Use of end‐systolic volume changes with exercise to detect left ventricular dysfunction in patients with coronary artery disease

To determine if end-systolic volume changes (ΔESV) in response to exercise were of value in detecting left ventricular dysfunction and compare it with other presently used criteria, 41 normal subjects and 122 patients with coronary artery disease (≥70 percent cross sectional luminal narrowing) were studied. All had upright maximal bicycle stress tests using equilibrium ra-dionuclide imaging in the left anterior oblique (LAO) projection. The sensitivity, specificity, and predictive value were determined for several criteria which included the following defined as normal responses: ΔEF≤5 absolute units, ΔEF>0, ΔESV 0 and ΔESV 0 criterion at 83% (101/122) and 66% (80/122) (p≤0.001), respectively, and was comparable to the EF≥5 criterion at 85% (104/122). The specificity of the ΔESV criterion was superior to the ΔEF≥5 criterion at 93% (38/41) and 80% (33/41) (p 0 criterion at 95% (39/41). This relationship was also apparent when those patients with infarctions were excluded. The end-systolic volume response to stress has a high sensitivity, specificity, and predictive value for detecting left ventricular dysfunction, perhaps due to the fact that it is a measure of left ventricular contractility. The end-systolic volume response to stress is superior in specificity to the ΔEF≥5 criterion and superior in sensitivity to the ΔEF>0 criterion. A combination of ΔEF>0 and AESV<0 appears to be a promising criterion for detecting left ventricular dysfunction.