Digoxin did not reduce overall mortality, but it reduced the rate of hospitalization both overall and for worsening heart failure. These findings define more precisely the role of digoxin in the management of chronic heart failure.

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SUMMARY We used first-pass radionuclide angiocardiography to assess filling fraction during the first third of diastole, peak filling rate and peak filling rate during the first third of diastole as indexes of left ventricular diastolic performance at rest and after upright bicycle exercise in 32 normal patients and 68 patients with coronary artery disease. The mean filling fraction was unchanged from rest to exercise in normal patients (47 ± 15% vs 46 ± 13%; NS). Even in 49 coronary patients with normal (. 50%) ejection fraction at rest, filling fraction was less than that in normal patients at rest (35 ± 11% vs 47 ± 15%,p < 0.001). Despite similar resting heart rates, patients with coronary disease had lower (p < 0.001) peak filling rate and peak filling rate during the first third of diastole than normal patients. With exercise, filling fraction decreased (p < 0.001) from the resting value in coronary patients. These data suggest that (1) indexes of diastolic performance can be noninvasively assessed at rest and during exercise using first-pass radionuclide angiocardiography, (2) abnormalities in early diastolic performance are often present at rest in patients with coronary artery disease despite normal systolic performance, and (3) exercise-induced ischemia results in increased early diastolic dysfunction in patients with coronary disease.ABNORMALITIES in left ventricular diastolic performance are common in patients with coronary artery disease.1 2 Myocardial relaxation during early diastole is an active, energy-dependent process and previous investigations have shown that hypoxia may impair the rate of myocardial relaxation.3 Abnormalities in diastolic performance during ischemia may occur in the absence of impaired systolic performance.4' The noninvasive assessment of left ventricular diastolic performance in the patient with coronary artery disease either at rest or during physiologic stress such as exercise has been difficult by traditional techniques.Use of first-pass angiocardiography and gated cardiac blood pool imaging have shown that the response of left ventricular systolic performance to exercise is a sensitive marker of left ventricular ischemia.6 8 Few

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