title: Accuracy of exercise testing in the assessment of the severity of myocardial ischemia as determined by means of technetium-99m tetrofosmin SPECT scintigraphy.
abstract: BACKGROUND
  The separation of patients with suspected or known coronary artery disease into low- and high-risk subgroups by means of noninvasive testing is highly relevant in the selection of patients who require further diagnostic or therapeutic investigation. We evaluated whether exercise electrocardiographic variables during exercise testing might be a means of predicting the severity of myocardial ischemia as assessed with myocardial scintigraphy.
  
  
  RESULTS
  We retrospectively reviewed 816 consecutive patients (mean age, 57+/-10 years) who underwent exercise technetium-99m tetrofosmin single photon emission computed tomography (SPECT) for the assessment of suspected or known coronary artery disease. Eight independent significant predictors of the extent and severity of reversible perfusion defects (ischemic perfusion score), which when integrated in a diagnostic algorithm satisfactorily discriminated patients with no reversible perfusion defects (sensitivity, 75%; specificity, 80%) and patients with severe impaired myocardial perfusion (> or =11 ischemic perfusion score; sensitivity, 77%; specificity, 82%), were identified by means of stepwise discriminant analysis. However, patients with mildly to moderately impaired myocardial perfusion (> or =21 but <11 ischemic perfusion score) were poorly discriminated (sensitivity, 50%; specificity, 78%). The set of variables that were significant (P<.0001) for prediction included sex, myocardial infarction, exercise angina, the maximal amount of ST segment depression, rate-pressure product threshold criteria, slope of ST segment depression, ST/heart rate index, and peak exercise heart rate.
  
  
  CONCLUSIONS
  The results of the use of clinical and electrocardiographic exercise variables satisfactorily agrees with the results from scintigraphy only for patients with no reversible perfusion defects and with severely impaired myocardial perfusion. However, it fails as an approach with universal applicability.
authors.affiliation: Institute of Cardiology, Ferrarotto Hospital, Italy. argal@ctonline.it
authors.forename: A R
authors.initials: AR
authors.lastname: Galassi
authors.forename: S
authors.initials: S
authors.lastname: Azzarelli
authors.forename: L
authors.initials: L
authors.lastname: Lupo
authors.forename: C
authors.initials: C
authors.lastname: Mammana
authors.forename: R
authors.initials: R
authors.lastname: Foti
authors.forename: C
authors.initials: C
authors.lastname: Tamburino
authors.forename: S
authors.initials: S
authors.lastname: Musumeci
authors.forename: G
authors.initials: G
authors.lastname: Giuffrida
mesh_terms: D000465:Algorithms; D003326:Coronary Circulation; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin