Guidelines for the interpretation of the exercise radionuclide ventriculogram for diagnosing coronary artery disease

In 622 patients with known coronary artery anatomy, heart rate (HR) · blood pressure (BP) product and left ventricular (LV) ejection fraction (EF) at maximal supine exercise measured by radionuclide ventriculography were used to estimate, by logistic regression analysis, the probabilities of absence of significant coronary artery disease (CAD), presence of significant CAD, presence of multivessel CAD and presence of 3-vessel CAD. Thus, for example, estimated probabilities of each of the aforementioned 4 categories of CAD are 0.39, 0.61, 0.32 and 0.12, respectively, for HR · BP product of 26,000 beats · mm Hg/min and LVEF of 0.6 at maximal exercise and 0.08, 0.92, 0.77 and 0.48, respectively, for HR · BP of 15,000 and LVEF of 0.4. The graphic presentations of these estimated probabilities form useful guidelines for interpreting the results of exercise radionuclide ventriculography. In addition, specific cutoff values at maximal exercise defined 2 groups: (HR · BP product ≥ 21,000 beats · mm Hg/min and LVEF ≥ 0.55) with a high (70%) likelihood of absence of significant CAD or 1-vessel CAD and a low (7%) likelihood of 3-vessel CAD, and (HR · BP product < 21,000 and LVEF < 0.55) with a high (72%) likelihood of multivessel CAD and a low (8%) likelihood of absence of CAD.