Abstract
We performed supine leg exercise test during cardiac catheterization in two patients with severe ischemic heart disease. Patients were exercised untill the onset of angina or showing ST depression in V-5 lead. The hemodynamic data were measured at rest and throughout exercise, and left ventriculography was performed at rest and after exercise, through a pig-tail catheter inserted into left ventricle via right brachial artery. Cardiac function was evaluated by quantitative analysis of the left ventricular wall motion. This method was supposed to be useful in evaluating the cardiac reserve and the severity of ischemic heart disease. The first patient had anginal pain after myocardial infarction. He showed increases in mean pulmonary arterial pressure, left ventricular end-diastolic pressure, left ventricular end-diastolic volume and left ventricular end-systolic volume, but decreases in ejection fraction and left ventricular stroke work index after exercise. The dyskinesis of left ventricular wall motion developed and the portion of the left ventricle was further distended after exercise. Coronary arterial bypass grafting surgery was performed for the first patient, thereafter the hemodynamic d to improved and the dyskinetic area of the left ventricle did not develop after exercise. The second patient had unstable angina, and he also showed increases in mean pulmonary arterial pressure, left ventricular end-diastolic pressure, left ventricular end-systolic volume and left ventricular end-diastolic volume, but decreases in ejection fraction and left ventricular stroke work index. With respect to the left ventricular wall motion, similar response was observed as in the first patient. Therefore, it is suggested that the left ventricular failure resulted from the diminished compliance of the left ventricle occurring during anginal attacks.
