Effect of exercise on left and right ventricular ejection fraction and wall motion

Objective: We evaluated the diagnostic value of response of left and right ventricular ejection fraction and wall motion to exercise using electron be am computed tomography. Methods and results: We attempted to determine the value of exercise electron beam computed tomography for detecting coronary artery disease, including evaluation of the right ventricular ejection frac tion and wall motion abnormalities. A study of 35 patients undergoing elect ron beam tomography exercise cine studies and coronary artery angiography f or the evaluation of chest pain was performed. Of the 18 patients with sign ificant coronary disease (greater than or equal to 50% luminal diameter ste nosis in at least one coronary artery), 17 (94%) had failure to increase gl obal left ventricular ejection fraction with exercise. Fourteen of 18 (78%) developed a wall motion abnormality during peak exercise, and eight (44%) developed a regional right ventricular wall motion abnormality during peak exercise. Of the 17 patients without obstructive disease, 14 (82%) had a in crease in ejection fraction greater than or equal to 5% and none had an abn ormal response in left ventricular wall motion during peak exercise (specif icity = 100%). The change in right ventricular ejection fraction with exerc ise was not a significant predictor of obstructive coronary disease in this study (P = NS). Using different criteria during stress to predict coronary disease, the accuracy was 89% (31/35) using an increase of <5% in ejection fraction, 89% (31/35) using the development of a new or worsened wall moti on abnormality, and 91% (32/35) using both left ventricular criteria. Concl usion: Our study suggests that exercise electron beam computed tomography a ppears to be a useful tool for the detection of coronary disease. A increas e of <5% in ejection fraction and abnormal left ventricular response to exe rcise were important predictors, while the exercise induced changes of righ t ventricular ejection fraction was not a significant predictor of obstruct ive disease. Both left and right ventricular wall motion abnormalities are useful and important parameters in identifying patients with obstructive di sease from those with normal coronary arteries. (C) 1999 Elsevier Science i reland Ltd. All rights reserved.