Exercise left ventriculography utilizing intravenous digital angiography.

Exercise left ventriculography has been shown to be a sensitive and specific tool for the detection of coronary artery disease. At the present time, such studies require radionuclide-base methods. Computer-based techniques recently have been shown to provide high resolution images of the left ventricle when the levophase of an intravenous injection of radiopaque contrast medium is imaged with fluoroscopy. To evaluate the possible efficacy of using "intravenous digital subtraction left ventriculograms" in exercise ventriculography, such ventriculograms were performed at rest and during maximal supine bicycle exercise in 31 patients. Studies that could be analyzed were obtained in 29 patients. In 21 patients with coronary artery disease, ejection fraction was 58% at rest and 45% with exercise (p less than 0.001 vs. rest). In contrast, in seven patients with no coronary artery disease, ejection fraction was 65% at rest and 69% with exercise (difference not significant). In a subgroup of 8 patients with "severe" coronary obstruction, the change in ejection fraction from rest to exercise was -18%, while in the remaining 13 patients with less severe disease, it was -9% (p less than 0.001). All patients with coronary artery disease manifested new or worsening segmental wall abnormality with exercise, compared with two of seven patients without coronary disease (p less than 0.01). Sixteen patients underwent rest and exercise radionuclide cineangiography in addition to digital subtraction angiography. There was a strong correlation between the two techniques for ejection fraction at rest (r = 0.78, p less than 0.001), ejection fraction and with exercise (r = 0.83, p less than 0.001) and change in ejection fraction from rest to exercise (r = 0.88, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)