Sensitivity, specificity and predictive accuracy of radionuclide cineangiography during exercise in patients with coronary artery disease. Comparison with exercise electrocardiography.

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Abstract
Noninvasive radionuclide cineangiography permits the assessment of global and regional left ventricular function during intense exercise. To assess the sensitivity of the technique in detecting coronary artery disease, 63 patients with .gtoreq. 50% stenosis of at least 1 coronary artery were studied. Of the 63, 59 (94%) had regional dysfunction with exercise; 56 (89%) developed lower-than-normal ejection fractions during exercise. When both regional dysfunction and subnormal ejection fractions are considered together, the sensitivity was 95%. Each patient underwent exercise ECG to either angina or 85% of predicted maximal heart rate. Of the 42 patients who developed angina during exercise ECG, 26 (62%) developed .gtoreq. 1 mm ST-segment depression; 4 additional patients (10%) had Q waves diagnostic of previous myocardial infarction. In contrast, 39 (93%, P < 0.001) developed regional dysfunction during radionuclide study and 1 additional patient developed a subnormal ejection fraction without regional dysfunction. To assess specificity, 21 patients with chest pain who had normal coronary arteries were studied. None developed regional dysfunction; ejection fraction increased in all to levels within the range previously defined as normal. The predictive accuracy in this symptomatic population was 100%. Apparently radionuclide cineangiography is highly sensitive (more so than exercise ECG), predictive and specific in detecting patients with coronary artery disease.

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