Publication Description
The effectiveness of exercise-treadmill testing in diagnosing coronary-artery disease in hypertensive patients is limited by a high rate of false positivity. Exercise radionuclide ventriculography, however, relies on different criteria (ejection fraction and wall motion), and we have evaluated this procedure in 37 hypertensive and 109 normotensive patients with chest pain, using coronary adenography as an indicator of coronary disease. In the hypertensive cohort there was no difference in the ejection fraction at rest between the 17 patients with coronary disease and the 20 without it. Neither group had a significant mean (±S.E.M.) change in ejection fraction from rest to exercise (-1.9±2 and -1.4±1 per cent, respectively). A wall-motion abnormality developed during exercise in 5 of the 17 hypertensive patients with coronary disease (29 per cent) and in 4 of the 20 without it (20 per cent) (P = not significant). In the normotensive cohort, however, the peak-exercise ejection fractions were significantly different. The 71 patients with coronary disease had a mean decrease of 3.6±1 per cent, in contrast to the patients without coronary disease, who had an increase of 6±1 per cent (P<0.001). An exercise-induced wall-motion abnormality was seen in 35 of the 71 patients with coronary disease (48 per cent), as compared with 3 of the 38 without it, (8 per cent) (P<0.001). We conclude that exercise radionuclide ventriculography is inadequate as a screening test for coronary atherosclerosis in hypertensive patients with chest pain. (N Engl J Med 1984; 311:1276–80.) EXERCISE radionuclide ventriculography is increasingly considered a superior noninvasive screening test for coronary-artery disease. Its sensitivity and specificity have been shown to exceed those of non-imaging exercise studies. 1 2 3 4 As with all noninvasive tests, there are unaccountable diagnostic errors and subgroups of patients in whom the test has a low diagnostic accuracy. 5 6 7 8 In this study we describe a population, patients with systemic hypertension, in whom exercise radionuclide ventriculography may be a poor choice as a diagnostic procedure. Methods Study Population All hypertensive patients referred to us for cardiac catheterization because of chest pain were entered in this study. For comparison we . . .