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Left ventricular ejection fraction change with exercise versus ejection fraction at rest in coronary artery disease:

Phyllis G Supino1, Edmund M Herrold, Frank Braegelman

  • 1Division of Cardiovascular Pathophysiology, Weill Medical College of Cornell University, New York, NY, USA.

American Journal of Therapeutics
|May 11, 2004
PubMed

Insights

The change in left ventricular ejection fraction (LVEF) with exercise varies significantly based on resting LVEF in coronary artery disease patients. Lower resting LVEF shows less variability and smaller exercise-induced changes in LVEF.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Clinical Prognostics

Background:

  • Previous studies show conflicting prognostic value of exercise-induced changes in left ventricular ejection fraction (Delta LVEF) in coronary artery disease (CAD).
  • Discrepancies may stem from patient selection, particularly variations in resting LVEF (LVEFrest).
  • The influence of LVEFrest on exercise response of LVEF remains under-investigated.

Purpose of the Study:

  • To investigate the relationship between resting LVEF (LVEFrest) and the magnitude and variability of exercise-induced changes in LVEF (Delta LVEF).
  • To determine if LVEFrest influences the predictive accuracy of Delta LVEF in patients with CAD.

Main Methods:

  • Analysis of data from 2655 patients with clinically evident CAD undergoing rest/exercise radionuclide cineangiography.
  • Stratification of patients into five LVEFrest subgroups: <30%, 30%-44%, 45%-59%, 60%-75%, and >75%.
  • Comparison of the standard deviation and average magnitude of Delta LVEF across LVEFrest subgroups.

Main Results:

  • The standard deviation of Delta LVEF was significantly lower in patients with LVEFrest <30% compared to higher LVEFrest subgroups (P < 0.00001).
  • The average increase and decrease in LVEF with exercise were smallest in the LVEFrest <30% group (P < 0.0001).
  • These findings suggest LVEFrest impacts Delta LVEF variability and magnitude.

Conclusions:

  • Resting LVEF significantly influences the exercise-induced changes and variability in LVEF in patients with CAD.
  • This relationship may explain discrepancies in the predictive accuracy of Delta LVEF across different study populations.
  • Further research is needed to assess the utility of incorporating LVEFrest into exercise-based prognostic assessments for individual patients.

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