Quantitative analysis of left ventricular function by cold pressor two-dimensional echocardiography in patients with coronary artery disease.

Quantitative assessment of left ventricular function in patients with coronary artery disease was made by computer analysis of two-dimensional echocardiography performed during a cold pressor test. Short-axis cross-sectional images of the left ventricle at the levels of the mitral valve and chordae tendineae were recorded by a phase array sector scanner in 12 patients with coronary artery disease and 11 normal controls. Endocardial outlines at end-diastole and end-systole were traced and analyzed by a computer system. The short-axis cross-sectional images were divided into octants and were analyzed. The segmental area and its changes during the cardiac cycle were measured and calculated for each octant. Regional function of the left ventricle was evaluated by percent changes of segmental area. The regional segmental area changes in patients with coronary artery disease were compared with those in normal controls. Similar increments were achieved in rate pressure product in the 2 groups. In relation to the perfusing coronary arteries, 8 segments were integrated arbitrarily into 3 walls (anteroseptal wall, lateral wall, and posterior wall and posterior septum). The cold pressor test induced wall motion abnormalities in 12 of 16 walls which were supplied by stenosed coronary arteries. In contrast, wall motion abnormalities were detected in only 5 of 38 walls which were supplied by coronary arteries without significant stenotic lesions. The sensitivity of cold pressor test-induced wall motion abnormalities in detecting coronary artery disease was 75% and the specificity was 87%. No serious complications were encountered in this study. In conclusion, computer-aided cold pressor two-dimensional echocardiography is a safe and sensitive method for the assessment of left ventricular function and diagnosis of coronary artery disease.