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Relation between left ventricular function at rest and with exercise and silent myocardial ischemia
A A Quyyumi1, J A Panza, J G Diodati
1Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892.
Journal of the American College of Cardiology
|April 1, 1992
Summary
Radionuclide ventriculography assessing left ventricular function is sensitive for detecting silent ischemia during ambulatory ECG monitoring. However, exercise-induced dysfunction doesn't always correlate with ST depression, suggesting different prognostic insights.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Electrophysiology
Background:
- Radionuclide measures of left ventricular function (LVF) predict prognosis.
- Silent ischemia during ambulatory monitoring also offers prognostic value.
- Direct comparisons between these methods are lacking.
Purpose of the Study:
- To examine the relationship between radionuclide ventriculography (radionuclide assessment of LVF) and myocardial ischemia during ambulatory ECG monitoring.
- To compare the prognostic information from resting and exercise LVF with exercise-induced ischemia.
Main Methods:
- 155 patients with coronary artery disease underwent radionuclide ventriculography (rest and exercise) and 48-hour ambulatory ECG monitoring.
- Left ventricular dysfunction was defined by ejection fraction changes.
- Ischemia was identified by ST segment depression during monitoring.
Main Results:
- 88% of patients showed exercise-induced LV dysfunction; 33% had resting LV dysfunction.
- Exercise-induced LV dysfunction was 94% sensitive for detecting ambulatory ischemic episodes.
- Only 55% of patients with exercise-induced LV dysfunction had ST depression; resting LV dysfunction was less prevalent in patients with ST depression (31% vs. 62%).
Conclusions:
- Exercise-induced left ventricular dysfunction on radionuclide ventriculography is a sensitive marker for detecting silent ischemia.
- The prognostic implications of radionuclide measures and ambulatory ECG monitoring may differ.
- Further research is needed to clarify the combined prognostic value of these techniques.