For almost 40 years, a small but intense group of cardiovascular investigators have evaluated cardiac performance by measuring the mass, velocity, and acceleration of blood ejected from the left ventricle. These studies reveal that energy is transferred from ventricle to blood very early in systole, and that the left ventricle is charac­ terized as an impulse generator. Recent explosive developments in Doppler echocar­ diography have allowed study of the energetics of ventricular contraction through noninvasive acceleration, velocity, and volumetric flow measurements. Compared against reference standards of ejection fraction, dP/dt, and instantaneous pressure gradient across the aortic valve, Doppler acceleration and velocity measurements are highly sensitive to changes in ventricular performance. Most patients seeking cardiovascular care present with coronary artery disease as a chief concern. This book focuses upon identification of coronary disease presence and severity through the evaluation of left ventricular Doppler ejection responses to stress loading. Chapters I through 4 detail basic research on the dynamics of left ventricular ejection in ischemic and nonischemic animal models. Chapters 5 through 13 present clinical correlates of changes in the Doppler systolic ejection pulse during exercise and under pharmacologic stress loading. Angiographic anatomy, thallium perfusion defects, and radionuclear ejection fraction responses serve as reference standards. Chapters 14, 15 and 16 address applications of Doppler echocardiography during the stresses of brief coronary occlusion, myocar­ dial infarction and post infarction recovery, while chapters 17 and 20 illustrate applications of stress Doppler techniques in valvular heart disease.

1. The Left Ventricular Impulse.- 2. Effect of Preload, Afterload, and Inotropic State on Doppler Ejection Dynamics.- 3. Effects of Beta Blockade, Beta Stimulation, and Afterload upon Doppler Ejection Dynamics.- 4. Effects of Regional Myocardial Ischemia on Doppler Ejection Dynamics.- 5. Practical Considerations in Doppler Stress Testing.- 6. Effects of Age and Gender Upon Doppler Stress Measurements at Rest and During Exercise in Normal Subjects.- 7. Exercise Doppler in Coronary Artery Disease: Correlation With Thallium-201 Perfusion Scintigraphy.- 8. Doppler Left Ventricular Ejection Dynamics: Correlation with Nuclear Ejection Indices During Exercise.- 9. Doppler Treadmill Studies in Coronary Patients: Angiographic Correlates.- 10. Uses and Limitations of Exercise Doppler Echocardiography in the Clinical Evaluation of Ischemic Heart Disease.- 11. Assessment of the Effect of Coronary Artery Bypass Grafting on Left Ventricular Function by Stress Doppler Cardiography.- 12. Doppler Assessment of Stress Induced Ischemic Diastolic Dysfunction.- 13. Pharmacologic Doppler Stress Testing in Coronary Artery Disease.- 14. Effects of Abrupt Coronary Occlusion on Doppler Ejection Dynamics in Man.- 15. Doppler Ultrasound Assessment of Left Ventricular Function - Risk Stratification in Acute Myocardial Infarction.- 16. Risk Stratification Following Myocardial Infarction Using Stress Doppler Ultrasound.- 17. Evaluation of Exercise Performance in Mitral Stenosis Using Doppler Echocardiography.- 18. Left Ventricular Ejection Force and Impulse: Noninvasive Assessment Using Doppler Ultrasound.- 19. Theoretical Analysis of the Left Ventricular Ejection Pulse.- 20. The Use of Color Doppler Ultrasound in Exercise Testing.