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Detecting abnormalities in left ventricular function during exercise before angina and ST-segment depression

M T Upton, S K Rerych, G E Newman

    Circulation
    |August 1, 1980
    PubMed
    Summary
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    In patients with coronary artery disease, left ventricular dysfunction often occurs before chest pain or ECG changes indicating myocardial ischemia. This study used radionuclide angiocardiography to reveal these early functional abnormalities during exercise.

    Area of Science:

    • Cardiology
    • Physiology

    Background:

    • Coronary artery disease (CAD) can lead to myocardial ischemia, manifesting as angina and electrocardiographic (ECG) changes.
    • The precise timing of left ventricular (LV) functional abnormalities relative to these clinical and ECG signs is not fully understood.

    Purpose of the Study:

    • To investigate whether abnormalities in LV function precede the onset of angina pectoris and ECG evidence of myocardial ischemia in patients with CAD.
    • To assess changes in LV ejection fraction, volumes, cardiac output, and wall motion during exercise in patients with and without CAD.

    Main Methods:

    • Utilized radionuclide angiocardiography (RNA) to evaluate LV function at rest and during two levels of upright bicycle exercise.
    • Studied 25 patients with CAD and 10 normal subjects.
    • In CAD patients, RNA was performed before and after the onset of ST-segment depression during exercise.

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    Main Results:

    • Normal subjects exhibited increased ejection fraction and decreased end-systolic volume with exercise.
    • In CAD patients, exercise induced LV functional abnormalities (reduced ejection fraction, increased volumes, wall motion deficits) in a significant number of patients *before* chest pain or ST-segment depression.
    • All CAD patients showed hemodynamic and wall motion abnormalities when ST-segment depression was present.

    Conclusions:

    • LV functional abnormalities frequently develop during exercise in patients with CAD *prior* to the manifestation of angina pectoris or ECG evidence of myocardial ischemia.
    • Radionuclide angiocardiography is a valuable tool for detecting these subclinical LV functional changes in CAD.