Selective cine coronary arteriography correlated with the hemodynamic response to physical stress.

The degree of radiologic abnormality of the coronary arterial circulation due to atherosclerosis, as detected by selective coronary cine arteriography, correlated well with certain hemodynamic changes in patients undergoing a measured amount of supine leg exercise. Notable among these were a rise in pulmonary artery pressure above the normal response level and cardiac index below the expected level. Although the incidence and date of onset of angina pectoris agreed in general with the severity of the rndiologic changes, enough exception was encountered to suggest that factors in addition to those detected by coronary visualization contribute to the genesis of angina pectoris in some patients. Coronary atherosclerosis, which causes an estimated 25 per cent narrowing of major coronary vessels, may be clinically “silent” when the exercise electrocardiogram is used as the diagnostic end point.