Diagnostic accuracy of radionuclide techniques in patients with equivocal electrocardiographic exercise testing

The aim of the present study was to evaluate the yield of radionuclide studies for the diagnosis of coronary artery disease (coronary artery narrowing greater than 50%) in a prospective series of 73 patients with thoracic pain and equivocal electrocardiographic stress testing. In the study population, the prevalence of coronary artery disease was 51%. The sensitivity, specificity, diagnostic accuracy and the post-test probability difference curves according to the Bayes' theorem were calculated for 201-thallium exercise testing and radionuclide exercise equilibrium ventriculography. For the latter study the following criteria were considered: (1) increase in left ventricular ejection fraction less than 5%; (2) the criterion proposed by Rozanski; (3) decrease in regional ejection fraction; and (4) abnormalities in phase and amplitude analysis (Fourier). 201-thallium exercise testing was the most sensitive (97%) and accurate (86%) study. Radionuclide ventriculography sensitivity was always lower for any criterion, although its best result was for evaluation of regional ejection fraction (85%). The most specific study was Fourier analysis (97%), although its sensitivity was low (42%). The application of Bayes' theorem to these results shows that the highest post-test probability difference values were achieved with 201-thallium exercise testing for prevalences higher than 40% and with Fourier analysis for lower prevalences.