[Function of the left ventricle under dynamic load in patients with coronary heart disease with and without angina pectoris].

Overall left ventricular function and regional wall motion abnormalities visualized by biplane cineangiocardiography were examined in 136 patients with significant coronary heart disease during supine bicycle ergometry. The stress test was tolerated without symptoms in 57 patients (42%) (26 without previous myocardial infarction, 31 with infarction), whereas it was limited by angina pectoris in 79 (58%) (40 without previous infarction, 39 with infarction). A de novo asynergy during exercise was observed in a similar percentage in patients without angina (17/26 [65%] without infarction, 29/31 [94%] with infarction) than in those with angina (29/40 [73%] without infarction, 33/39 [85%] with infarction). During exercise, left ventricular ejection fraction decreased and enddiastolic pressure increased to the same extent in all four subgroups, all changes being highly significant. It is concluded that in patients with coronary heart disease objective signs of ischemia during exercise (de novo asynergy, fall in ejection fraction and rise in enddiastolic pressure) are observed independently of whether angina pectoris occurred or not. Thus, angina is not an indispensable symptom of the occurrence of hemodynamically relevant ischemia during dynamic exercise.