Chest, Vol 80, 459-464, Copyright © 1981 by American College of Chest Physicians

ARTICLES

Radionuclide angiographic correlation of the R wave, ejection fraction, and volume responses to upright bicycle exercise

PS Greenberg, MH Ellestad, R Berge, K Johnson, M Hayes, M Bible and H Morales- Ballejo

The change in the R wave and the response of the ejection fraction to upright bicycle stress testing with radionuclide angiographic studies were determined for 18 control subjects and 29 patients with coronary arterial disease (70 percent stenosis or more). In the control group, all had an increase in the ejection fraction from 64.8 +/- 7.7 to 75.7 +/- 9.4 percent with stress (P less than 0.01). All control subjects had a decrease in the R wave with exercise. In the group with coronary arterial disease, most patients had a decrease in the ejection fraction averaging from 63.5 +/- 10.9 to 58.6 +/- 12.8 percent (P less than 0.01). An appropriate response of the R wave and ejection fraction (decrease in R wave and increase in ejection fraction or increase in R wave and decrease in ejection fraction) occurred in 23 (79 percent) of 29 subjects (P less than 0.005). The sensitivity, specificity, and predictive value for the response of the ejection fraction were as follows: 83 percent (24/29); 100 percent (18/18); and 100 percent (24/24). Of the patients with coronary arterial disease and an increase in the R wave, 17 (94 percent) had multivessel disease, while six (55 percent) of 11 with a decrease in the R wave had multivessel disease (P less than 0.05). The systolic volume decreased in all control subjects by -15.9 +/- 8.6 units (P less than 0.01) and increased in most of the group with coronary arterial disease by 13.7 +/- 17.8 units (P less than 0.01) in response to stress. There were 20 of 29 patients (P less than 0.05) with an appropriate response of the R wave and systolic volume to stress (increase in R wave and systolic volume or decrease in both). The change in the R wave did not correlate with the change in the diastolic volume with stress (P greater than 0.05). Changes in the R wave with exercise correlate with the change in the ejection fraction (and hence ventricular function) and with the changes in systolic volume, which may be one of the mechanisms of the response of the R wave, suggesting that the change in the R wave is related to changes in contractility. Increase in the R wave with stress suggests multivessel coronary arterial disease.