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First-Pass Radionuclide Cineangiography: A Reevaluation of Its Sensitivity and Limitations in the Detection of Significant Coronary Artery Disease

Departments of Internal Medicine, Cardiology, and Nuclear Medicine, Massapequa General Hospital, Seaford, New York

Michael L. Sacher

Departments of Internal Medicine, Cardiology, and Nuclear Medicine, Massapequa General Hospital, Seaford, New York

Stuart W. Landau

Departments of Internal Medicine, Cardiology, and Nuclear Medicine, Massapequa General Hospital, Seaford, New York

Kathleen A. Dietrich

Departments of Internal Medicine, Cardiology, and Nuclear Medicine, Massapequa General Hospital, Seaford, New York

Allen Chien

Departments of Internal Medicine, Cardiology, and Nuclear Medicine, Massapequa General Hospital, Seaford, New York

Frances Dooley

Departments of Internal Medicine, Cardiology, and Nuclear Medicine, Massapequa General Hospital, Seaford, New York

The sensitivity of first-pass cineangiography in the detection of significant coronary artery disease (CAD) was recently assessed in 33 patients. No normal controls were studied. Overall sensitivity was 86% with a predictive value of 83% and a 36% false-positive rate. Attainment of an adequate exercise end point increased sensitivity to 92%; failure to achieve this end point diminished sensitivity to 71%. Correlation between first-pass and contrast angiography ejection fractions was high (r = 0.88, p < .005) with a moderate correlation in wall motion analysis (r=0.58, p < .005). The development or the intensification of a wall motion abnormality (WMA) was the single most sensitive indicator of CAD (84%). Presence of WMA plus failure of the ejection fraction to increase by 6% over baseline increased testing sensitivity to 89%. The mean WMA score for patients with CAD was 2.0±1.5 compared with 0.6±1.3 for those with nor mal study results (p < .01). The first-pass method identified 4 subjects who sub sequently had normal findings from catheterization. Data confirm testing sensitivity of the first-pass technique and underscore the apparent limitations of this modality in differentiation of patients with normal vasculture.

Angiology, Vol. 43, No. 6, 470-476 (1992)
DOI: 10.1177/000331979204300603


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