Diagnostic accuracy of rest-exercise first pass ventriculography with a fast single crystal gamma camera in detecting coronary artery disease

Rest and exercise radionuclide ventriculograms were performed in 61 non infarcted, male, patients who underwent cardiac catheterization for chest pain and in 16 normal control subjects. Studies were performed using the first pass method with a fast single crystal gamma camera, which allowed a count rate of 140±19 Kcounts/sec to be reached during left ventricular filling; the count integral on left ventricular area was 10.8±1.6 Kcounts and the maximum count/pixel 155±16. We analyzed sensitivity, specificity, positive and negative predictive value of global ejection fraction (EF) and of the regional wall motion in identifying ventricular function abnormalities due to obstructive coronary artery disease. The regional wall motion was evaluated with four functional images: regional ejection fraction (REF), amplitude (A) and phase (PH) from Fourier analysis and systolic transit times (TT). Sensitivity was near 90% for EF, REF, A and TT, while PH was less sensitive (80%); all functional images were more specific (nearly 90%) than EF (80%). Both sensitivity and specificity were lower for the exercise EKG (59% and 63%, respectively) in this patient group. Significant differences between single vessel and multiple vessel disease were also observed either for the EF increase/decrease (-1.34±7.4 and -7.82±9.96; P<0.05) or for the number of segments which developed wall motion abnormalities during exercise (1.22±0.73 and 2.15±1.04; P<0.02). In conclusion, with our method, a fast single crystal gamma camera is suitable for obtaining optimal first pass radionuclide ventriculograms with a count density sufficient either for global or regional left ventricular function evaluation. First pass radionuclide ventriculography seems to provide very high diagnostic accuracy in the detection of coronary artery disease in non infarcted, male, subjects. (orig.)