscle than we needed to just
scrape by with.  The more significant thing would be how a person feels,
symptom-wise, what his exercise/activity tolerance is, can he/she
sustain a reasonably normal life within those limits.  An Olympic
runner, for instance, would be pretty much out of a job after a
significant heart attack due to the loss of cardiac output, however a
computer programmer would never notice the difference most likely.  My
husband, for instance, had a large MI and has experienced a large drop
in cardiac output.  However, his lifestyle is such that he can deal with
it and have no real impairments in his normal activities.  I think the
primary things to consider are:
-can you realistically perform your work duties?
-can you adjust your home life sufficiently so that you continue to have
a good quality of life?
If your answer to these is "yes", then ejection fraction is a
meaningless term--quality of life is the meaningful thing to consider.
--
Alvena Ferreira

Home page:  http://www.apex.net/users/thehydes


Mon, 09 Apr 2001 03:00:00 GMT
 Stress echo vs thallium stress test


Quote:
>My husband, for instance, had a large MI and has experienced a large drop
>in cardiac output.  However, his lifestyle is such that he can deal with
>it and have no real impairments in his normal activities.  I think the
>primary things to consider are:
>-can you realistically perform your work duties?
>-can you adjust your home life sufficiently so that you continue to have
>a good quality of life?
>If your answer to these is "yes", then ejection fraction is a
>meaningless term--quality of life is the meaningful thing to consider.

All that is fine until CHF ( congestive heart failure ) eventually
shows up and gradually, or sometimes rapidly, gets worse. This can take
some time to show up especially if the muscle damage is not too extensive,
the patient relatively young, and there are no later illnesses or events
to trigger the onset of CHF.

Sooner or later a damaged heart is going to develop failure, it is a matter
of time.

In this newsgroup people have reported Ejection Fractions of 8% and
claimed they can barely just about struggle round a supermarket at
13% EF and then be whacked out for the rest of the day.

An EF of 15% is only about 25% of a normal heart output capacity.
Imagine running your four-cylinder car on one cylinder, 24 hours all day
every day?

Mind you a car engine is not a fair analogy but my car limps and clonks
along if only 5 out of 6 cylinders are still firing.

Bye for now,



Tue, 10 Apr 2001 03:00:00 GMT
 Stress echo vs thallium stress test

Quote:

> but you can lose a lot of
>heart function and continue a normal life.

Hmm...I have serious doubts about that statement. It all depends what
you regard as a normal life. Deteriorating heart function will inevitably
substantially diminish what might be considered a normal life.

Quote:
>Below 25% is generally considered
>a transplant or other treatment candidate.

What other treatment?  ACE inhibitors have possibly the best potential
for preserving excessive loss of heart function but only if you can
tolerate a dosage of 20mg + daily.

Perhaps by "other treatments" you mean the electro-mechanical heart pump
which is now available if you have US$100,000 available and like to carry a
sack of rechargeable batteries on your back.

Looks to be a long way to go to before the heart pumps are small enough
and cheap enough for widespread use.

Quote:
>>Hmm...I never seem to get any definitive information about Ejection
>>Fraction values drom echo tests either from local cardiologists or from
>>cardiologists on this newsgroup.

>>There are usually two values given in an echo test report...something like
>>12% and 36%. When I press the cardiologist for a single figure he usually
>>says something like..."Oh, let's say 20%". Go figure.

>>I have also asked more than once for something definitive about Ejection
>>Fractions but to no avail so I conclude that EF is not very meaningful
>>but raher is a very variable indicator of heart function. Total output
>>volume over a specified period of heart action seems to be a better
>>indicator than Ejection Fractions.

>>Bye,

Later,


Tue, 10 Apr 2001 03:00:00 GMT
 Stress echo vs thallium stress test

Quote:


>>>There are usually two values given in an echo test report...something like
>>>12% and 36%. When I press the cardiologist for a single figure he usually
>>>says something like..."Oh, let's say 20%". Go figure.

I thought that the two ejection fraction figures given in a echocardiogram
report are at rest and at peak heart rate?  For example at rest my ejection
fraction was estimated at 60%.  At peak heart rate the ejection fraction
climbed to 80%.


Tue, 10 Apr 2001 03:00:00 GMT
 Stress echo vs thallium stress test
Quote:


> >My husband, for instance, had a large MI and has experienced a large drop
> >in cardiac output.  However, his lifestyle is such that he can deal with
> >it and have no real impairments in his normal activities.  I think the
> >primary things to consider are:
> >-can you realistically perform your work duties?
> >-can you adjust your home life sufficiently so that you continue to have
> >a good quality of life?
> >If your answer to these is "yes", then ejection fraction is a
> >meaningless term--quality of life is the meaningful thing to consider.

> All that is fine until CHF ( congestive heart failure ) eventually
> shows up and gradually, or sometimes rapidly, gets worse. This can take
> some time to show up especially if the muscle damage is not too extensive,
> the patient relatively young, and there are no later illnesses or events
> to trigger the onset of CHF.
> Sooner or later a damaged heart is going to develop failure, it is a matter
> of time.
> In this newsgroup people have reported Ejection Fractions of 8% and
> claimed they can barely just about struggle round a supermarket at
> 13% EF and then be whacked out for the rest of the day.
> An EF of 15% is only about 25% of a normal heart output capacity.
> Imagine running your four-cylinder car on one cylinder, 24 hours all day
> every day?
> Mind you a car engine is not a fair analogy but my car limps and clonks
> along if only 5 out of 6 cylinders are still firing.

I totally agree, however sitting around and comparing a 50% EF to a 60%
EF is merely an exercise in needless worry and becomes an exercise in
academics.  There are many other factors TNTC affecting the tolerance of
any given EF.  While obviously CHF is going to rear its ugly head at
some point in time, there is little way to know when that is going to be
until the scenario presents itself clinically.  I prefer not to sit
around calculating my numbers but instead to be enjoying my life.
However, there may be those who enjoy the numbers game instead of living
their life, and if so, then fine--we all spend our time doing what we
want, that is the real joy of life.  
--
Alvena Ferreira



Tue, 10 Apr 2001 03:00:00 GMT
 Stress echo vs thallium stress test


Quote:
>I totally agree, however sitting around and comparing a 50% EF to a 60%
>EF is merely an exercise in needless worry and becomes an exercise in
>academics.

There is no cause for worry at either 50% to 60%, both are normal or
close to normal.

[...snip...]

Quote:
> I prefer not to sit around calculating my numbers but instead to be > > >
> enjoying my life.

That's great if you are OK but folks with EFs down to as low as 20% to
12% are not likely to be in your happy state are they?

Quote:
>However, there may be those who enjoy the numbers game instead of living
>their life, and if so, then fine--we all spend our time doing what we
>want, that is the real joy of life.  

It's not a matter of enjoying the numbers game but one of understanding
what the numbers really mean and conducting one's life accordingly.

Understanding the real meaning of EF test results just seems difficult.

Bye,



Wed, 11 Apr 2001 03:00:00 GMT
 Stress echo vs thallium stress test

Quote:


>>>>There are usually two values given in an echo test report...something like
>>>>12% and 36%. When I press the cardiologist for a single figure he usually
>>>>says something like..."Oh, let's say 20%". Go figure.
>I thought that the two ejection fraction figures given in a echocardiogram
>report are at rest and at peak heart rate?  For example at rest my ejection
>fraction was estimated at 60%.  At peak heart rate the ejection fraction
>climbed to 80%.

Ah apologies, I see that the subject here is _Stress_ echo test. The EF
values I quoted were from a normal non-stress echocardiograph test.

Bye,



Wed, 11 Apr 2001 03:00:00 GMT
 Stress echo vs thallium stress test


: >I totally agree, however sitting around and comparing a 50% EF to a 60%
: >EF is merely an exercise in needless worry and becomes an exercise in
: >academics.

: There is no cause for worry at either 50% to 60%, both are normal or
: close to normal.

: [...snip...]

: > I prefer not to sit around calculating my numbers but instead to be > > >
: > enjoying my life.

gee, Heart Disease by Braunwald, ejection fractions of 50% with, oh,
mitral regurgitation, death rate is about 53% _with_ surgery, at the end
of 10 years.  (ordinary surgeons, presumably)

but who cares about data and long-term results, anybody here? i'm
surprised at some of these comments, especially from someone who worked as
a cardiac rehab nurse?  you really should know better and not be so
cavalier with medical research, precious little that there is.

as i might recall, it's page 1028 in the latest edition.

sometimes the ejection fraction is important, sometimes not, but it's not
a useless academic exercise if you care about someone's life expectancy.

: That's great if you are OK but folks with EFs down to as low as 20% to
: 12% are not likely to be in your happy state are they?

: >However, there may be those who enjoy the numbers game instead of living
: >their life, and if so, then fine--we all spend our time doing what we
: >want, that is the real joy of life.  

: It's not a matter of enjoying the numbers game but one of understanding
: what the numbers really mean and conducting one's life accordingly.

: Understanding the real meaning of EF test results just seems difficult.

: Bye,



Sat, 14 Apr 2001 03:00:00 GMT
 Stress echo vs thallium stress test
I stand corrected.  
alvena
--
Alvena Ferreira


> gee, Heart Disease by Braunwald, ejection fractions of 50% with, oh,
> mitral regurgitation, death rate is about 53% _with_ surgery, at the end
> of 10 years.  (ordinary surgeons, presumably)

> but who cares about data and long-term results, anybody here? i'm
> surprised at some of these comments, especially from someone who worked as
> a cardiac rehab nurse?  you really should know better and not be so
> cavalier with medical research, precious little that there is.

> as i might recall, it's page 1028 in the latest edition.

> sometimes the ejection fraction is important, sometimes not, but it's not
> a useless academic exercise if you care about someone's life expectancy.



Sat, 14 Apr 2001 03:00:00 GMT
 
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