Monitoring Left Ventricular Function Using an Ambulatory Nuclear Device during Esophageal Motility Testing

Abstract

This study examined the left ventricular (LV) and esophageal functions in patients with chest pain syndrome and normal coronary angiograms. The nonimaging ambulatory nuclear device which allows continuous monitoring of LV ejection fraction (EF), relative LV volume, and electrocardiographic changes was used serially to study changes during exercise, ice immersion, and provocative esophageal motility studies with edrophonium (Tensilon) and Bernstein tests. There were 16 patients, 9 women and 7 men, between the ages of 44 and 68 years. The baseline LVEF was 58 ± (SEM) 2%. The EF during Tensilon and Bernstein tests were not significantly different from baseline; the changes were 3 ± 1 and 0 ± 1 %, respectively, compared to baseline (p = NS); 4 of 15 patients (27%) had >6% decrease during ice immersion test. Exercise testing (n = 8) resulted in 16 ± 3% increase in EF compared to baseline (p = 0.0004). There were no S-T segment changes during any of the above interventions. One of the 16 patients (6%) had baseline esophageal spasm, and another patient (6%) had positive Tensilon and Bernstein tests. Thus, (1) routine baseline and provocative esophageal motility studies result in a low but definite yield of positive results (12.5%) in patients with chest pains and normal coronary angiograms, and (2) there is no significant change in LV function during provocative esophageal motility studies with either Tensilon or Bernstein test. These procedures, if deemed necessary, therefore, may be used safely as office procedures in comparable groups of patients.