Radionuclide and Hemodynamic Assessment of Left Ventricular Functional Reserve in Patients with Left Ventricular Aneurysm and Congestive Cardiac Failure

The hemodynamic response to exercise stress was assessed in 17 patients with left ventricular (LV) aneurysm, demonstrated by contrast left ventriculography, and congestive cardiac failure (CCF) before and after sublingual isosorbide dinitrate (ISDN). Radionuclide ventriculography was performed at rest and during exercise in 14 patients. ISDN increased mean exercise LV stroke work index (LVSWI) from 31 to 39 g-m/m2 (p < 0.001) and reduced mean exercise LV filling pressure from 38 to 25 mm Hg (p < 0.001). Using the combined criteria ofLVSWI and ejection fraction of the contractile section of the left ventricle (EFCS), no patient with rest EFCS of < 40% achieved a good absolute response to exercise in LV performance with or without ISDN. Of the six patients with rest EFCS 2 40% only three achieved a good response. While rest EFCS < 40% indicates poor LV functional reserve, good LV functional reserve is not always indicated by rest EFCS 2 40%.