Effects of angiographic contrast medium on left ventricular function in coronary artery disease. Comparison with static and dynamic exercise

To evaluate several types of cardiovascular stress tests adaptable to the cardiac catheterization laboratory, modified ventricular function curves were constructed in 60 selected patients with a chest pain syndrome by plotting left ventricular stroke work index (SWI) against left ventricular end-diastolic pressure (EDP). After infusion of angiographic contrast medium, all normal control subjects exhibited an ascending ventricular function curve (λ[ΔSWI/ΔEDP]>0.1). Nine of the 10 patients with coronary artery disease and abnormal resting dynamics had a flat or depressed ventricular function curve. Twenty-six of the 37 patients with coronary artery disease and normal resting dynamics also had a depressed ventricular function curve. Nine normal subjects, when challenged by both static and dynamic exercise, exhibited an ascending ventricular function curve similar to the response to angiographic contrast medium. When 21 patients with coronary artery disease and normal dynamics underwent stress, flat or depressed ventricular function curves were seen in 71 percent of patients after infusion of angiographic contrast medium, 48 percent of the patients after static exercise, and 38 percent of patients after dynamic exercise. No patient with a normal response to the contrast medium had an abnormal response to either form of submaximal exercise. Thus, the combined hypervolemic and myocardial depressant effects of angiographic contrast medium serve as a convenient and reliable intervention to elicit left ventricular dysfunction in patients with coronary artery disease and normal ventricular function at rest.