Clinical and angiographic implications of a depressed echocardiographic ejection fraction in coronary artery disease

To evaluate the clinical and angiographic implications of a depressed echocardiographic ejection fraction (EF) in coronary artery disease, 45 patients with an echocardiographic EF < 0.50 were studied with complete cardiac catheterizations. Most of the patients had clinical evidence of a prior myocardial infarction, cardiomegaly, and/or congestive heart failure. All had coronary arteriographic evidence of multivessel disease and either reduced cardiac output, elevated left ventricular end‐diastolic pressure, or both. Reduction in percentage of echocardiographic dimensional shortening closely paralleled reduction in echocardiographic EF. Forty of the 45 patients (89%) had an angiographic EF less than 0.50. There was considerable scatter of angiographic EF's with echocardiographic EF's between 0.40 and 0.50, limiting the usefulness of these latter values. However, 23 of the 24 patients (96%) with an echocardiographic EF less than 0.40 had an angiographic EF less than 0.40, and there was a linear relationship between these echocardiographic and angiographic values with a correlation coefficient (r) = 0.54 (SEE = ±0.15, p<0.05). All of the 12 patients with both reduced septal and reduced posterior wall excursion on the echocardiogram had both abnormal echocardiographic and angiographic ejection fractions, and 10 of the 12 had EF < 0.40 by both techniques. Our study suggests that coronary artery disease patients with extensive left ventricular dysfunction can be identified noninvasively, and the echocardiographic EF may be useful in deciding whether such patients may require special cardiac catheterization procedures to evaluate contractile reserve if cardiac surgery is being considered.