Changes in left ventricular function as determined by the multi-wire gamma camera at near presyncopal levels of lower body negative pressure

Abstract

At presyncopal levels of lower body negative pressure (LBNP), we have frequently observed electrocardiographic responses that may be due to changes in cardiac position and/or shape, but could be indicative of altered myocardial function. To further investigate this, we evaluated cardiac function using a nuclear imaging technique in 21 healthy subjects (17 men and 4 women) after 30 minutes of supine rest and near the end of a presyncopal-limited LBNP exposure (LBNP averaged 65 plus or minus 3 mmHg at injection). Cardiac first pass images were obtained with a Multi-Wire Gamma Camera following an intravenous bolus injection of 30-50 millicurries of Tantalum-178. Manual blood pressures and electrocardiograms were obtained throughout the 3 minute graded LBNP protocol. Between rest and injection during LBNP, heart rate increased (P less than 0.01) from 67 plus or minus 3 beats per minute to 99 plus or minus beats per minute, systolic blood pressure decreased (P less than 0.01) from 110 plus or minus 3 mmHg to 107 plus or minus 3 mmHg and left ventricular ejection fraction (EF) decreased (P less than 0.01) from 0.57 plus or minus 0.02 to 0.48 plus or minus 0.02. During LBNP, ST segment depression of at least 0.5 mm occurred in 7 subjects. Subjects with ST depression had greater reductions (P = 0.05) in EF than subjects without ST depression (0.15 plus or minus 0.07 versus 0.005 plus or minus 0.03), but also tolerated greater levels (P less than 0.05) of negative pressure (88 plus or minus mmHg versus 69 plus or minus 5 mmHg). There was a significant relationship between presyncopal LBNP level and EF (R(exp 2) = 0.50, P less than 0.05). Our findings suggest there may be a decrease in systolic myocardial function at high levels of LBNP.