Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website

Original Article

Volume 3, Number 4, August 2012, pages 164-171

Depressed Exercise Peak Ejection Rate Detected on Ambulatory Radionuclide Monitoring Reflects End-Stage Cardiac Inotropic Reserve and Predicts Mortality in Ischaemic Cardiomyopathy


Figure 1.
Figure 1. The radionuclide data of a 62-year-old man who had undergone LV aneurysmectomy and presented with occlusion of the anterior descending coronary artery, 90% stenosis of the circumflex and the right coronary artery free of obstructions. This patient manifested a 6-month mortality. A) Patient’s polar map from SPECT representing LV total pixels. The black spot represents the ADS size with an extent of 60% of the LV total pixels; the white spot represents reversibility with an extent of 2% of total ADS pixels. B) The panel shows, in this same subject, 26 min continuous ambulatory radionuclide monitoring recordings of heart rate, systolic and diastolic volumes and peak filling rate trends, at resting conditions and at peak exercise. At peak exercise (red arrow), the increment in heart rate was not associated with according changes in the systolic and diastolic volumes and peak filling rate. These data imply failure of the Frank-Starling mechanism and explain the mechanisms underlying failure of the contractile reserve and the patient’s outcome.
Figure 2.
Figure 2. Compared to SURV patients, N-SURV patients showed lower exercise PERs with minimally overlapping values.
Figure 3.
Figure 3. Kaplan-Meier curves; exercise (ex) PER values stratified individuals with respect to mortality.


Table 1. Patient Clinical Characteristics
Patient/ageMI site/LV structural damageNumber of coronary arteries with CAD/ extent of coronary obstructionsADS extent as % of LV total pixelsADS rev as % of ADS pixelsNew York Heart Association classificationFollow-up results
*implantable cardioverter-defibrillator (ICD), ** permanent pacemaker implantation for sinus node dysfunction; coronary artery disease (CAD), myocardial infarction (MI), anterior (Ant), inferior (Inf), lateral (Lat), left anterior coronary artery (LAD), left circumflex coronary artery (LCX), right coronary artery (RCA), heart failure (HF).
1/62Ant3/3 by-pass/occluded only graft to LAD4592N-SURV (Fatal MI)
2/62Ant/prior LV aneurysm resection2/occluded LAD/ LCX with 90% stenosis6023N-SURV (HF)
3/69Ant, Inf, Lat3/patent stent to RCA and LCX, LAD with 50% stenosis4903SURV
4/76Ant, Inf1/occluded stent to LAD29553SURV
5/74Ant, Inf, Lat /LV aneurysm1/occluded LAD1102N-SURV (HF)
6/74Ant3/3 by-pass with only occluded graft to LAD25103N-SURV (HF)
**7/78Ant1/LAD with 30% stenosis15822SURV
8/72Inf/valvular aortic stenosiscoronary arteries with minimal obstructions802SURV
9/53Ant, Inf, Latcoronary arteries with minimal obstructions /vasospastic angina2202SURV
10/50Infectatic LAD702SURV
11/62Ant, Infcoronary arteries with minimal obstructions2052SURV
**12/67Ant3/3 by-pass with only 2 occluded grafts2853N-SURV (HF)
*13/68Ant, Lat3/severe stenosis not eligible for revascularisation47173N-SURV (HF)
*14/68Ant, Lat, Inf1/patent stent to RCA2702N-SURV
15/64Ant1/occluded LAD2102SURV


Table 2. The LV Function Parameters Recorded With Vest
restPexerciserestPexerciserest Pexercise P
HR/bpm88 ± 110.297 ± 1783 ± 120.001106 ± 100.40.2
EDV(mL)105 ± 50.297 ± 16102 ± 50.7105 ± 220.20.4
ESV(mL)80 ± 80.0265 ± 2065 ± 110.0252 ± 160.0080.2
% EF25 ± 70.0134 ± 1038 ± 90.0150 ± 130.010.02
PFR(edv/s)1.3 ± ± 0.61.3 ± ±
PER(edv/s)1.4 ± 30.012 ± 0.62.3 ± ± 0.70.0030.003