Regional left ventricular function in the three main coronary artery territories at rest and during exercise

Twenty consecutive patients (mean age 51.6 years) with persistent severe angina pectoris underwent aorto-coronary bypass surgery receiving an overall of 60 anastomosis. On an average, 9.4 +/- 1.5 months p.o. first pass radionuclide ventriculograms (18 to 24 mCi 99m Technetium-Pertechnetate i.v.) were performed at rest and after exercise. Besides measurement of global ejection fraction (GEF), regional ejection fraction (REF) was assessed employing for the first time a new technique: each RAO-view of p.o. radionuclide left ventriculogram was subdivided into three regions according to supply of the three main coronary arteries and their branches as visualized on pre-operative coronary angiogram. GEF improved after maximum exercise in 13 cases by 8.1% points (from 50.4 to 58.5%), remained unchanged three times and decreased four times by 7.1 points (from 51.6 to 44.5%; all changes p less than 0.05). In completely revascularized regions (n = 35) REF improved 24 times by 9.7 points (from 51.1 to 60.8%), did not differ from rest REF six times and decreased in three case by 7.3 points (from 48.6 to 41.3%; all changes p less than 0.05). completely revascularized regions responded to exercise like normally perfused areas (increase 7.8 points (from 50.6 to 58.4%; n = 7; p less than 0.05). REF deteriorated in incompletely revascularized regions (n = 9) six times by 12.8 points (from 58.0 to 45.2%), remained unchanged twice and improved once by 4.5 points. Total group's REF decreased by 7.3 points (from 56.8 to 49.5%; p less than 0.05). Exercise REF of incompletely revascularized regions was highly significant inferior to that of completely revascularized regions (49.5 to 58.4%; p less than 0.01). GEF is a weighted balanced of the three regional ejection fractions. The most important parameter is REF of LAD territory.