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Exercise Left Ventricular Performance in Patients with Chest Pain, Ischemic-Appearing Exercise Electrocardiograms, and Angiographically Normal Coronary Arteries

HARVEY J. BERGER, M.D.; MILTON J. SANDS, M.D.; ROSS A. DAVIES, M.D.; FRANS J. TH. WACKERS, M.D.; JONATHAN ALEXANDER, M.D.; ANTHONY S. LACHMAN, M.D.; BYRON W. WILLIAMS, M.D.; and BARRY L. ZARET, M.D.
[+] Article and Author Information

Grant support: in part by grant RO 1-HL20690-03 from the National Heart, Lung, and Blood Institute.

▸Requests for reprints should be addressed to Harvey J. Berger, M.D.; Nuclear Medicine Section, Yale University School of Medicine, 333 Cedar Street; New Haven, CT 06510.


New Haven, New Britain, and Danbury, Connecticut


© 1981 American College of PhysiciansThe American College of Physicians


Ann Intern Med. 1981;94(2):186-191. doi:10.7326/0003-4819-94-2-186
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Left ventricular performance was evaluated using first-pass radionuclide angiocardiography in 31 patients with chest pain, an ischemic-appearing exercise electrocardiogram, and angiographically normal coronary arteries at rest and during maximal upright bicycle exercise. Thallium-201 (201TI) imaging was done in all patients after treadmill exercise and in selected patients after ergonovine provocation. Resting left ventricular performance was normal in all patients. An abnormal ejection fraction response to exercise was detected in 12 of 31 patients. Regional dysfunction was present during exercise in four patients, all of whom also had abnormal global responses. Three of these 12 patients and two additional patients had exercise-induced 201TI perfusion defects. In all nine patients who underwent ergonovine testing, there was no suggestion of coronary arterial spasm. Thus, left ventricular dysfunction during exercise, in the presence of normal resting performance, was found in a substantial number of patients with chest pain, an ischemic-appearing exercise electrocardiogram, and normal coronary arteries.

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