Comparative value of 2-dimensional echocardiography and radionuclide angiography for quantitating changes in left ventricular performance during exercise limited by angina pectoris.

To compare left ventricular (LV) ejection fraction (EF) measurements made during exercise by 2-dimensional echocardiography (2-D echo) and gated equilibrium radionuclide angiography (RNA), 18 patients with angina pectoris were studied during graded upright bicycle ergometry. For RNA, the left anterior oblique view was used with the patient grasping the camera gantry during the 2-minute count acquisition required for EF calculation. For 2-D echo, biapical views were recorded with the patient's arms resting on a platform, and EF was calculated from volume measurements made using Simpson's rule. Exercise duration was similar for both studies, but EF at maximal exertion was higher by RNA than by 2-D echo (46 +/- 15% vs 35 +/- 15%, p less than 0.001). However, echo EF determined 1 minute before maximal exertion, which corresponded to the midpoint of the 2-minute count collection period for RNA, was similar to the RNA value at maximal exercise (44 +/- 12%). Analysis of individual EF values by 2-D echo at rest, at 1 minute before maximal exercise and at maximum exercise showed that there was little change in EF during submaximal exercise, but that EF decreased considerably at maximal exertion when the patients had angina pectoris. Therefore, when the time frame of data acquisition is considered, exercise 2-D echo and gated equilibrium RNA provide similar information regarding LVEF. The latter has the advantage of a 100% successful study frequency and the former is superior in its ability to detect the rapid changes in LV performance during exercise-limiting symptoms.

Exercise 2-dimensional echocardiography. Quantitation of left ventricular performance in patients with severe angina pectoris.

To assess the feasibility and reproducibility of exercise 2-dimensional (2-D) echocardiography for quantitating left ventricular size and performance, 25 patients with angina pectoris due to severe coronary artery disease and 10 normal subjects were studied before and after the administration of nitroglycerin. In 18 (72%) of the 25 patients, suitable biapical 2-D echocardiograms for quantitative analysis were recorded during upright bicycle exercise. Left ventricular volume (Simpson's rule), ejection fraction (EF), and wall motion score (10 segments graded 0 to 3, normal to dyskinetic) were measured at rest, and at peak exercise (control), 30 minutes later at rest, after nitroglycerin at rest, and at peak exercise. EF increased during control exercise in the normal subjects from 57 +/- 16 to 71 +/- 22% (p less than 0.01), but was unchanged in the patients during exercise before nitroglycerin. In 7 patients (39%), marked increases in EF (greater than 0.05 units) during exercise occurred after nitroglycerin administration. The wall motion score increased significantly in the patients during control exercise, from 2.6 +/- 3.4 to 5.6 +/- 4.5, but was less at maximal exercise after nitroglycerin (3.4 +/- 4.0, p less than 0.001). Intra- and interobserver variability in these measurements was acceptable. Thus, quantitation of left ventricular performance during exercise by biapical 2-D echocardiography can be accomplished in a high proportion of patients with coronary artery disease (CAD) and can be used to assess the effects of therapeutic interventions.