Related Experiment Video
Updated: May 25, 2026
Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice
Published on: April 13, 2015
Ejection fraction change and coronary artery disease severity: a vasodilator contrast stress-echocardiography study
Angelo Squeri1, Nicola Gaibazzi, Claudio Reverberi
1U.O. Cardiologia, Dipartimento Cardio-Nefro-Polmonare, Azienda Ospedaliero, Universitaria di Parma, Via Gramsci 14, Parma, Italy. angelo.squeri@yahoo.it
Insights
Change in left ventricular ejection fraction (ΔLVEF) during dipyridamole stress echocardiography can identify patients with severe coronary artery disease. A reduced or negative ΔLVEF indicates multivessel disease and identifies high-risk individuals.
Area of Science:
- Cardiology
- Noninvasive Cardiac Imaging
- Coronary Artery Disease
Background:
- Identifying patients with left main or three-vessel coronary artery disease (CAD) is crucial for prognosis in ischemic heart disease.
- Standard vasodilator stress echocardiography may not reveal multivessel disease through wall motion abnormalities alone.
Purpose of the Study:
- To evaluate the utility of change in left ventricular ejection fraction (ΔLVEF) in identifying patients with multivessel obstructive coronary artery disease.
- To assess ΔLVEF during dipyridamole stress echocardiography.
Main Methods:
- Retrospective review of 150 patients undergoing dipyridamole stress echocardiography and subsequent coronary angiography.
- Calculation of ΔLVEF by subtracting rest ejection fraction from stress ejection fraction.
- Classification of patients into control, single-vessel, two-vessel, and three-vessel disease groups based on angiography.
Main Results:
- Mean ΔLVEF was negative in patients with three-vessel or left main CAD (-2.8 ± 5.1%), significantly lower than in single-vessel (10.2 ± 5.1%) or two-vessel disease (6.2 ± 4.1%) groups.
- The decrease in ΔLVEF in three-vessel disease was primarily due to increased end-systolic volume.
- ΔLVEF demonstrated excellent accuracy (AUC 0.96) in identifying multivessel disease, outperforming wall motion score index changes (AUC 0.62).
Conclusions:
- A significantly lower ΔLVEF is observed in patients with severe coronary artery disease (three-vessel or left main).
- Reduced ΔLVEF effectively identifies high-risk patients with multivessel obstructive CAD.
- These findings suggest that reduced ΔLVEF can guide more aggressive therapeutic strategies for high-risk patients.
Background:
An important goal of noninvasive stress testing is the identification of patients with left main coronary artery or three-vessel disease, because coronary artery disease extension and severity are major prognostic factors in ischemic heart disease. Wall motion abnormalities during vasodilator stress echocardiography become apparent in more than one coronary territory only in a small number of patients with multivessel disease. The aim of this study was to assess the value of change in left ventricular ejection fraction change (ΔLVEF) to identify patients with multivessel obstructive coronary artery disease during dipyridamole stress echocardiography.
Methods:
All dipyridamole stress echocardiographic studies performed at the authors' institution from October 2007 through March 2010 were retrospectively reviewed, and 150 patients who underwent coronary angiography within the next 60 days were selected. Left ventricular end-diastolic volume and end-systolic volume were measured at baseline and at the end of high-dose dipyridamole; ΔLVEF was calculated as stress ejection fraction minus rest ejection fraction. Patients were divided into four groups (controls and patients with single-vessel, two-vessel, and three-vessel disease) on the basis of coronary angiographic results.
Results:
The mean LVEF increased significantly from rest to peak stress in all groups except the three-vessel disease group. Mean ΔLVEF was negative in patients with three-vessel or left main coronary artery disease (-2.8 ± 5.1%) and significantly lower compared with all other angiographic groups (10.2 ± 5.1% and 6.2 ± 4.1%, respectively, for single-vessel and two-vessel disease). The negative value of ΔLVEF for three-vessel disease was due mainly to increased end-systolic volume at peak stress. Receiver operating characteristic curves demonstrated excellent accuracy of ΔLVEF compared with change in wall motion score index in identifying patients with multivessel disease, with areas under the curves of 0.96 and 0.62, respectively.
Conclusions:
ΔLVEF is significantly lower in patients with severe coronary artery disease compared with those with single-vessel or two-vessel disease; reduced ΔLVEF identifies high-risk patients, who are likely to benefit from a more aggressive therapeutic strategy.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:20Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for diagnosing...
01:17Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion, evaluates...
01:26Coronary Artery Disease II: Pathophysiology