Worsening Left Ventricular Performance on Serial Exercise Radionuclide Angiography Does Not Identify High-Risk Patients

To determine whether worsening exercise performance on serial exercise radionuclide angiography identifies patients at increased risk of future cardiac events. One hundred nine medically treated patients with previous Q-wave myocardial infarction underwent two exercise radionuclide angiographic studies at least 6 months apart (median, 16 months) without an intervening clinical event. Worsening exercise performance between the two studies was defined by five criteria: (1) lower (5% or more) peak exercise ejection fraction; (2) worsening peak exercise wall motion score; (3) combination of criteria 1 and 2; (4) worsening serial delta (exercise – rest) ejection fraction; or (5) increasing exercise ST-segment depression of 1mm or more. Patients were followed up for a median duration of 3.9 years after the second exercise study. Five cardiac deaths and 10 nonfatal myocardial infarctions occurred during follow-up. A Cox proportional hazards analysis failed to show an association between any of the aforementioned variables and cardiac events. Of the 15 patients with cardiac events, 4 (27%) had a lower (5% or more) exercise ejection fraction and 2 (13%) had a worsening exercise wall motion score. Of the 94 patients without cardiac events, 37 (39%) had a lower (5% or more) exercise ejection fraction and 28 (30%) had a worsening serial exercise wall motion score (not a statistically significant difference). Worsening exercise performance on serial exercise radionuclide angiography does not identify patients at increased risk of future cardiac events.