The ischemic segment and left ventricular function during exercise angina

Abstract

Summary: Improvement of the quality of transpulmonary left ventriculograms by exercise was demonstrated in 5 patients in a pre-study. In the main study transpulmonary left ventriculography was performed in 10 patients with coronary artery disease (CAD) at rest and during exercise, producing maximum angina pectoris (AP). Left ventricular pressure was recorded simultaneously. The extent of CAD, demonstrated in all patients by coronary angiography, was quantitated by a score. In the exercise ventriculograms, local wall motion was quantitated by 14 hemiaxes. During exercise AP, all patients developed wall motion abnormalities not present at rest. There was a significant linear correlation between coronary score and number of abmormally shortening hemiaxes « 30% shortening) during exercise-AP (y = 0.16 x + 4.34; r = 0.933). The number of anormal hemiaxes correlated significantly (p < 0.05) with left ventricular enddiastolic pressure (LVEDP), dp/dt min, endsystolic volume index, enddiastolic volume index, ejection fraction, stroke work index, minute work, compliance SV / L1 PD/ESV, and cardiac index. During exercise AP the extent of ischemic wall motion abnormalities is determined by localization and severity of coronary artery lesions. The extent of ischemic impairment of wall motion determines the severity of impairment of left ventricular pump function, filling pressure, and maximum speed of relaxation. Transpulmonary left ventriculography during exercise AP is a safe and relatively simple method to quantitate the extent of ischemic wall motion abnormalities. It could be useful in the selection of patients for coronary artery surgery and in the assessment of the results of this operation.lbc sludies were performed in the catheterization laboratories of the Georg-August-University Gocttingen and the Rehabilitationszentrum Bad Krozingcn, West Germany.

Evaluation of effects of nitroglycerin therapy by echocardiography

“…Left ventricular cine-angiography during exercise has demonstrated that areas of myocardium, which develop wall motion abnormalities correlate well with coronary artery narrowings (Sharma et al 1975, Rentrop et al 1978. With this in mind, the early Echo report of Fogelman et al (1972) of wall motion abnormalities during angi-na has started a growing interest in exercise echocardiography.…”

Noninvasive assessment of segmental left ventricular wall motion: Its clinical relevance in detection of ischemia

“…187 In addition to diagnosing the presence of CHD, qUllntitative assessment of segmental wall motion at known levels of stress may allow assessment of severity of coronary artery stenosis. Quantification of wall motion abnormalities with exercise has been described by Sharmtl and Taylor (91) using left contrast ventriculography, and recently has been improved by Rentrop et al (80), using transpulmonary left contrast ventriculograms. These authors showed a significant correlation between the extent of exercise induced segmental wall motion abnormality and extent and severity of CHD.…”