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The left-ventricular ejection fraction, reflecting the contractile capacity of the myocardium according to the clinical data, is the most objective criterion in indication for the operation for aortocoronary shunting. The indices of central hemodynamics appearing in response to the exercise test during intracardiac catheterization of the right heart and monitor-computer control with mathematical analysis were used in objective appraisal of the left-ventricular ejection fraction in selecting for surgical treatment patients suffering from ischemic heart disease with normal and reduced ejection fraction of the left ventricle. Two gradations of patients with ischemic heart disease were set apart during the hemodynamic exercise test: the first--patients with a high and effective chronotropic reserve--subgroup I("+X") and the second--patients with a poor and ineffective chronotropic reserve--subgroup II("--X"). It was found that in a single-valued left-ventricular ejection fraction (normal or low) in patients with ischemic heart disease there may be the presence or absence of latent cardiac insufficiency according to the results of the hemodynamic exercise test which must be determined in indications for surgical treatment.

Risk factors, survival rate, and quality of life of non-operated and operated patients with complicated IHD (over 50% diameter narrowing of the LCA trunk, occlusion of 3-4 coronary arteries, left ventricular aneurysm and rhythm disturbances) have been studied. The disease course and prognosis are influenced by a number of risk factors. For the non-operated patients, these are the magnitude of narrowing and the number of occluded coronary arteries, the occlusion level, involvement of great coronary arteries, the dimensions of the cicatrical zone, reduced myocardial contractility, left ventricular end diastolic pressure of more than 20 mm Hg, patient's age, and rhythm disturbances revealed on standard resting ECG. The postoperative survival rate and quality of life are significantly improved as compared to the conservatively treated group. The major risk factor is incomplete postoperative myocardial revascularisation, and combined high-grade extrasystole with supraventricular arrhythmias.