EXERCISE MYOCARDIAL PERFUSION AND WALL-MOTION IMAGING TO PREDICT RECURRENCE OF ANGINA-PECTORIS AFTER SUCCESSFUL ANGIOPLASTY

This study investigates the predictive value of concurrent exercise ra dionuclide ventriculography and myocardial perfusion scintigraphy obta ined six weeks after successful percutaneous transluminal coronary ang ioplasty for the recurrence of angina. Methods. Both studies were obta ined simultaneously with a single injection of technetium-99m sestamib i using the first-pass technique and the computerized tomographic tech nique, respectively. Ninety-five patients were investigated ar rest an d at maximal exercise 6 weeks after technically successful coronary an gioplasty. Results. Exercise-induced left ventricular dysfunction was present in 44 patients (46%). Exercise-induced myocardial perfusion de fects were noted in 29 patients (30%). All patients underwent a six mo nths follow-up. Seventeen patients (18%) had recurrent angina pectoris . Exercise-induced left ventricular dysfunction at six weeks after ang ioplasty was significantly associated with the recurrence of angina (p =0.002), but exercise-induced perfusion defects were not. An abnormal left ventricular response to exercise was more sensitive than exercise -induced perfusion defects (82% versus 47%) to identify those patients with recurrent angina. The combination of both tests allows to select patients at very high (40%) and very low (7%) risk of recurrent angin a. Conclusion. Exercise-induced left ventricular dysfunction is more s trongly associated with the recurrence of angina pectoris during a 6 m onth follow-up than are exercise-induced myocardial perfusion defects.