Radiology, Vol 161, 685-689, Copyright © 1986 by Radiological Society of North America
Detection of multivessel disease after myocardial infarction using intravenous stress digital subtraction angiography
GR Bellamy, J Yiannikas, R Detrano, C Simpfendorfer and EE Salcedo
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.
