title: Abnormal left ventricular ejection fraction response to mental stress and exercise in cardiomyopathy.
abstract: BACKGROUND
  A decline in left ventricular (LV) ejection fraction in response to mental stress and exercise is regarded as an indicator of myocardial ischemia. In patients with LV dysfunction, the ejection fraction is sensitive to afterload, which increases during stress. Thus, the effects of mental stress and exercise on LV systolic function in patients with cardiomyopathy were examined.
  
  
  METHODS
  The ambulatory nuclear VEST (Capintec, Inc., Ramsey, N.J.) was used to monitor LV ejection fraction in patients with cardiomyopathy (10 idiopathic and 9 ischemic). Patients underwent a series of mental stress tests (serial 7s, Stroop color, and Paced auditory addition) and treadmill exercise. Heart rate, systolic blood pressure, and LV ejection fraction were measured.
  
  
  RESULTS
  Mental stress and exercise increased heart rate and systolic blood pressure. For idiopathic cardiomyopathy, LV ejection fraction decreased during serial 7s, Stroop color, Paced auditory addition and exercise by -8% +/- 6%, -7% +/- 5%, -7% +/- 3%, -9% +/- 10%, respectively. For ischemic cardiomyopathy, LV ejection fraction declined by -4% +/- 3%, -7% +/- 5%, -6% +/- 3%, -2% +/- 6% during the same stress tests. There was no difference between the idiopathic and ischemic groups. Each patient showed a 5% or greater decline in LV ejection fraction during one mental stress test. There was an inverse relation between changes in LV ejection fraction and systolic blood pressure during all mental stress tests and exercise (r = -0.47, p < 0.0001).
  
  
  CONCLUSIONS
  In patients with depressed baseline systolic function, the decline in systolic function during mental stress and exercise could be related in part to increases in LV afterload.
authors.affiliation: Department of Internal Medicine, Medical College of Pennsylvania, Allegheny General Hospital, Pittsburgh 15212, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Wolz
authors.forename: A R
authors.initials: AR
authors.lastname: Flores
authors.forename: D J
authors.initials: DJ
authors.lastname: Grandis
authors.forename: J E
authors.initials: JE
authors.lastname: Orie
authors.forename: D S
authors.initials: DS
authors.lastname: Schulman
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000503:physiopathology*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000503:physiopathology*; D013318:Stroke Volume; D016277:Ventricular Function, Left