Author + information
- Received August 17, 1982
- Revision received November 16, 1982
- Accepted November 19, 1982
- Published online April 1, 1983.
- Nicholas L. DePace, MD,
- Abdulmassih S. Iskandrian, MD, FACC*,
- A-Hamid Hakki, MD, FACC,
- Sally A. Kane, RN and
- Bernard L. Segal, MD, FACC
- ↵*Address for reprints: Abdulmassih S. Iskandrian, MD, Likoff Cardiovascular Institute, Hahnemann University and Hospital, 230 North Broad Street, Philadelphia, Pennsylvania 19102.
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] < 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 < 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. Younger 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.
- Received August 17, 1982.
- Revision received November 16, 1982.
- Accepted November 19, 1982.
- American College of Cardiology Foundation