Author + information
- Received December 14, 1982
- Revision received April 21, 1983
- Accepted April 26, 1983
- Published online September 1, 1983.
- Kenneth A. Brown, MD,
- Robert D. Okada, MD, FACC*,1,
- Charles A. Boucher, MD, FACC,
- James A. Rothendler, MD,
- H. William Strauss, MD, FACC and
- Gerald M. Pohost, MD, FACC1
- ↵*Address for reprints: Robert D. Okada, MD, Cardiac Unit, Massachusetts General Hospital, Boston, Massachusetts 02114.
The relation of exercise-induced changes in hepatic blood volume to right and left ventricular ejection fraction response to exercise and the presence of proximal right coronary artery disease was examined in 47 patients undergoing angiography for the evaluation of chest pain. Hepatic blood activity was measured on separate 20 second anterior static liver images at rest and peak exercise during supine exercise equilibrium radionuclide cineangiography using a small lead marker to allow reproducible placement of a hepatic region of interest. Average hepatic counts/picture element at exercise compared with rest were used to determine an exercise/rest hepatic blood volume ratio.
Patients with normal coronary arteries (Group A, n = 10) and patients with disease limited to the left coronary artery (Group B, n = 19) showed a significant decrease in hepatic counts with exercise (exercise/rest ratio 0.74 ± 0.09 and 0.80 ± 0.09, respectively) and patients with proximal right coronary artery disease (Group C, n= 18) showed no change in hepatic counts (ratio 1.00 ± 0.09). Mean hepatic blood volume ratio was greater among patients demonstrating a decrease in right ventricular ejection fraction during exercise than among patients with no change (p < 0.01) or an increase (p < 0.001) in right ventricular ejection fraction. Among patients without proximal right coronary artery disease (Groups A and B), those with a decrease in left ventricular ejection fraction during exercise had a higher mean hepatic blood volume ratio than did patients who demonstrated an increase (p < 0.05) in left ventricular ejection fraction. If a hepatic blood volume ratio of 0.92 (mean of Group A + 2 standard deviations) was considered abnormal, only 2 (11%) of 19 patients with disease limited to the left coronary artery compared with 15 (83%) of 18 patients with proximal right coronary artery disease had an abnormal hepatic blood volume ratio.
Hepatic blood volume response to exercise can be easily determined during exercise equilibrium radionuclide cardiac imaging. Measurement of such a response may be helpful in evaluating the presence of proximal right coronary artery disease and assessing right ventricular function during exercise.
↵1 Drs. Okada and Pohost are Established Investigators of the American Heart Association, Dallas, Texas
This study was supported in part by U.S. Public Health Service Grants HL21751, HL07416 and HL26215 from the National Institutes of Health, Bethesda, Maryland
- Received December 14, 1982.
- Revision received April 21, 1983.
- Accepted April 26, 1983.
- American College of Cardiology Foundation