Exercise myocardial perfusion and wall motion imaging to predict recurrence of angina pectoris after successful angioplasty.

Objectives: This study investigates the predictive value of concurrent exercise radionuclide ventriculography and myocardial perfusion scintigraphy obtained six weeks after successful percutaneous transluminal coronary angioplasty for the recurrence of angina.

Methods: Both studies were obtained simultaneously with a single injection of technetium-99m sestamibi using the first-pass technique and the computerized tomographic technique, respectively. Ninety-five patients were investigated at rest and at maximal exercise 6 weeks after technically successful coronary angioplasty.

Results: Exercise-induced left ventricular dysfunction was present in 44 patients (46%). Exercise-induced myocardial perfusion defects were noted in 29 patients (30%). All patients underwent a six months follow-up. Seventeen patients (18%) had recurrent angina pectoris. Exercise-induced left ventricular dysfunction at six weeks after angioplasty 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 a very high (40%) and very low (7%) risk of recurrent angina.

Conclusion: Exercise-induced left ventricular dysfunction is more strongly associated with the recurrence of angina pectoris during a 6 month follow-up than are exercise-induced myocardial perfusion defects.