Ventricular response to dynamic exercise and the cold pressor test

The ventricular response to stress has been used to identify patients with coronary artery disease, but the most suitable stress test remains in dispute. We compared the ventricular response to supine exercise and the cold pressor test in 10 control subjects and in 12 patients with coronary artery disease. We did not find the previously reported increase of ejection fraction in normal subjects during the cold pressor test, although there was a significant decrease in ejection fraction in patients with coronary artery disease. On supine exercise, normal subjects steadily increased ejection fraction and decreased end-systolic left ventricular volume; patients with coronary artery disease failed to increase ejection fraction and to decrease end-systolic volume. In this study the failure to decrease end-systolic volume during supine exercise appeared the most reliable indicator of impairment of coronary circulation.