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The value and limitation of radionuclide angiocardiography with stress in women

The radionuclide angiograms (RNA) with exercise of 64 females were reviewed. There were 30 patients with coronary artery disease, 5 normal controls, 6 patients with normal coronary arteries and hemodynamics, and 23 patients with cardiomyopathy (left ventricular end‐diastolic pressure ⩾15 or ⩾18 pre‐ and postangiogram). In the coronary artery disease group, 12 of the 30 (40%) had ST‐segment depression and another 12 (40%) had a wall motion abnormality with exercise. In the cardiomyopathy group, 8 of the 23 (35%) had ST‐segment depression, and (26%) developed wall motion abnormality with exercise. In the normal coronary group, 2 of the 6 (33%) had a positive ST‐segment response, and none had a wall motion abnormality with exercise. The ejection fraction (EF) response with exercise in the normal coronary group was 65.4‐72% (p<0.02), in the coronary artery disease group 59.1‐56.2% (p<0.025), and in the cardiomyopathy group 62‐58.8% (p<0.03). If °EF⩾5 units with exercise was the normal response, then 5 of 11 (45%) normals were misclassified. If °EF>0 was a normal response, then the specificity was 10 of 11 (91%) for normals or 5 of 6 (83%) for the normal coronary group at angiography. The sensitivity for coronary artery disease was 23 of 30 (77%) and 17 of 23 (74%) for cardiomyopathy. Of the cardiomyopathy patients 3 of 4 (75%) had a positive TL‐201 scan with exercise consistent with reversible ischemia. In summary, many females with chest pain have abnormal hemodynamics despite normal coronary arteries. Use of °EF>0 as the criteria for a normal response to exercise is more specific than °EF⩾5 with exercise for separating normals from abnormals. A wall motion abnormality that develops with exercise can be seen with cardiomyopathy or with coronary artery disease in females. The radionuclide angiographic studies with exercise can separate normal from abnormal, but not cardiomyopathy from coronary artery disease. The positive TL‐201 response with exercise in the cardiomyopathy group would suggest that a regional process could be present and only cardiac catheterization can separate cardiomyopathy from coronary artery disease.