Stunned left ventricular myocardium after exercise treadmill testing in coronary artery disease

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Abstract

Myocardial stunning (postischemic ventricular dysfunction) occurs in dogs after coronary stenosis following treadmill exercise. Less data are available in humans regarding development of stunned myocardium after exercise. Regional wall motion changes were evaluated in 22 patients with known coronary artery disease using 2-dimensional echocardiography and exercise treadmill testing. Wall motion was scored as 1 = normal, 2 = hypokinetic, 3 = akinetic, 4 = dyskinetic. At least 1 left ventricular segment with normal resting function developed an increase in wall motion score at 15 or 30 minutes compared with values at rest. The wall motion score in the midportion of the ventricular septum increased from 1.0 at rest to 1.6 (p < 0.004) at 30 minutes after exercise; the basal inferior wall score worsened from 1.0 at rest to 1.9 (p < 0.01) at 30 minutes after exercise. Coronary angiographic data in these patients revealed that left anterior descending narrowing correlated best with left ventricular septal wall motion abnormalities, whereas right coronary artery and circumflex narrowing best correlated with inferior and posterior wall motion abnormalities. Eight normal adult volunteers with no history of myocardial ischemia also underwent 2-dimensional echocardiography and exercise testing. No wall motion abnormalities were observed at any time after exercise. The present study suggests that in patients with coronary artery disease, exercise treadmill testing may induce regional wall motion abnormalities of the left ventricle that persist ≥30 minutes after exercise, an observation consistent with the phenomenon of stunned myocardium.

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    Citation Excerpt :

    Robertson et al28 showed that 6 of 10 patients with catheterization-confirmed 2- or 3-vessel obstructive coronary artery disease (ie, >75% luminal narrowing) had new exercise-induced regional wall motion abnormalities by 2-dimensional echocardiography that persisted 30 minutes after exercise. In a study of 22 patients with predominantly multivessel coronary artery disease, Kloner et al29 found that 95% and 90%, respectively, had persistence of new regional wall motion abnormalities at 15 and 30 minutes after exercise. This study was conducted with patients with known or suspected coronary artery disease and a 2-day protocol, and thus the results might not apply to other patient populations.

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