Is determined by the integrative ability of neurohormonal, central, and peripheral oxygen delivery cross system mechanisms collectively possessing adaptive capacity.
Sequential and concurrent pathologic perturbations to one or more of these above mechanism are offset by compensative adaptive responses in other component systems to maintain homeostasis, a process called coordinated adaptation.
CVRC is finite and repeat insults lead to dysfunction such as ventricular dysfunction or acute coronary syndromes.
Impairments to CVRC are etiologic to many chronic disease conditions.
Evaluation includes assessment of left ventricular ejection fraction (LVEF) by echocardiography or radionuclide angiography.
Resting LVEF provides a snapshot of cardiac performance, but is not a sensitive measure of subclinical myocyte damage, and is not prognostic in patients with preserved LVEF of greater than 50%.
LVEF is load, rate and contractility dependent.
Pharmacologic and non-pharmacologic stress test of commonly applied in conjunction conventional imaging to detect obstructive coronary artery disease.
Exercise testing and determination of inotropic reserve are independent predictive his prognosis beyond clinical factors, coronary anatomy and LVEF.