Detection of silent left ventricular dysfunction during daily activities in coronary artery disease patients by the nuclear VEST.
Myocardial ischemia during routine daily activities was studied in patients with known coronary artery disease with an ambulatory radionuclide probe and recording device (VEST) and routine rest and exercise gated blood pool imaging. Seventeen patients were monitored for 60 minutes while sitting (baseline), standing in place, walking, eating (6 patients), and urinating (4 patients). Eleven of them (64%) failed to show an augmentation of at least 5% in the LVEF on an exercise gated blood pool imaging study (Group I) and 6 (36%) showed a normal response (Group II). Three patients (18%) in Group I experienced angina. Transient left ventricular dysfunction was detected by the VEST during walking, urinating or eating in 80% of the patients in Group I and 33% in Group II (p < 0.05). During walking, mean ejection fraction slightly decreased from 45 +/- 12% to 43 +/- 13% in Group I while the ejection fraction increased from 46 +/- 8% to 51 +/- 12% in Group II (p = 0.04 for the difference in responses). Standing in place and eating did not affect the mean ejection fraction. Urination in 4 patients in Group I caused a significant drop in ejection fraction in 3 patients for a mean change from 51 +/- 9% at rest to 42 +/- 15%. By contrast, none of the patients had angina or diagnostic ECG changes during the monitoring period.(ABSTRACT TRUNCATED AT 250 WORDS)
Vassiliadis
I V
IV
Department of Medicine, Mount Sinai Medical School, New York, NY 10029.
Machac
J
J
Sharma
S
S
Horowitz
S F
SF
Goldsmith
S J
SJ
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D015444:Exercise; D015637:Gated Blood-Pool Imaging / Q000379:methods*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016277:Ventricular Function, Left