Author + information
- Received April 18, 1983
- Revision received July 18, 1983
- Accepted July 20, 1983
- Published online December 1, 1983.
- Harvey L. Goldberg, MD, FACC,
- Jeffrey W. Moses, MD, FACC,
- Jeffrey S. Borer, MD, FACC*,1,
- Jeffrey Fisher, MD,
- Israel Tamari, MD,
- Nancy T. Skelly, BS and
- Barry Cohen, BA
- ↵*Address for reprints: Jeffrey S. Borer, MD, The New York Hospital-Cornell Medical Center, 525 E. 68th Street, New York, New York 10021.
Exercise left ventriculography has been shown to be a sensitive and specific tool for the detection of coronary artery disease. At the present time, such studies require radionuclide-based methods. Computer-based techniques recently have been shown to provide high resolution images of the left ventricle when the levophase of an intravenous injection of radiopaque contrast medium is imaged with fluoroscopy. To evaluate the possible efficacy of using “intravenous digital subtraction left ventriculograms” in exercise ventriculography, such ventriculograms were performed at rest and during maximal supine bicycle exercise in 31 patients. Studies that could be analyzed were obtained in 29 patients.
In 21 patients with coronary artery disease, ejection fraction was 58% at rest and 45% with exercise (p < 0.001 vs. rest). In contrast, in seven patients with no coronary artery disease, ejection fraction was 65% at rest and 69% with exercise (difference not significant). In a subgroup of 8 patients with “severe” coronary obstruction, the change in ejection fraction from rest to exercise was -18%, while in the remaining 13 patients with less severe disease, it was -9% (p < 0.001). All patients with coronary artery disease manifested new or worsening segmental wall abnormality with exercise, compared with two of seven patients without coronary disease (p < 0.01).
Sixteen patients underwent rest and exercise radionuclide cineangiography in addition to digital subtraction angiography. There was a strong correlation between the two techniques for ejection fraction at rest (r = 0.78, p < 0.001), ejection fraction with exercise (r = 0.83, p < 0.001) and change in ejection fraction from rest to exercise (r = 0.88, p < 0.001).
It is concluded that exercise ventriculography utilizing intravenous digital subtraction angiography is feasible and provides information comparable with that available from radionuclide cineangiography.
- Received April 18, 1983.
- Revision received July 18, 1983.
- Accepted July 20, 1983.
- American College of Cardiology Foundation