Comparative accuracy of wall-motion analysis by digital subtraction and first-pass radionuclide ventriculography1

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Forty-six patients referred for coronary angiography and direct contrast ventriculography were also examined using first-pass radionuclide and digital subtraction ventriculography for detection of wall motion abnormalities at rest. All three ventriculograms were reviewed by independent observers and the five wall segments graded on the right anterior oblique view as normal, mildly hypokinetic, moderately hypokinetic, severely hypokinetic, akinetic, or dyskinetic. Though the resting radionuclide ventriculogram was superior for identifying ventricles which were normal according to direct contrast ventriculography (89% versus 63%), digital subtraction ventriculography was more sensitive for identification of abnormal ventricles (100% versus 74%), particularly in identifying akinetic segments (77% versus 23%) and distinguishing segmental from diffuse ventricular dysfunction (100% versus 44%). Digital ventriculography caused overestimation of wall segment abnormality, while radionuclide ventriculography caused underestimation of segmental dysfunction. The authors conclude that digital subtraction ventriculography is more sensitive than radionuclide ventriculography but also less specific.



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