Accuracy of radionuclide angiocardiography in the diagnosis of coronary artery disease — A prospective study

ARSTRACTS

CLINICAL UTILITY OF COLD PRESSOR RADIONUCLIDE VENTRICULOGRAPHY IN CORONARY ARTERY DISEASE. Joshua Wynne, MD, FACC; B. Leonard Holman, MD, FACC; Gilbert H. Hudge, MD; Kenneth M. Borow, MD, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA.

THE REGIONAL EJECTION FRACTION IMAGE (REFI) - AN ACCURATE METHOD FOR THE DETECTION OF CORONARY HEART DISEASE Hvlton I. Miller, MB; Jack Baron, BSc; Shimon Braun, MD; Shlomo Laniado, MD, FACC ; Tel Aviv Medical Center, Israel

To evaluate the utility of cold pressor radionuclide ventriculography (RVG) in coronary artery disease (CAD), 20 patients (I5 with and 5 without CAD) underwent RVG before and during cutaneous exposure to iced water for an average of 4.8kl.l minutes. Heart rate (64.%10.3 to 67.7210.6, plO% decline in LV EF as the definition of an abnormal response, the cold pressor RVG had a sensitivity of only 33% (S/15) and a specificity of 80% (4/S) for the diagnosis of CAD. We conclude that while the cold pressor RVG may be of occasional value in patients unable to perform adequate levels of exercise, its low sensitivity suggests that it is inferior to exercise RVG or even exercise electrocardiography in the diagnosis of CAD.

Computer generated colcur coded REFI’s derived from ECG synchronised radionuclide cardiac blood pool imaging, using an Anger camera and a simple data processing system, were obtained in 101 patienta undergoing coronary angiography, at rest and during handgrip exercise (HG). Angiographic diameter narrowing of&50% of 1 or more major coronary branches was considered diagnostic of CHD. A regional reduction of the colour coded REFIAl2% during HG and regional ventricular border motion abnormalities (BMA) induced by HG was consider -ed positive for significant CHD. 34/101 patients had normal coronary arteries (NCA), 32/67 (46%) of CHD patients had Q waves on ECG. Results No. Positive HG REFI Positive HG BMA NCA 34 2/34 (6%) 2/34 (6%)

COLD PRESSOR THALLIUM 201 MYOCAPDIAL SCINTIGRAPHY IN DETECTION OF CORONARY ARTERY DISEASE: AN ALTERNATIVE TO EXERCISE

SCINTIGRAPHY

Masood Ahmad,MD,FACC; Jersy P. Dubiel,MD,FACC; Helmut Haibach,MD; Scott H. Goldberg: __ _. John F. Sanfelinw.MD: Richard H. Martin,MD,FACC, VA and University Hospitals, Columbia, MO. Thirty patients (pts)(age range 37-69 yrs) with chest pain syndromes underwent myocardial scintigraphy following injection of Thallium 201 during the standard cold pressor test (CPT). Twenty-three of 25 pts with cineangiographically confirmed coronary artery disease (CAD) developed transient perfusion deficits which normalized 4 hours later. All 5 pts without CAD (confirmed by coronary cineangiography) had normal scintigrams. In 22 pts who had previously performed a symptom-limited maximum exercise stress test, the sensitivity of exercise ECG in detecting ischemia was 88% and specificity 75% in comparison to a sensitivity of 89% and a specificity of 100% by CPT-Thallium 201 scintigraphy. Exercise Thallium 201 scintigraphy was performed in 14 pts. Eleven of 12 pts with CAD developed transient perfusion deficits following exercise and the 2 pts without CAD had normal scintigrams. Identical results were obtained by CPT-Thallium 201 scintigraphy in these 14 pts. Systolic pressure x heart rate was 103.0+17.0 at 2 minutes of CPT compared to 210.0+18.0 at peak exercise (p
444

February 1981

The American Journal of CARDIOLOGY

CHD

67

66/67

is&,

52;67

i&)

For detection of CHD using REFI sensitivity was 99% spscificity 94% aa compared to sensitivity of 76% and specificity of 94% for HG BMA. Changes in ejection fraction with HG did not allow differentiation of patients wlth CHD. HG with REFI was a sufficient stress for detection of CHD. It is more sensitive than conventional assessment of BMA and may prove useful aa a screening test.

ACCURACY OF RADIONUCLIDE ANGIOCARDIOGRAPHY IN THE DIAGNOSIS OF CORONARY ARTERY DISEASE - A PROSPECTIVE STUDY Erle H. Austin, M.D.; Frederick R. Cobb, M.D.; R. Edward Coleman, M.D.; Robert H. Jones, M.D., FACC, Duke University Medical Center, Durham, NC The purpose of this investigation was to assess prospectively the accuracy of rest and exercise (R/E) radionuclide angiocardiography (RNA) in detecting coronary artery disease (CAD). By retrospective analysis of 496 patients we determined optimal RNA criteria for the presence or absence of CAD. Multivariate analysis of catheterization proven normals provided a formula to predict normal exercise ejection fraction (EF) in a given patient. The presence of CAD was indicated by one or more of the following RNA measurements: 1) rest EF c.50. 2) exercise EF .06 or more 20 ml, 4) exercise-induced wall motion abnormality. The absence of CAD was indicated by the absence of all four criteria. These criteria were used to define a positive or negative RNA, and the diagnostic accuracy was assessed in 125 consecutive patients by comparison with coronary arteriograms. Significant CAD (,75X stenosis) was present in 70 of 86 men and in 15 of 39 women. Sensitivity (SFNS), specificity (SPEC) and efficiency (EFFIC) for RNA were:

86 Men 39 Women 125 Patients

SENS

SPEC

.87 .80 .86

.69 .50 .56

EFFIC .a4 .61 .76

We conclude that R/E RNA is sensitive and specific in men. However, poor specificity limits its value as a diagnostic tool in women.

Volume 47