Exercise first-pass radionuclide ventriculography in detection of coronary artery disease.

Abstract

Patients [34] with coronary artery disease were exercised on a bicycle ergometer until angina developed. There was a highly significant fall in ejection fraction from a mean of 61.1 to 52.9 which was more pronounced in the group with 3 vessel coronary artery disease. A coronary index took into account the extent and distribution of coronary artery lesions. Patients with an index < 0.3 (that is more severe disease) had greater falls in ejection fraction than those with higher indices. All 5 patients in whom there was a fall in ejection fraction of 15% or more had 3 vessel disease. Wall motion abnormalities were assessed by a hemiaxial method. Of 34 exercise-induced zones of wall motion abnormalities, 32 were in regions supplied by significantly stenosed coronary arteries. A positive test was defined as an abnormal exercise ejection fraction (< 50%), an exercise-induced wall motion abnormality, or a fall in ejection fraction at angina of at least 10%. Of the 19 patients with triple vessel disease, 18 (95%) had a positive result, as did 11 of 15 (73%) patients with 1 or 2 vessel disease. A group of 8 patients with normal coronary arteries were exercised and none showed a positive result. Exercise 1st-pass radionuclide ventriculography demonstrates changes in global and regional ventricular function in patients with coronary artery disease which are not present in normal subjects. It may also help to identify patients at high risk.