Exercise-induced alterations in left ventricular volumes and the pressure-volume relationship: a sensitive indicator of left ventricular dysfunction in patients with coronary artery disease.

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Abstract
Patients (33) with coronary artery disease (CAD) and 13 subjects without demonstrable cardiac disease were studied with multigated equilibrium blood pool imaging to assess the diagnostic value of exercise-induced alterations in left ventricular (LV) volumes, segmental wall motion, ejection fraction (LVEF) and the end-systolic pressure-volume relationship. In subjects without cardiac disease, left ventricular end-diastolic volume (LVEDV) was 102 .+-. 7.2 ml (SEM [standard error of mean]) at rest and 125 .+-. 9.7 ml at peak exercise (PEx) (P < 0.001). Left ventricular end-systolic volume (LVESV) was 35 .+-. 3.0 ml at rest and 29 .+-. 3.4 ml at PEx (P < 0.01). LVEF increased from 0.72 .+-. 0.02 at rest to 0.82 .+-. 0.02 at PEx (P < 0.001). The 9 patients with 1 vessel CAD had an increase in LVEDV (P < 0.001) and LVEF (P < 0.02) at PEx, but no significant change in LVESV. The 24 patients with significant 2 or 3 vessel CAD had increases in both LVEDV (169 .+-. 13.2 ml to 195 .+-. 13.7 ml, P < 0.001) and LVESV (86 .+-. 12.0 ml to 102 .+-. 12.0 ml, P < 0.01) at PEx and a decrease in LVEF (0.56 .+-. 0.03 to 0.52 .+-. 0.03, P < 0.05). The relationship between cuff-determined peak systolic blood pressure and LVESV index (P/V index) was used to further characterize alterations in LV function at rest and during PEx. In subjects without cardiac disease, this index rose substantially during PEx (7.6 .+-. 0.73 at rest vs. 14.9 .+-. 1.78 with PEx, P < 0.001). This change was less dramatic in those with 1 vessel disease and absent in patients with 2 or 3 vessel disease (4.2 .+-. 0.60 at rest vs. 3.9 .+-. 0.50 at PEx). The change in LVESV alone was different in each group. The assessment of exercise-induced alterations in LVESV and the P/V index is useful for evaluating LV dysfunction associated with angiographically important coronary artery disease.