Gold 195m in the assessment of the cold pressor test by first pass radionuclide ventriculography.

First pass radionuclide ventriculography was performed with gold 195m in a sequential evaluation of left ventricular ejection fraction during cold pressor stimulation. We studied 10 normal controls, 10 patients with angina pectoris who had proven coronary artery disease and normal left ventricular function during contrast angiography and 10 patients with dilated cardiomyopathy with normal coronary arteries and impaired left ventricular function at contrast angiography. Mean resting ejection fraction was similar in controls and patients with coronary heart disease (57 +/- 2 vs 58 +/- 3) but was significantly lower in the cardiomyopathic subjects (27 +/- 4, P less than 0.001). After 30 seconds cold pressor stimulation, mean left ventricular ejection fraction fell in the normal controls (57 +/- 2 to 52 +/- 2, P less than 0.05) but was unchanged in those with coronary heart disease and dilated cardiomyopathy (58 +/- 3 to 55 +/- 3 and 27 +/- 4 to 24 +/- 4, both NS). No further significant change occurred after 2.5 minutes stimulation (53 +/- 1, 58 +/- 3 and 23 +/- 3, respectively). There was no difference in the pattern of left ventricular ejection fraction response between the groups. Six controls, 4 patients with coronary heart disease and 4 patients with dilated cardiomyopathy had a significant fall in left ventricular ejection fraction and 4, 5 and 6, respectively, developed a new or further deterioration in regional wall motion. Thus neither changes in regional wall motion nor left ventricular ejection fraction response distinguished either patient group from the normal controls. We do not recommend cold pressor stimulation as a diagnostic test for coronary heart disease.