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Detection of multivessel disease after myocardial infarction using intravenous stress digital subtraction angiography
Insights
A fall in left ventricular ejection fraction (EF) during stress testing effectively detects multivessel disease after myocardial infarction. However, this method shows moderate specificity due to false positives.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Myocardial infarction (MI) can lead to impaired left ventricular function.
- Assessing coronary anatomy post-MI is crucial for guiding treatment.
- Stress testing combined with angiography aids in evaluating cardiac function and disease severity.
Purpose of the Study:
- To correlate left ventricular ejection fraction (EF) and wall-motion responses during stress with coronary anatomy in patients with prior MI.
- To evaluate the sensitivity and specificity of stress intravenous digital subtraction angiography (DSA) for detecting multivessel disease.
Main Methods:
- Forty-six patients with prior MI underwent stress intravenous DSA and coronary angiography.
- Left ventricular EF and wall-motion responses to exercise were assessed.
- Coronary anatomy was analyzed to identify single-vessel versus multivessel disease.
Main Results:
- Patients with multivessel disease (21/46) showed a significant decrease in left ventricular EF with exercise (59% to 48%, P = .0001).
- Patients with single-vessel disease (25/46) had minimal change in EF (66% to 64%).
- A decrease in EF had 95% sensitivity and 60% specificity for multivessel disease; wall-motion abnormalities had 72% sensitivity and 71% specificity.
Conclusions:
- A fall in left ventricular EF during stress intravenous DSA is highly sensitive for detecting multivessel disease post-MI.
- While sensitive, this method has moderate specificity due to false positives.
- New wall motion abnormalities demonstrate only moderate sensitivity and specificity for multivessel disease.
Abstract:
Forty-six patients with prior myocardial infarction underwent stress intravenous digital subtraction angiography (DSA) and coronary angiography. The left ventricular ejection fraction (EF) and wall-motion responses to exercise were correlated with the coronary anatomy. Twenty-five patients with single vessel disease showed essentially no change in left ventricular EF with exercise (a decrease from 66% to 64%), but those with multivessel disease (21 patients) had a significant decrease in left ventricular EF (from 59% to 48%) (P = .0001). A decrease in left ventricular EF had a sensitivity of 95% and specificity of 60% for the detection of multivessel disease, whereas an increase in wall-motion abnormality had a sensitivity and specificity of 72% and 71%, respectively. After myocardial infarction, a fall in left ventricular EF with stress intravenous DSA is highly sensitive for the detection of multivessel disease, but there are a number of false-positive results, resulting in only moderate specificity. A new wall motion abnormality has only a moderate sensitivity and specificity.