TY - JOUR
T1 - Right ventricular ejection fraction response to exercise in patients with coronary artery disease
T2 - influence of both right coronary artery disease and exercise-induced changes in right ventricular afterload
AU - Brown, Kenneth A.
AU - Okada, Robert D.
AU - Boucher, Charles A.
AU - Strauss, H. William
AU - Pohost, Gerald M.
N1 - Funding Information:
From the Cardiac Unit, Department of Medicine and Division of Nuclear Medicine, Massachusetts General Hospital, Boston, Massachusetts. This study was supported in part by U.S. Public Health Service Research Grants HL21751 and HL26215 and Cardiovascular Nuclear Medicine Training Grant HL07416 from the National Institutes of Health, Bethesda, Maryland. Drs. Okada and Pohost are Established Investigators of the American Heart Association, Dallas, Texas. Manuscript received June 27, 1983: revised manuscript received October 31, 1983, accepted November 4, 1983.
PY - 1984
Y1 - 1984
N2 - To determine the influence of proximal right coronary artery disease and right ventricular afterload on right ventricular ejection fraction response to exercise, 64 patients were studied at rest and after supine exercise with gated equilibrium radionuclide angiography and coronary angiography. Right ventricular afterload response to exercise was estimated from determinations of exercise-induced changes in pulmonary blood volume, previously shown to correlate with exercise-induced changes in pulmonary capillary wedge pressure. Values for right ventricular ejection fraction decreased from rest to exercise (48 ± 5% to 42 ± 9%, p < 0.001) in patients with an elevated pulmonary blood volume ratio, but increased from 48 ± 5% to 54 ± 6% (p < 0.001) in patients with a normal pulmonary blood volume ratio. Values were unchanged in patients with isolated proximal right coronary artery disease (rest 49 ± 3%, exercise 47 ± 7%), decreased in patients with combined right and left coronary disease (rest 48 ± 6%, exercise 39 ± 10%, p < 0.001) and increased (rest 47 ± 5%, exercise 52 ± 6%, p < 0.001) in patients with isolated left coronary artery disease. To determine the coinfluence of coronary anatomy and changes in pulmonary blood volume, patients were classified by pulmonary blood volume ratio. Among patients with a normal pulmonary blood volume ratio, right ventricular ejection fraction did not change significantly in those with proximal right coronary artery disease during exercise, but increased significantly in patients with isolated left coronary disease. Among patients with an elevated pulmonary blood volume ratio, right ventricular ejection fraction during exercise increased significantly in those with proximal right coronary artery disease but was unchanged in patients with isolated left coronary disease. Thus, the right ventricular ejection fraction response to exercise appears to be influenced by both patency of the right ventricular coronary blood supply and by exercise-induced changes in pulmonary blood volume, which reflect increases in pulmonary capillary wedge pressure and thus right ventricular afterload. The effects of these two factors on right ventricular ejection fraction appear to be additive.
AB - To determine the influence of proximal right coronary artery disease and right ventricular afterload on right ventricular ejection fraction response to exercise, 64 patients were studied at rest and after supine exercise with gated equilibrium radionuclide angiography and coronary angiography. Right ventricular afterload response to exercise was estimated from determinations of exercise-induced changes in pulmonary blood volume, previously shown to correlate with exercise-induced changes in pulmonary capillary wedge pressure. Values for right ventricular ejection fraction decreased from rest to exercise (48 ± 5% to 42 ± 9%, p < 0.001) in patients with an elevated pulmonary blood volume ratio, but increased from 48 ± 5% to 54 ± 6% (p < 0.001) in patients with a normal pulmonary blood volume ratio. Values were unchanged in patients with isolated proximal right coronary artery disease (rest 49 ± 3%, exercise 47 ± 7%), decreased in patients with combined right and left coronary disease (rest 48 ± 6%, exercise 39 ± 10%, p < 0.001) and increased (rest 47 ± 5%, exercise 52 ± 6%, p < 0.001) in patients with isolated left coronary artery disease. To determine the coinfluence of coronary anatomy and changes in pulmonary blood volume, patients were classified by pulmonary blood volume ratio. Among patients with a normal pulmonary blood volume ratio, right ventricular ejection fraction did not change significantly in those with proximal right coronary artery disease during exercise, but increased significantly in patients with isolated left coronary disease. Among patients with an elevated pulmonary blood volume ratio, right ventricular ejection fraction during exercise increased significantly in those with proximal right coronary artery disease but was unchanged in patients with isolated left coronary disease. Thus, the right ventricular ejection fraction response to exercise appears to be influenced by both patency of the right ventricular coronary blood supply and by exercise-induced changes in pulmonary blood volume, which reflect increases in pulmonary capillary wedge pressure and thus right ventricular afterload. The effects of these two factors on right ventricular ejection fraction appear to be additive.
UR - https://www.scopus.com/pages/publications/0021347323
U2 - 10.1016/S0735-1097(84)80346-0
DO - 10.1016/S0735-1097(84)80346-0
M3 - Article
AN - SCOPUS:0021347323
SN - 0735-1097
VL - 3
SP - 895
EP - 901
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 4
ER -