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Left ventricular angiography on exercise. A new method of assessing left ventricular function in ischaemic heart
Insights
Left ventricular function during exercise differs significantly in patients with ischemic heart disease, especially those experiencing angina. Angiography reveals distinct changes in ventricular volumes, highlighting limitations of ejection fraction at rest.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Assessing left ventricular function is crucial in ischemic heart disease.
- Previous studies have explored various parameters, but a clear understanding of exercise-induced changes, particularly concerning angina, remains important.
Purpose of the Study:
- To investigate and differentiate left ventricular function in patients with ischemic heart disease (IHD) compared to healthy individuals during supine leg exercise.
- To specifically analyze the impact of angina presence on left ventricular performance in IHD patients.
Main Methods:
- Studied 17 patients with IHD (subdivided into 'with angina' and 'without angina') and 4 healthy controls.
- Utilized supine leg exercise to assess cardiac function.
- Employed angiographic methods to measure left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV).
Main Results:
- At rest, no significant differences in heart rate, cardiac output, stroke volume, or left ventricular end-diastolic pressure (LVEDP) were observed between groups.
- During exercise, cardiac output and stroke volume were depressed, and LVEDP was elevated in the overall IHD group.
- Exercise revealed distinct changes: decreased LVEDV/LVESV in controls, no change in IHD without angina, and increased LVEDV/LVESV in IHD with angina.
Conclusions:
- Angiographic assessment of left ventricular volumes during exercise effectively differentiates between normal individuals, IHD patients without angina, and IHD patients with angina.
- The presence of angina significantly impacts left ventricular volume dynamics during exercise.
- Standard ejection fraction measurements at rest may not consistently reflect exercise-induced functional changes in left ventricular performance.
Abstract:
Left ventricular function was studied in 17 patients with ischaemic heart disease and compared with 4 patients with normal left ventricular function. The patients in the homogeneous group of ischaemic heart disease were further subdivided into those 'without angina' (n=5) and those 'with angina' (n=12), depending upon the presence of angina during supine leg exercise at the time of definitive study. At rest there was no significant difference in the heart rate, cardiac output, stroke volume, and left ventricular end-diastolic pressure (LVEDP) in the three groups. During exercise the cardiac output and stroke volume were significantly depressed and LVEDP was significantly raised in the ischaemic heart disease group as a whole but within this group failed to show any significant difference in patients with and without angina. The left ventricular end-diastolic volume (LVEDV) and end-systolic volume (LVESV) measurements showed clear separation of these three groups only on exercise. On exercise, there was decrease in LVEDV and LVESV (P less than 0.05; P less than 0.02) in the group with normal left ventricular function, no change in the group with ischaemic heart disease without angina, and striking increase in LVEDV and LVESV in the group with ischaemic heart disease and angina (P less than 0.01 and P less than 0.02, respectively). This angiographic method of assessing left ventricular function shows clear separation of the three groups and also highlights the significance of angina. Ejection fraction (EF), a commonly measured parameter of left ventricular function, failed to reflect consistent changes on exercise as compared to values at rest which emphasizes the limitations of the measurement of ejection fraction at rest.