Detection of left ventricular wall motion abnormalities for the diagnosis of coronary artery disease: a comparison of exercise radionuclide and pacing intravenous digital ventriculography.

Intravenous digital ventriculography before and after pacing was compared with equilibrium gated nuclear ventriculography at rest and after exercise. Specifically, the relative abilities of the 2 techniques to detect resting and stress-related wall motion abnormalities were tested. Twelve normal patients and 28 patients with coronary artery disease (CAD) were tested. Neither technique produced a new wall motion abnormality in a patient with normal coronary arteries. Six patients with CAD had a history of a myocardial infarction (MI); an abnormality at rest was present in all 6 by both techniques. Of the 22 patients with CAD and a normal baseline ventriculogram, a wall motion abnormality developed in 18 during digital ventriculography with pacing; a wall motion abnormality developed in 15 with exercise nuclear ventriculography. Wall motion abnormalities by nuclear ventriculography (performed in the left anterior oblique projection) tended to be apical; digital ventriculography (performed in the right anterior oblique projection) more often produced an abnormality of the anterior or inferior wall, which could be predictive of coronary anatomy. Thus, the 2 techniques are substantially equivalent for the detection of wall motion abnormalities in CAD.