Exercise radionuclide angiography was performed in 65 normal subjects (group I), in 31 patients with exercise-induced transient thallium defects after acute myocardial infarction (AMI) (group II), and in 16 patients without exercise-induced transient thallium defects, angina or electrocardiographic changes after AMI (group III). Absolute left ventricular (LV) volumes were measured using a correction for attenuation in each patient. Similar peak heart rate-blood pressure products were achieved in groups II and III. Although the mean LV ejection fraction (EF) response to exercise in group III (increase of 0.11 +/- 0.10 units) closely resembled that of normal persons (increase of 0.14 +/- 0.09 units) and was significantly different from that of group II (decrease of 0.04 +/- 0.12), there was considerable individual variation. An abnormal EF response to exercise, defined as failure of EF to increase by at least 0.05 units, was found in 6 subjects (9%) in group I, 26 patients (84%) in group II, and 2 patients (13%) in group III. End-systolic volume failed to decrease in 10 subjects (15%) in group I, 25 patients (81%) in group II and 7 patients (44%) in group III. New regional wall motion abnormalities were found in no subject in group I, in 16 patients (52%) in group II and in only 1 patient (6%) in group III. Thus, although group responses of EF or end-systolic volume appeared to correlate with the presence or absence of ischemia, some patients with exercise-induced transient thallium defects after AMI responded normally to exercise radionuclide angiography stress testing and some patients without other evidence of exercise-induced ischemia after AMI responded to exercise radionuclide angiography testing abnormally.(ABSTRACT TRUNCATED AT 250 WORDS)