Identification of severe and extensive coronary artery disease by postexercise regional wall station abnormalities in Tc-99m sestamibi gated single-photon emission computed tomography

Postexercise wall motion abnormality (WMA) in patients with normal resting myocardial perfusion may represent prolonged postischemic stunning, and may be related to the presence of severe angiographic coronary artery disease (CAD). This study assesses the diagnostic value of postexercise WMA by tech netium-99m (Tc-99m) sestamibi gated single-photon emission computed tomogra phy (SPECT) in patients with normal resting perfusion. Ninety-nine patients underwent exercise gated Tc-99m sestamibi/resting thallium-201 SPECT and c oronary angiography within 90 days of nuclear testing. All patients had nor mal perfusion at rest. Multivariate logistic regression analysis demonstrat ed an incremental value of wall motion and perfusion over perfusion data al one in identifying severe and extensive CAD. Sensitivity for identifying an y severely stenosed coronary artery by WMA was significantly higher than by severe perfusion defect (78% vs 49%, p <0.0001). Overall specificities of severe perfusion defect and WMA were 91% and 85%, respectively (p = NS). Th us, postexercise WMA detected by gated Tc-99m sestamibi SPECT in patients w ith normal resting perfusion is a sensitive marker of severe and extensive CAD. (C) 2000 by Excerpta Medica, Inc.