Identification of "surgical" coronary anatomy by exercise radionuclide cineangiography.
Radionuclide cineangiography with exercise has been used to identify patients with coronary arteriographic patterns for which bypass grafting has been shown to prolong life. However, patients with severe prior myocardial damage were included in these studies, although the randomized medicine versus surgery trials recognized an effect of resting ejection fraction on operative risk and excluded patients with severely compromised function. Moreover, continuing reports from trials of surgery and from an ancillary evaluation of angioplasty have refined the set of coronary anatomic patterns for which mechanical therapy prolongs life, although stenosis severity criteria varied (50 vs 70 to 75%) between these trials. In this study, we have focused on patients who would have been eligible for the randomized trials of surgical therapy, and included only those with at least moderately preserved ventricular function at rest (ejection fraction greater than or equal to 30%). In such patients, exercise parameters were significantly more accurate than rest variables in identifying all anatomic patterns appropriately treated mechanically; logistic regression selected ejection fraction change with exercise, followed by systolic blood pressure change with exercise, as the 2 most powerful independent covariates among patients with "surgical" coronary anatomy defined by a 70% stenosis criterion; absolute exercise ejection fraction contributed no significant independent information. When defined at a 50% stenosis severity level, blood pressure change and angina class were more powerful than absolute exercise ejection fraction, but a crude, noninvasively determined analog of stroke work, incorporating change in both ejection fraction and blood pressure, was most accurate.(ABSTRACT TRUNCATED AT 250 WORDS)
Wallis
J B
JB
Cardiology Division, New York Hospital-Cornell Medical Center, New York 10021.
Borer
J S
JS
D000328:Adult; D002933:Cineradiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D003331:Coronary Vessels / Q000473:pathology; D005080:Exercise Test; D005260:Female; D015637:Gated Blood-Pool Imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume