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The interval ejection fraction: a cineangiographic and radionuclide study
Insights
The first-third ejection fraction (1/3 EF) is not a reliable indicator for detecting coronary artery disease (CAD). This study found 1/3 EF has limited clinical usefulness in identifying patients with CAD.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Nuclear Medicine
Background:
- Coronary artery disease (CAD) is a significant health concern.
- Accurate detection of CAD is crucial for timely intervention.
- The clinical utility of specific cardiac imaging metrics requires ongoing evaluation.
Purpose of the Study:
- To assess the effectiveness of the first-third ejection fraction (1/3 EF) in detecting coronary artery disease (CAD).
- To compare the diagnostic value of 1/3 EF with global ejection fraction (EF) in patients with stable angina.
Main Methods:
- Resting contrast ventriculography and first-pass radionuclide angiography were performed in 47 subjects.
- Participants included 22 normal controls and 25 patients with severe CAD.
- Analysis focused on global EF and 1/3 EF, comparing values between groups.
Main Results:
- Only patients with resting wall motion abnormalities and depressed global EF showed significantly lower 1/3 EF.
- 1/3 EF was depressed in only two of 25 CAD patients, both with asynergy and low global EF.
- First-pass radionuclide angiography yielded similar findings, with limited sensitivity for 1/3 EF in detecting CAD.
Conclusions:
- The first-third ejection fraction (1/3 EF) at rest demonstrates limited clinical value for detecting coronary artery disease (CAD).
- Global ejection fraction, particularly when combined with assessment of wall motion abnormalities, appears more informative for CAD detection.
- Further research may explore other imaging parameters for improved CAD diagnosis.
Abstract:
To evaluate the clinical usefulness of the first-third ejection fraction (1/3 EF) for detecting patients with coronary artery disease (CAD), resting contrast ventriculography and first-pass radionuclide angiography with a high-count-rate, multicrystal camera system were performed in 47 subjects: 22 normal controls (group 1) and 25 patients with clinically stable angina pectoris and severe CAD (mean 2.3 vessels) without (group 2, n = 12) and with (group 3, n = 13) resting wall motion abnormalities. By contrast angiography, only group 3 had depressed global EF or 1/3 EF compared with control (global EF: group 1,0.71 +/- 0.09; group 2, 0.67 +/- 0.09 [NS]; group 3,049 +/- 0.05 [p less than 0.01 vs groups 1 and 2]; 1/3 EF: group 1,0.29% +/- 0.06;' group 2, 0.28 +/- 0.05 [NS]; group 3,0.22 +/- 0.05 [p less than 0.02 vs groups 1 and 2]). Whereas 11 of 25 CAD patients had global EF outside the normal range, only two of 25 had depressed 1/3 EF. Both had left ventricular asynergy and a depressed global EF. Studies performed using first-pass radionuclide angiography revealed similar results i.e., only four of 25 CAD patients, all with left ventricular asynergy and depressed global EF, had depressed 1/3 EF values. A wide range of 1/3 EF values was found in normal subjects by both techniques. Thus, the ejection fraction during the first third of systole at rest is of limited value for detecting patients with CAD.