Exercise Radionuclide Ventriculographic Responses in Hypertensive Patients with Chest Pain

Document Type

Journal Article

Publication Date

11-15-1984

Journal

New England Journal of Medicine

Volume

311

Issue

20

DOI

10.1056/NEJM198411153112003

Abstract

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.). © 1984, Massachusetts Medical Society. All rights reserved.

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