Exercise radionuclide ventriculography is commonly used in patients with coronary artery disease, for both diagnostic purposes and patient management decisions. Both applications are reviewed in this article. There has been much debate as to the diagnostic efficacy of this test. Four factors influence this determination: (1) patient referral biases, (2) the optimal criteria for test interpretation, (3) the technique for performing radionuclide ventriculography, and (4) technical factors. The role of each factor is discussed. After consideration of these factors, it is concluded that the diagnostic efficacy of exercise radionuclide ventriculography is high. This test is used as a criterion for many patient management decisions, such as the need for coronary artery bypass surgery or coronary angioplasty. This test is well suited for such purposes because of its ability to quantitate the magnitude of ischemia. In addition to left ventricular ejection fraction, the importance of the following five wall motion variables are reviewed relative to the information they provide regarding ischemic magnitude: (1) extent, (2) magnitude, (3) time to onset and (4) duration of exercise-induced wall motion abnormalities, and (5) the paradoxical reversal of rest abnormalities following exercise. It is shown how consideration of all potential variables enhances the clinical utility of this test.
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