Ambulatory radionuclide monitoring of the left ventricular function with the nuclear vest was performed at the time of treadmill testing in 52 patients after an uncomplicated myocardial infarction to identify patients at high risk for clinical events during the 1st year. The patients were evaluated with the nuclear vest during their postinfarction treadmill exercise, activities aimed at provoking myocardial ischemia, and during routine ambulation. Of the 52 patients, 18 had ischemic responses on treadmill testing, but the vest demonstrated 72 ischemic ejection fraction responses in 29 patients. Fifty-one of these episodes were found with exercise (n = 27),mental stress (n = 17), or other provocative maneuvers, while 21 episodes in 14 patients were unprovoked occurring during routine ambulatory activities. During the 15-month follow-up period, 16 patients experienced an adverse cardiac event (31 %), including 6 with recurrent infarction or unstable angina, 1 cardiac death, and 9 referred for angioplasty or bypass surgery because of new or increasing symptoms. Of the 16 adverse events, ambulatory vest studies predicted 15, for a 94% sensitivity, a 62% specificity, and a positive predictive value of 52%, and were more sensitive than treadmill testing which only identified 10 patients. Four particular findings on ambulatory ventricular functioning monitoring helped predict patient outcome. The magnitude of the ejection fraction response to provocative maneuvers identified high-risk patients, as 14 of 17 who demonstrated a decrease in ejection fraction of > 10 ejection fraction units during exercise, mental stress, or other maneuvers had events. Unprovoked ischemic episodes occured in 14 patients; 12 had cardiac complications (75% sensitivity, 95% specificity, 86% predictive value). Mental stress induced ischemia was also a powerful predictor of outcome, as 13 of 17 patients with this finding had cardiac events (81 % sensitivity, 89% specificity, 76% predictive value). Finally, 9 of 11 patients who developed a fall in ejection fraction within 6 min of treadmill exercise had cardiac events. Ambulatory monitoring with the nuclear vest was useful in predicting the prognosis in the postinfarction patients and provided a complete assessment of the factors which may initiate myocardial ischemia in individual patients.

Keywords:
Ambulatory radionuclide monitoring, Silent ischemia, Myocardial infarction, Prognosis
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1991
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