Author + information
- Received November 15, 1983
- Revision received March 28, 1984
- Accepted April 13, 1984
- Published online September 1, 1984.
- Leonard E. Ginzton, MD, FACC*,1,
- Michael M. Laks, MD, FACC1,
- Marianne Brizendine, RN1,
- Richard Conant, PhD1 and
- Ismael Mena, MD1
- ↵*Address for reprints: Leonard E. Ginzton, MD, Division of Cardiology, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, California 90509.
Thirty-five patients with previous myocardial infarction and 25 normal subjects underwent subcostal view two-dimensional echocardiography at rest and at peak upright bicycle exercise. The purpose was to assess changes in left ventricular volume with maximal upright bicycle exercise and to compare the utility of the peak systolic pressure/end-systolic volume index ratio and ejection fraction as indicators of left ventricular function.
With exercise, normal subjects had a decrease in end-systolic volume index (22 ± 8 to 11 ± 3 ml/m2) (p < 0.001); the normal ejection fraction (59 ± 9 to 72 ± 8%, p < 0.001) and the pressure/volume ratio (6 ± 3 to 18 ± 6, p < 0.001) increased. In patients with prior myocardial infarction there was no change in end-systolic volume index, ejection fraction or pressure/volume ratio with exercise. Although at peak exercise significant differences between normal subjects and patients with prior infarction were demonstrated in end-systolic vol- unie index (p < 0.001), ejection fraction (p < 0.001) and pressure/volume ratio (p < 0.001), the pressure/volume ratio provided sharper delineation between the two groups than did ejection fraction. The exponential relation of the pressure/volume ratio and ejection fraction at peak exercise demonstrates that the pressure/volume ratio is more sensitive as an indicator of normal or borderline left ventricular function and that ejection fraction is more sensitive in quantifying the degree of left ventricular dysfunction.
It is concluded that 1) the peak systolic pressure/end-systolic volume ratio at the peak of upright bicycle exercise is better than ejection fraction in distinguishing between normal subjects and patients with prior myocardial infarction and 2) the pressure/volume ratio and ejection fraction have complementary roles in identifying and quantifying abnormal left ventricular function.
- Received November 15, 1983.
- Revision received March 28, 1984.
- Accepted April 13, 1984.
- American College of Cardiology Foundation