Site of myocardial ischemia as a determinant of postexercise blood pressure and heart rate response in coronary artery disease (original) (raw)
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The American Journal of Cardiology, 1987
The relation between exercise left ventricular ejection fraction and blood pressure (BP) reqonses after an acute myocardial infarction (AM) was investigated. Twenty-eight to 37 days after an uncomplicated AfUll, 224 consecutive patients underwent exercise radionuclkte angiography in the 40° semisupine position. In 180 patients (group A, 80 % ), BP increased more than 5 mm H9 every stage; in 44 patients, BP reywnrses were abnormal; in 33 (group B, 15% ), BP did not increase during 2 stages; in 11 (group C, 5% ), it decreased more than 5 mm Hg after an initial increase. Ejection fraction did not differ significantly among the 3 groups at rest (51 f 13 in group A, 50 f 18 in grou B, 47 f 13 in group C [diierence not significant '3 ) or at peak exercise (51 f 16% in group A, 46 f 19% in group B, and 43 f 16 % in group C, [difference not significant]). Exercise-induced left ventricular failure or hemodynamic decompensation occurred in 22 patients. In these patients, ejectii fraction at rest was 44 f 19% and decreased to 35 f 16% (p <0.05) with exercise. Only 9 of these patients (41% ) had abnormal BP responses, with the other 13 (59% ) showing a normal BP response. The 35 patients with abnormal BP responses in the absence of hemodynamic decompensation were asymptomatii, terminatirrg exercise because of fatigue. The ejection fraction at rest and during exercise in these patients was similar to that in patients with normal BP responses. Thus, after a recent AMI, abnormal BP responses durlng exercise associated with clinical evidence of hemodynamic decompensation are related to myocardial dysfunction. However, in the absence of symptoms, such abnormal BP responses are not related to severity of left ventricular dysfunction, and in some patients may be ascribed to exertional reduction in systemic resistance. (Am J Cardiol 1987;59:1256-1260 A n abnormal arterial blood pressure (BP) response during a bicycle exercise test, manifested by either a failure to increase or an overt decrease at sequential increments in workload, is traditionally included among the compulsory endpoints, regardless of the pretest diagnosis .'m3 Early after an acute myocardial infarction (AMI), an abnormal BP response during exercise has been associated with both a worse prog-nosis4v5 and multivessel coronary artery disease,6s7 par-
International Journal of Environmental Research and Public Health
Exercise stress testing (EST) has limited power in diagnosing obstructive coronary artery disease (CAD). The heart rate variability (HRV) analysis might increase the sensitivity of CAD detection. This study aimed to evaluate the correlation between short-term HRV and myocardial ischemia during EST, including the acceleration, maximum, and recovery stages of heart rate (HR). The HRV during EST from 19 healthy (RHC) subjects and 35 patients with CAD (25 patients with insignificant CAD (iCAD), and 10 patients with significant CAD (sCAD)) were compared. As a result, all HRV indices decreased at the maximum stage and no significant differences between iCAD and sCAD were found. The low-frequency power of heart rate signal (LF) of the RHC group recovered relatively quickly from the third to the sixth minutes after maximum HR, compared with that of the sCAD group. The relative changes of most HRV indices between maximum HR and recovery stage were lower in the sCAD group than in the RHC grou...
Nile Journal of Medical Sciences, 2015
Coronary artery disease has been thought that autonomic nervous system dysfunction especially increased sympathetic tonus and relatively decreased parasympathetic activity is related to coronary artery disease. Abnormal heart rate recovery after exercise test, is a simple available parameter, that reflects autonomic nervous system disfunction. GATED myocardial perfusion SPECT is used in the diagnosis and prognosis of coronary artery disease. In this study we compared heart rate recovery with myocardial perfusion scintigraphy findings. Methods: In our study there were 50 subjects (27 female, 23 male). Multiple lineer regression analysis was used to determine relationship between heart rate recovery and GATED myocardial perfusion SPECT parameters, age, gender, and history. Results: Multiple lineer regresion revealed strong independent negative assosiation between heart rate recovery and myocardial defect severity on stress images (β=-0.957; SE= 0.650; p= 0.043). Age was also an independent predictor of heart rate recovery with negative assosiation (β=-0.473; SE= 0.250; p= 0.022). Correlation coefficient (R) and R square (R 2) of the model were 0.604, and 0.365 respectively. Conclusion: On stresss protocol, myocardial damage is more severe in patients who have decreased heart rate recovery. Since the severity of myocardial damage on stresss is a strong predictor of cardiac events and prognosis, heart rate recovery was also have prognostic value on future cardiac events.
American Journal of Hematology, 2009
Previous studies have suggested that physical exercise may have an effect on the turnover of the endothelial compartment. Following a maximal exercise testing (Bruce protocol), a prompt and significant increase in the number of circulating endothelial cells (CECs) was detected (D 1 50% vs. basal; P 5 0.0001) in 12 healthy volunteers, without significant changes in the marker of myocardial ischemia; the frequency of CECs correlated significantly with systolic blood pressure (SBP) and rate-pressure product at peak exercise (r 5 0.78, P 5 0.003, and r 5 0.64, P 5 0.03, respectively). These results support the role of peak SBP during maximal exercise possibly as mechanical factor facilitating the detachment of CECs and the endothelial turnover.
BMC Cardiovascular Disorders
Background Many hemodynamic parameters provide limited information regarding obstructive coronary artery disease (CAD) during exercise stress testing particularly when exercise is suboptimal. Hemodynamic gain index (HGI) is a recent sensitive indicator of ischemia and has been associated with increased mortality. This study evaluated the clinical impact of HGI in patients who underwent concomitant exercise stress testing and coronary computed tomography angiography (CCTA). Methods A total of 284 consecutive patients from the executive health program between 2010 and 2018 were identified. Resting and peak heart rate (HR) as well as systolic blood pressure (SBP) measurements were recorded. Framingham risk score (FRS), Duke treadmill score (DTS) and HGI (\frac{{{\text{HRpeak}} \times {\text{SBPpeak}} - {\text{HRrest}} \times {\text{SBPrest}}}}{{{\text{HRrest}} \times {\text{SBPrest}}}})$$ ( HRpeak × SBPpeak - HRrest × SBPrest HRrest × SBPrest ) were calculated. The latter was divided...
Circulation, 1988
It has been previously reported that at treadmill exercise testing an abnormal ratio of recovery systolic blood pressure (SBP) to peak exercise SBP is more sensitive than exercise-induced angina or ST segment depression for diagnosing coronary artery disease (CAD). To investigate whether the SBP ratio keeps its diagnostic value during upright bicycle exercise, we evaluated the ratio of postexercise SBP to peak SBP in 73 patients with angiographically documented CAD and in 48 patients with normal coronary arteries (OV group) undergoing maximal stress testing on a bicycle ergometer. Three minutes after exercise ended, SBP ratio was significantly higher in the CAD than in the OV group (0.79 ± 0.1 vs 0.71 + 0.08; p < .001). Setting the upper normal limits of the recovery SBP ratio at 2 SDs from the mean for the OV group (SBP ratio = 0.98 and 0.88 at 1 and 3 min after exercise, respectively), with an increase or no change in SBP ratio at between 1 and 3 min of recovery considered an abnormal response, the sensitivity of SBP ratio was 30%, the specificity was 83%, and the accuracy was 51%. The respective values for ST depression were 81% (p < .0001 vs SBP ratio), 48% (p < .001 vs SBP ratio), and 67% (p < .01 vs SBP ratio). Thus, for bicycle ergometer exercise testing, ST segment depression seems to be more accurate than SBP ratio in diagnosing CAD.
Journal of the American College of Cardiology, 1991
Exercise stress testing is routinely used for the noninvasive assessment of coronary artery disease and is considered a safe procedure. However, the provocation of severe ischemia might potentially cause delayed recovery of myocardial function. To investigate the possibility that maximal exercise testing could induce prolonged impairment of left ventricular function, 15 patients with angiographically proved coronary disease and 9 age-matched control subjects with atypical chest pain and normal coronary arteries were studied. Radionuclide ventriculography was performed at rest, at peak exercise, during recovery and 2 and 7 days after exercise. Ejection fraction, peak filling and peak emptying rates and left ventricular wall motion were analyzed.