Effects of beta-adrenergic blocking drugs on sensitivity and specificity of radionuclide ventriculography during exercise in patients with coronary heart disease

doi:10.1016/0002-8703(83)90192-8

American Heart Journal

Volume 106, Issue 2, August 1983, Pages 271-278

https://doi.org/10.1016/0002-8703(83)90192-8 Get rights and content

Abstract

We examined the impact of beta-adrenergic blocking drugs on the sensitivity and specificity of radionuclide ventriculography in 95 patients with angiographically proved coronary disease and in 22 angiographically normal subjects. Sixty of the former and seven of the latter were receiving beta-adrenergic blocking agents. All had normal regional and global left ventricular function at rest. Exercise-induced asynergy and failure of exercise to increase ejection fraction by at least 0.05 were considered abnormal findings. The specificity of the criterion, failure to increase ejection fraction, was so impaired (0.87 vs 0.29) by these agents as to negate the usefulness of that observation for the diagnosis of coronary disease. The utility of the ejection fraction measurement to assess the severity of occlusive disease is also compromised, since that response is ameliorated by these drugs. An exercise-induced decline in ejection fraction of at least 0.05 was observed significantly less frequently in patients receiving beta blockers (30% vs 54%; p < 0.025).

References (20)

RD Okada et al.
Exercise radionuclide imaging approaches to coronary artery disease
Am J Cardiol
(1980)
JS Borer et al.
Sensitivity, specificity, and predictive accuracy of radionuclide cineangiography during exercise in patients with coronary artery disease
Circulation
(1979)
A Battler et al.
Improvement in exercise-induced left ventricular dysfunction with oral propranolol in patients with coronary heart disease
Am J Cardiol
(1979)
RC Marshall et al.
Effect of oral propranolol on rest, exercise, and post-exercise left ventricular performance in normal subjects and patients with coronary artery disease
Circulation
(1981)
S Port et al.
Effects of propranolol on left ventricular function in normal men
Circulation
(1980)
SG Sorensen et al.
Serial exercise radionuclide angiography
Circulation
(1980)
J Lindsay et al.
Usefulness of radionuclide ventriculography for the identification and assessment of patients with coronary heart disease
Am Heart J
(1980)
NG Nolan et al.
The radionuclide cardiac ventriculogram
Eur J Nucl Med
(1980)
DG Pavel et al.
In vivo labelling of red blood cells with 99-m TC: A new approach to blood pool visualization
J Nucl Med
(1977)
DG Pavel et al.
Multifaceted evaluation of left ventricular function by the first transit technique using Anger H type camera and an optimal protocol; correlation with biplane roentgen angiography. Nuclear cardiology: Selected computer aspects

There are more references available in the full text version of this article.

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Effects of beta-adrenergic blocking drugs on sensitivity and specificity of radionuclide ventriculography during exercise in patients with coronary heart disease

Abstract

Exercise radionuclide imaging approaches to coronary artery disease

Am J Cardiol

Sensitivity, specificity, and predictive accuracy of radionuclide cineangiography during exercise in patients with coronary artery disease

Circulation

Improvement in exercise-induced left ventricular dysfunction with oral propranolol in patients with coronary heart disease

Am J Cardiol

Effect of oral propranolol on rest, exercise, and post-exercise left ventricular performance in normal subjects and patients with coronary artery disease

Circulation

Effects of propranolol on left ventricular function in normal men

Circulation

Serial exercise radionuclide angiography

Circulation

Usefulness of radionuclide ventriculography for the identification and assessment of patients with coronary heart disease

Am Heart J

The radionuclide cardiac ventriculogram

Eur J Nucl Med

In vivo labelling of red blood cells with 99-m TC: A new approach to blood pool visualization

J Nucl Med

Multifaceted evaluation of left ventricular function by the first transit technique using Anger H type camera and an optimal protocol; correlation with biplane roentgen angiography. Nuclear cardiology: Selected computer aspects