Accuracy of diagnosis of coronary artery disease by radionuclide management of left ventricular function during rest and exercise.

Abstract

SUMMARY Rest and exercise radionuclide angiocardiographic measurements of left ventricular function were obtained in 496 patients who underwent cardiac catheterization for chest pain. Two hundred forty-eight of these patients also had an exercise treadmill test. An ejection fraction less than 50% was the abnormality of resting left ventricular function that provided the greatest diagnostic information. In patients with normal resting left ventricular function, exercise abnormalities that were optimal for diagnosis of coronary artery disease were an ejection fraction at least 6% less than predicted, an increase of greater than 20 ml in end-systolic volume and the appearance of an exercise-induced wall motion abnormality. The sensitivity and specificity of the test were lower in patients who were taking propranolol at the time of study and in patients who failed to achieve an adequate exercise end point. In the 387 patients with an optimal study, the test had a sensitivity of 90% and a specificity of 58%. Radionuclide angiocardiography was more sensitive and less specific than the exercise treadmill test. The high degree of sensitivity of the radionuclide test suggests that it is most appropriately applied to patient groups with a high prevalence of disease, including those considered for cardiac catheterization. MYOCARDIAL

Left ventricular dysfunction in patients with angina pectoris, normal epicardial coronary arteries, and abnormal vasodilator reserve.

“…In fact. 21 27 Second, exercise stress may not be the appropriate provocation to elicit an abnormal coronary vasodilator response in some patients. It is possible that coadministration of a vasoconstrictor stimulus during exercise (analogous to the administration of ergonovine during pacing) might have induced left ventricular dysfunction by unmasking or exacerbating small-vessel vasoconstriction or inappropriate vasodilation.…”

Improvement of Left Ventricular Dysfunction During Exercise by Walking in Patients With Successful Percutaneous Coronary Intervention for Acute Myocardial Infarction.

“…Indeed, previous reports about ventricular function at rest and during exercise have shown that in patients with coronary artery disease, the LVEF decreases or does not change, and regional wall motion abnormalities appear during exercise. 11,12 It is possible that such patients have residual stenosis in the infarct-related arteries and that exercise-induced ischemia is still present. In contrast, the most common response to exercise in normal volunteers is an increased LVEF.…”

Limitations of radionuclide ventriculography in the non-invasive diagnosis of coronary artery disease. A correlation with right heart haemodynamic values during exercise.

“…We presume that the fulfilment of this prerequisite for an accurate evaluation of test sensitivity and specificity25 was a major reason why radionuclide ventriculography was found to be less reliable than previously reported. Numerous reports have included patients with a history of myocardial infarction,l 1 29 These data show that the results of studies that include patients receiving beta adrenergic blockade6 11 30 are of questionable value. The relatively high sensitivity and specificity of the clinical assessment of chest pain in our study agree with those reported by others.31 32 The limited predictive power of the ST segment response to exercise is also consistent with previous findings.33 34 The increase in the left ventricular diastolic pressure with exercise has been well documented in patients with coronary artery disease.…”