Detection of multivessel disease after myocardial infarction using intravenous stress digital subtraction angiography.
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.
D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D005082:Physical Exertion; D013382:Subtraction Technique