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European Heart Journal 1990 11(11):980-989;
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

Diagnostic accuracy of radionuclide techniques in patients with equivocal electrocardiographic exercise testing

J. CANDELL-RIERA, J. CASTELL-CONESA*, D. ORTEGA-ALCALDE*, F. M. DOMÈNECH-TORNÈ* and J. SOLER-SOLER

Servicio de Cardiologia, Hospital General Vall d'Hebron Barcelona, Spain
*Servicio de Medicina Nuclear, Hospital General Vall d'Hebron Barcelona, Spain

Received 4 August 1989; revised 10 November 1989; .

Address for reprints. J. Candell-Riera, Servicio de Cardiologia, Hospital General Vall d'Hebron, Paseo Vall d'Hebron, s/n, 08035 Barcelona, Spain.

Abstract

The aim of the present study was to evaluate the yield of radionuclide studies for the diagnosis of coronary artery disease (coronary artery narrowing > 50%) in a prospective series of 73 patients with thoracic pain and equivocal electrocardiographc stress testing. In the study population, the prevalence of coronary artery disease was 51%. The sensitivity, specificity, diagnostic accuracy and the post-test probability difference curves according to the Bayes' theorem were calculated for 201-thallium exercise testing and radionuclide exercise equilibrium ventriculography. For the latter study the following criteria were considered: (1) increase in left ventricular ejection fraction <5%: (2) the criterion proposed by Rozanski; (3) decrease in regional ejection fraction; and (4) abnormalities in phase and amplitude analysis (Fourier).

201-thallium exercise testing was the most sensitive (97%) and accurate (86%) study. Radionuclide ventriculography sensitivity was always lower for any criterion, although its best result was for evaluation of regional ejection fraction (85%). The most specific study was Fourier analysis (97%), although its sensitivity was low (42%).

The application of Bayes' theorem to these results shows that the highest post-test probability difference values were achieved with 201-thallium exercise testing for prevalences higher than 40% and with Fourier analysis for lower prevalences.

Key Words: Thallium-201 • radionuclide ventriculography • coronary artery disease


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