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Comparison of wall motion and regional ejection fraction at rest and during isometric exercise: concise communication
Insights
Radionuclide angiographic assessment of regional ejection fraction is a sensitive and specific tool for detecting coronary heart disease. This method significantly improves detection rates compared to traditional wall motion assessment.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Regional abnormalities in left-ventricular wall motion indicate coronary heart disease.
- Radionuclide angiography is a key diagnostic tool.
Purpose of the Study:
- To compare the diagnostic value of radionuclide angiographic assessment of wall motion versus computer-generated regional ejection fraction.
- To evaluate these methods at rest and during handgrip exercise in patients undergoing coronary arteriography.
Main Methods:
- 129 patients undergoing coronary arteriography were assessed.
- Wall motion was determined by superimposing end-diastolic and end-systolic perimeters.
- Relative regional ejection fraction was quantified using a 16-color isocount image.
Main Results:
- Regional ejection fraction detected more cases of coronary artery disease (CAD) than wall motion analysis, especially in multivessel disease (69 vs 52, p < .01).
- Sensitivity was significantly higher for regional ejection fraction (91%) compared to wall motion (67%, p < .001).
- Specificity was high for both methods (94% for wall motion, 87% for regional ejection fraction).
Conclusions:
- Radionuclide angiographic assessment of regional ejection fraction during handgrip exercise is highly sensitive and specific for CAD.
- This quantitative method significantly enhances CAD detection compared to qualitative wall motion assessment with minimal specificity loss.
Abstract:
The detection of regional abnormalities of left-ventricular wall motion provides strong evidence for the presence of coronary heart disease. In 129 patients undergoing coronary arteriography, the relative value of radionuclide angiographic assessment of wall motion was compared with computer-generated regional ejection fraction, at rest and during handgrip exercise. Wall motion was determined by superposition of computer-derived end-diastolic and end-systolic perimeters. Relative regional ejection fraction was determined using a computer-generated 16-color isocount image that permitted a quantitative assessment of zonal contribution to ejection fraction. Of the 129 patients, coronary arteries were normal in 31 and diseased in 98. Of 24 patients with single-vessel disease, wall-motion abnormalities were present, at rest or during exercise in 15, whereas regional ejection fraction detected 20 patients. Seventy-four patients had multivessel disease. Of these, wall-motion abnormalities occurred in 52 but regional ejection fraction was abnormal in 69 (p less than .01). Overall, sensitivity was 67% by wall motion and 91% by relative regional ejection fraction (p less than .001). Specificity was 94% by wall motion and 87% by regional ejection fraction (not significant). Thus, radionuclide angiographic assessment of regional ejection fraction during handgrip exercise is both highly sensitive and specific for coronary heart disease and significantly enhances detection of coronary heart disease compared with wall-motion assessment, with little loss in specificity.