Detection of coronary heart disease using radionuclide determined regional ejection fraction at rest and during handgrip exercise: correlation with coronary arteriography.

Abstract

The detection of regional asynergy provides strong evidence for a critical reduction of coronary blood flow to that zone. The usefulness of combining computer-assisted radionuclide angiography and isometric handgrip exercise testing to detect coronary heart disease (CHD) was evaluated. Patients (129) with chest pain undergoing cardiac catheterization were evaluated using radionuclide angiography. Patients (34) had severe contraction abnormalities during the initial radionuclide angiographic study. Of these, 33 had significant CHD. Patients (95) had normal or borderline normal left ventricular contraction and underwent a 2nd radionuclide angiogram during handgrip. Radionuclide angiogram data were quantitatively analyzed by computer to determine regional left ventricular contribution to ejection fraction during handgrip stress. Of the 95 patients, 30 had normal coronary arteries of whom 26 (87%) had normal relative regional ejection fraction. Patients (65) had CHD; 20 had single and 45 had 2 or 3 vessel obstructuve disease. Of the 20 with single vessel disease, 16 (9 at rest and an additional 7 during handgrip) had an area of decreased relative regional ejection fraction ranging from 31-87% in the corresponding segment during radionuclide angiography. Of the 45 patients with 2 or 3 vessel disease, 40 had regional abnormalities in ejection fraction during handgrip of from 31-100% (24 at rest and an additional 16 during handgrip). Of these patients (24) had multiple abnormalities in relative regional ejection fraction indicating multivessel disease. Of the 95 patients who underwent isometric handgrip stress, sensitivity was 86% for detection of CHD and specificity was 87% for accurately defining the patients with normal coronary arteries. The radionuclide angiographic assessment of relative regional ejection fraction during isometric handgrip exercise may provide a useful new diagnostic approach for patients with suspected CHD and provide important additional data concerning its location and severity.