Circulation, Vol 64, 586-601, Copyright © 1981 by American Heart Association
RH Jones, P McEwan, GE Newman, S Port, SK Rerych, PM Scholz, MT Upton, CA Peter, EH Austin, KH Leong, RJ Gibbons, FR Cobb, RE Coleman and DC Sabiston Jr
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 injection fraction at least 6%
less than predicted, an increase 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.
ARTICLES
Accuracy of diagnosis of coronary artery disease by radionuclide management of left ventricular function during rest and exercise
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