Detection of coronary heart disease using radionuclide determined regional ejection fraction at rest and during handgrip exercise: correlation with coronary arteriography.

SUMMARY The detection of regional asynergy provides strong evidence for a critical reduction of coronary blood flow to that zone. In the present study, the usefulness of combining computer-assisted radionuclide angiography and isometric handgrip exercise testing to detect coronary heart disease (CHD) was evaluated. One hundred twenty-nine patients with chest pain undergoing cardiac catheterization were evaluated using radionuclide angiography. Thirty-four patients were found to have severe contraction abnormalities during the initial radionuclide angiographic study. Of these, 33 had significant CHD. Ninety-five patients had normal or borderline normal left ventricular contraction and therefore underwent a second radionuclide angiogram during handgrip. Radionuclide angiogram data were quantitatively analyzed by computer to determine regional left ventricular contribution to ejection fraction during handgrip stress. Of the 95 patients, 30 had normal coronary arteries of whom 26 (87%) had normal relative regional ejection fraction. Sixty-five patients had CHD; 20 had single and 45 had two or three vessel obstructive disease. Of the 20 with single vessel disease, 16 (nine at rest and an additional seven during handgrip) had an area of decreased relative regional ejection fraction ranging from 31-87% in the corresponding segment during radionuclide angiography. Of the 45 patients with two or three vessel disease, 40 had regional abnormalities in ejection fraction during handgrip of from 31-100% (24 at rest and an additional 16 during handgrip). Moreover, 24 of these patients had multiple abnormalities in relative regional ejection fraction indicating multivessel disease. Overall, of the 95 patients who underwent isometric handgrip stress, sensitivity was 86% for detection of CHD and specificity was 87% for accurately defining the patients with normal coronary arteries.The results of the present study suggest that the radionuclide angiographic assessment of relative regional ejection fraction during isometric handgrip exercise may provide a useful new diagnostic approach for patients with suspected CHD as well as providing important additional data concerning its location and severity.