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Swnmary:To determine if end-systolic volume changes (AESV) in response to exercise were of value in detecting left ventricular dysfunction and compare it with other presently used criteria, 41 normal subjects and 122 patients with coronary artery disease (270 percent cross sectional luminal narrowing) were studied. All had upright maximal bicycle stress tests using equilibrium radionuclide imaging in the left anterior oblique (LAO) projection. The sensitivity, specificity, and predictive value were determined for several criteria which included the following defined as normal responses: AEF15 absolute units, AEF>O, AESVO and AESVO criterion at 83% ( 101 / 122) and 66% (80/ 122) (pO criterion at 95% (39/41). This relationship was also apparent when those patients with infarctions were excluded. The end-systolic volume response to stress has a high sensitivity, specificity, and predictive value for detecting left ventricular dysfunction, perhaps due to the fact that it is a measure of left ventricular contractility. The end-systolic volume response to stress is superior in specificity to the AEF25 criterion and superior in sensitivity to the AEF>O criterion. A combination of AEF>O and AESV