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Figure 4 Example of a patient with 90% left anterior descending coronary artery stenosis without new wall motion abnormality at peak stress developed only after metoprolol. Apical four-chamber views at end systole with normal thickening at rest (heart rate of 46 beats/min; rate–pressure product of 6,578 mm Hg/min; and left ventricular end-systolic volume index [LVESVI] of 15.7 ml/m2) and low doses. At peak stress, HR was 139 beats/min, rate–pressure product was 20,850 mm Hg/min, and LVESVI was 12.8 ml/m2. After metoprolol, there is a lack of thickening in the apical septum (white arrows; HR of 103 beats/min; rate–pressure product of 15,450 mm Hg/min; and LVESVI of 33.3 ml/m2). For the accompanying video corresponding to Figure 4, please see the following link: http://www.cardiosource.com/library/journals/journal/suppdata?acronym=JAC&pii=s0735109703002420&filename=Stress_eco_met_3.mpg.
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