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Value of left ventricular ejection fraction during exercise in predicting the extent of coronary artery disease
Insights
A quantitative scoring system for coronary artery disease extent strongly correlates with exercise left ventricular ejection fraction. This relationship is enhanced in younger patients and those with higher exercise heart rates, improving diagnostic accuracy.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Quantitative Analysis
Background:
- Assessing the relationship between left ventricular (LV) performance during exercise and the severity of coronary artery disease (CAD) is crucial for patient management.
- Traditional methods of interpreting coronary angiograms may not fully capture the extent of CAD, potentially limiting correlation with functional parameters.
Purpose of the Study:
- To determine the relationship between left ventricular performance during exercise and the extent of coronary artery disease.
- To evaluate the utility of a quantitative scoring system for CAD extent compared to conventional angiographic interpretation in predicting exercise LV performance.
Main Methods:
- Exercise radionuclide ventriculography was performed in 65 patients who also underwent cardiac catheterization.
- A scoring system was developed to quantitate CAD extent, considering the number and location of stenoses in major and secondary coronary vessels.
- Patients were categorized into no significant CAD, single-vessel disease, and multivessel disease groups based on conventional angiographic interpretation.
Main Results:
- Exercise left ventricular ejection fraction (LVEF) was significantly higher in patients without CAD compared to those with single or multivessel disease (p < 0.001), but with considerable overlap.
- A strong negative correlation was found between the quantitative CAD score and exercise LVEF (r = -0.70; p < 0.001).
- This correlation improved with higher exercise heart rates (r = -0.73) and younger patient age (r = -0.82).
Conclusions:
- The absolute exercise left ventricular ejection fraction, assessed quantitatively using a scoring system, is the most significant exercise variable correlating with the extent of coronary artery disease.
- Younger age and higher exercise heart rates strengthen this correlation.
- While changes in LVEF from rest to exercise aid diagnosis, the absolute exercise LVEF level is a better predictor of CAD extent.
Abstract:
To determine the relation between left ventricular performance during exercise and the extent of coronary artery disease, the results of exercise radionuclide ventriculography were analyzed in 65 patients who also underwent cardiac catheterization. A scoring system was used to quantitate the extent of coronary artery disease. This system takes into account the number and site of stenoses of the major coronary vessels and their secondary branches. The conventional method of interpreting the coronary angiograms indicated that 26 patients had significant coronary artery disease (defined as 70% or more narrowing of luminal diameter) of one vessel, 21 had multivessel disease and 18 had no significant coronary artery disease. Although the exercise left ventricular ejection fraction was significantly higher in patients with no coronary artery disease than in patients with one or multivessel disease (probability [p] less than 0.001), there was considerable overlap among the three groups. With the scoring system, a good correlation was found between the coronary artery disease score and the exercise left ventricular ejection fraction (r = -0.70; p less than 0.001). If the exercise heart rate was 130 beats/min or greater or the age of the patient was 50 years or less, an even better correlation was found (r = -0.73 and r = -0.82, respectively). The exercise ejection fraction (but not the change in ejection fraction, end-diastolic volume and end-systolic volume from rest to exercise) correlated with the extent of coronary artery disease. The exercise ejection fraction is the most important exercise variable that correlates with the extent of coronary artery disease when the latter is assessed quantitatively by a scoring system rather than the conventional method of reporting coronary angiograms. Young age and greater exercise heart rate strengthened the correlation. The change in ejection fraction from rest to exercise is useful in the diagnosis of coronary artery disease, but it was the absolute level of exercise ejection fraction that predicted the extent of disease.