Dymond D S, Foster C, Grenier R P, Carpenter J, Schmidt D H
Am J Cardiol. 1984 Jun 1;53(11):1532-7. doi: 10.1016/0002-9149(84)90574-5.
Eleven patients without significant coronary artery disease (CAD) (group A), 22 patients with significant CAD and no prior myocardial infarction (MI) (group B), and 10 patients with CAD and a previous MI (group C) were imaged at rest, at peak exercise and immediately after exercise by first-pass radionuclide angiography. At peak exercise, mean left ventricular (LV) ejection fraction (EF) did not change significantly in group A or C and decreased significantly in group B. However, in all groups mean LVEF increased significantly immediately after exercise. Examination of potential criteria for an abnormal LVEF response showed that changes from rest to peak exercise were sensitive for detection of CAD but were not specific. Postexercise criteria were more specific but relatively insensitive: 15 of 32 patients (47%) with CAD showed a normal (greater than 5% increase over rest) response after exercise. Similarly, a regional abnormality at peak exercise was 100% sensitive, compared with a sensitivity of 78% after exercise for the whole group, and only 68% in patients without prior MI. Seven patients would have been misclassified as normal if postexercise imaging alone had been performed. The likelihood of an abnormal postexercise EF response was related to the extent of CAD: No patient with 1-vessel, 8 of 17 with 2-vessel and 9 of 12 with 3-vessel CAD showed such a response. Peak exercise imaging is necessary to achieve maximal sensitivity for the detection of CAD, and a high false-negative rate will be obtained if postexercise imaging only is used. The combination of peak exercise and postexercise imaging may be of value in assessing the severity of CAD.
对11例无明显冠状动脉疾病（CAD）的患者（A组）、22例有明显CAD但无既往心肌梗死（MI）的患者（B组）和10例有CAD且有既往MI的患者（C组）在静息状态、运动高峰时及运动后即刻进行首次通过放射性核素血管造影成像。在运动高峰时，A组和C组的平均左心室（LV）射血分数（EF）无显著变化，B组则显著降低。然而，在所有组中，运动后即刻平均LVEF均显著增加。对LVEF反应异常的潜在标准进行检查发现，从静息到运动高峰的变化对CAD的检测敏感但不特异。运动后标准更特异但相对不敏感：32例CAD患者中有15例（47%）运动后反应正常（比静息时增加超过5%）。同样，运动高峰时的局部异常敏感性为100%，而整个组运动后的敏感性为78%，无既往MI的患者中仅为68%。如果仅进行运动后成像，7例患者会被误分类为正常。运动后EF反应异常的可能性与CAD的程度有关：单支血管病变的患者无一人出现这种反应，双支血管病变的17例中有8例，三支血管病变的12例中有9例出现这种反应。运动高峰成像对于CAD检测实现最大敏感性是必要的，如果仅使用运动后成像将获得较高的假阴性率。运动高峰和运动后成像相结合可能对评估CAD的严重程度有价值。
