Clinical and hemodynamic significance of left ventricular diastolic volume changes by exercise radionuclide ventriculography in coronary artery disease

Document Type

Journal Article

Publication Date

3-1-1989

Journal

The American Journal of Cardiology

Volume

63

Issue

9

DOI

10.1016/0002-9149(89)90892-8

Abstract

Recent studies have suggested that left ventricular (LV) dilatation during exercise radionuclide ventriculography may identify coronary artery disease (CAD). Coronary anatomy and LV end-diastolic pressure at catheterization were compared with results of supine exercise radionuclide ventriculography in 66 patients evaluated for chest pain. Forty-six patients had significant CAD (>75% diameter stenosis) and 20 patients were normal. Radionuclide ventriculography was performed within 18 hours of catheterization, at rest and at peak exercise. Relative LV end-diastolic volumes were extrapolated from end-diastolic counts. LV end-diastolic counts increased during exercise in 19 of 20 normal subjects. In patients with CAD, LV end-diastolic counts increased in 35 (group A) and decreased in 11 (group B). The percent change in LV end-diastolic counts from rest to exercise, rest ejection fraction, exercise ejection fraction and rest LV end-diastolic pressure for each group were 20 ± 23%, 60 ± 13%, 67 ± 13% and 8 ± 3 mm Hg in normal subjects; 20 ± 20%, 50 ± 12%, 47 ± 13% and 12 ± 4 mm Hg in group A; and -9 ± 8%, 54 ± 21%, 49 ± 18% and 21 ± 7 mm Hg in group B (mean ± standard deviation). An increase in LV end-diastolic counts was unrelated to ejection fraction response or presence of underlying CAD but only correlated to rest LV end-diastolic pressure (p < 0.01). Both normal subjects and group A patients with CAD increased LV end-diastolic counts in the setting of a normal LV end-diastolic pressure, whereas group B patients with CAD and high LV end-diastolic pressure decreased LV end-diastolic counts. Thus, supine exercise-induced left ventricular dilatation is the expected response in normal subjects and patients with CAD and normal filling pressure. © 1989.

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