TY - JOUR
T1 - Spectrum of global left ventricular responses to supine exercise. Limitation in the use of ejection fraction in identifying patients with coronary artery disease
AU - Osbakken, Mary D.
AU - Boucher, Charles A.
AU - Okada, Robert D.
AU - Bingham, John B.
AU - Strauss, H. William
AU - Pohost, Gerald M.
N1 - Funding Information:
From The Cardiac Unit and Division of Nuclear Medicine, Massachusetts General Hospital, Boston, Massachusetts. Supported in part by Research Grants HL 21751 and HL 26215 and Cardiovascular Nuclear Training Grant 1-732-HL-07416 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland. Manuscript received June 1, 1981; revised manuscript received July 2, 1982, accepted July 2, 1982.
PY - 1983/1/1
Y1 - 1983/1/1
N2 - Left ventricular function was evaluated with rest and supine bicycle exercise-multigated blood pool scans in 53 patients who had previously undergone coronary angiography for evaluation of a chest pain syndrome. There were 21 normal patients (<25% stenosis in any coronary artery, left ventricular end-diastolic pressure ≤12 mm Hg, and normal left ventriculography) and 32 patients with coronary artery disease (CAD) (>50% narrowing in 1 or more major coronary arteries). Thirty-two (60%) were receiving propranolol at the time of the study. The normal patient group had a significant increase in mean ejection fraction (EF) during exercise (+0.08 ± 0.09), while the CAD group had no increase (0 ± 0.11; p <0.05). Mean end-systolic volume decreased significantly in the normal group (-5 ± 8 ml/m2) but demonstrated no significant change in the CAD group (1 ± 12 ml/m2; p <0.05 compared with normal patients). There was no significant change in mean end-diastolic volume in either group. Mean ejection rate, mean peak systolic pressure/end-systolic volume ratio, and mean pulmonary blood volume ratio also differed in the normal versus CAD patients. Despite mean differences, there was considerable overlap in both groups of individual EF responses: 8 of 21 (38%) of the normal group did not have an increase in EF of 0.05 with exercise, while 15 of 32 (47%) of the CAD group did have an increase in EF of 0.05 with exercise. However, the addition of peak systolic pressure/end-systolic volume ratio and pulmonary blood volume (exercise/rest) ratio improved the sensitivity for detecting CAD from 53 to 84% without adversely affecting specificity. Thus, there is a wide spectrum of left ventricular EF responses to supine exercise. In our patient population, EF alone was an insensitive and nonspecific marker of CAD. The addition of other parameters of global left ventricular function, which may be generated using radionuclide angiography, helps distinguish patients with CAD from normal subjects.
AB - Left ventricular function was evaluated with rest and supine bicycle exercise-multigated blood pool scans in 53 patients who had previously undergone coronary angiography for evaluation of a chest pain syndrome. There were 21 normal patients (<25% stenosis in any coronary artery, left ventricular end-diastolic pressure ≤12 mm Hg, and normal left ventriculography) and 32 patients with coronary artery disease (CAD) (>50% narrowing in 1 or more major coronary arteries). Thirty-two (60%) were receiving propranolol at the time of the study. The normal patient group had a significant increase in mean ejection fraction (EF) during exercise (+0.08 ± 0.09), while the CAD group had no increase (0 ± 0.11; p <0.05). Mean end-systolic volume decreased significantly in the normal group (-5 ± 8 ml/m2) but demonstrated no significant change in the CAD group (1 ± 12 ml/m2; p <0.05 compared with normal patients). There was no significant change in mean end-diastolic volume in either group. Mean ejection rate, mean peak systolic pressure/end-systolic volume ratio, and mean pulmonary blood volume ratio also differed in the normal versus CAD patients. Despite mean differences, there was considerable overlap in both groups of individual EF responses: 8 of 21 (38%) of the normal group did not have an increase in EF of 0.05 with exercise, while 15 of 32 (47%) of the CAD group did have an increase in EF of 0.05 with exercise. However, the addition of peak systolic pressure/end-systolic volume ratio and pulmonary blood volume (exercise/rest) ratio improved the sensitivity for detecting CAD from 53 to 84% without adversely affecting specificity. Thus, there is a wide spectrum of left ventricular EF responses to supine exercise. In our patient population, EF alone was an insensitive and nonspecific marker of CAD. The addition of other parameters of global left ventricular function, which may be generated using radionuclide angiography, helps distinguish patients with CAD from normal subjects.
UR - http://www.scopus.com/inward/record.url?scp=0020695230&partnerID=8YFLogxK
U2 - 10.1016/S0002-9149(83)80007-1
DO - 10.1016/S0002-9149(83)80007-1
M3 - Article
C2 - 6849264
AN - SCOPUS:0020695230
SN - 0002-9149
VL - 51
SP - 28
EP - 35
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 1
ER -