Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The electrocardiographic response to exercise stress testing (EST) was compared with coronary arteriographic findings in 114 men referred for evaluation of chest pain. The men were divided into two groups: group A (69 men) in whom the coronary arteriograms showed at least one major vessel with greater than 70 percent reduction in cross sectional area, and group B (45 men) in whom there was no evidence of coronary arterial narrowing. In both groups A and B the description of chest pain was judged to be at least consistent with the diagnosis of angina pectoris if not always representing classical angina pectoris. Only men with a positive finding to EST and those with a negative EST response after achieving at least 90 percent of predicted maximum heart rate were included in the calculations. Our results were strikingly similar to those obtained from an extensive review of the literature and showed the following: sensitivity, 80.4 percent; specificity, 88.6 percent; predictive value of a positive test result, 91.1 percent; predictive value of a negative test result, 75.6 percent, and efficiency of the test 83.7 percent. The maximal EST is a useful predictor of coronary artery disease when a male population is evaluated for chest pain. When a population is selected on some basis other than chest pain (such as elevated lipids or age), EST is a much less useful predictor of coronary artery disease.
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PMID:Electrographic exercise stress testing and coronary arteriography. Correlation among 114 men with chest pain. 90 56

The maximal P-wave duration in all time-aligned leads, and the maximal P-wave amplitude in leads V5 and V6 were measured on a 12-lead, signal-averaged electrocardiogram during the recovery period of an exercise stress test (EST). The study group consisted of 75 patients with coronary artery disease (CAD) documented by greater than or equal to 50% diameter stenosis in 1 or more arteries and a control group of 47 subjects, 15 of them young volunteers and 32 with no or minimal coronary atherosclerosis and normal left ventricular function. All subjects underwent a symptom limited EST, with use of the Ellestad protocol. Signal-averaged P waves recorded before exercise, and for the first 6 minutes in recovery were measured using a 5x magnifier. The mean P duration before exercise in the control group was 107 +/- 16 ms (+/- 1 standard deviation) and 111 +/- 15 ms at the third minute of recovery, (p less than 0.001). In patients with CAD it was 112 +/- 12 and 129 +/- 19 ms (+/- 1 standard deviation), p less than 0.001, respectively. Differences in P-wave duration were found to be statistically significant (p less than 0.001) throughout recovery in the group with CAD when compared with control and maximal values at the third minute. The increase in P-wave duration (greater than or equal to 20 ms) was used as an additional parameter to exercise-induced ST-segment depression, ST elevation, or anginal pain for the test interpretation. The sensitivity increased from 57 to 75% and the specificity decreased from 85 to 77%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Significance of signal-averaged P-wave changes during exercise in patients with coronary artery disease and correlation with angiographic findings. 174 63

The feasibility, safety and prognostic importance of high-dose (0.84 mg/kg over 10 minutes) dipyridamole 2D echocardiography test (DET) were evaluated in 78 asymptomatic patients 10 to 14 days after uncomplicated acute myocardial infarction and the results were compared with those of exercise stress test (EST). Criteria of positivity were: for DET a new or worsening asynergy; for EST, ST segment depression greater than or equal to 1 mm (patients were in complete pharmacological wash-out). Patients were followed-up for 9 to 22 months (mean 14 +/- 5) or until one of the following end-points occurred: death, infarction or severe angina. DET was positive in 13/17 patients and EST in 5/17 patients with poor clinical outcome (sensitivity 76% vs 29%; p less than 0.005); for hard events only (death or infarction) sensitivity was respectively 64% vs 9%; (p less than 0.05). Both tests had the same specificity (92%). Cumulative event-free survival curves as a function of DET and EST results were both statistically different (p less than 0.001 and p less than 0.05 respectively). Cumulative survival curves obtained by the combination of DET and EST results showed: 1) an uneventful course in patients with both tests or only DET negative; 2) and a poor clinical outcome in patients with both test or only DET positive (p less than 0.001) DET correctly predicted clinical outcome in 12/16 patients in whom there was disagreement between the two tests. We conclude that DET is more sensitive than EST for identifying patients at increased risk for coronary events and more accurate for predicting clinical outcome after uncomplicated acute myocardial infarction.
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PMID:[Prognostic value of echocardiography with high-dose dipyridamole after recent uncomplicated myocardial infarction]. 205 73

The effect of trimetazidine was evaluated in patients with stable angina by adding it to the other antianginal regimen in a double blind crossover design each of 8 week's duration. The method of evaluation made use of symptom recall, daily dairy of the intake of sublingual nitrates or of anginal discomfort and in some, symptom limited treadmill exercise stress test (EST). Thirty-six patients completed the trial. Symptom-wise, 16 patients could not differentiate the effect of the true tablet from the placebo. Eight had less and 12 had more angina while on the drug. Of the 17 evaluable EST, 9 showed no change in the degree of ischemic changes while 4 performed with less and 4 with more ischemia while on the drug. Symptom-wise and taking into account the pre and post trial periods, a placebo effect was not found to be dominant. It is concluded that trimetazidine does not improve angina among those already being treated with conventional doses of nitrates, beta and calcium blockers.
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PMID:Trimetazidine and stable angina a double-blind trial. 219 89

Exercise stress testing (EST) after myocardial infarction helps to define the clinical subsets of patients at high and low risk. It should be performed before hospital discharge, unless a contraindication exists. In order to exclude false positives, EST must be repeated 4-6 weeks later. EST helps to recognize the presence of residual ischaemia. Significant ST segment depression during exercise, associated or not with angina, is the most important indicator of ischemia. These patients with ischaemia at distance i.e., those with ST segment changes in ECG leads without W waves, are at high risk. Some continuous exercise variables (degree of ST deviation, time of recovery and exercise duration) are related to cardiac mortality. Exercise induced complex ventricular arrhythmias seem to be related to left main or three vessels disease, and a greater likelihood of sudden death, particularly when coexist a low ejection fraction, important segmentar disturbances of contractility and ST segment depression. EST after myocardial infarction has great value to assess the results of medical therapy and/or coronary angioplasty or bypass grafting. EST also constitutes a valuable clinical tool to support a comprehensive rehabilitation programme.
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PMID:[Value of the ergometric test after myocardial infarction]. 225 61

Twenty-four patients with a history of effort angina, a positive exercise stress test (EST) and coronary artery disease were enrolled in the study; 12 patients had a positive dipyridamole-echocardiography test (DET) and 12 had a negative DET. Each patient performed a total of 4 ESTs in the absence of therapy on two successive days; for each test the rate-pressure product (RPP), an established index of myocardial oxygen demand, was measured at the onset of ischaemia (ST depression greater than 0.15 mV) or at the peak of maximal exercise (if a repeated EST was negative). Taking into account the lowest of the 4 RPP values (X 1/100) in each patient, there was no significant difference between DET-negatives and DET-positives (185.2 +/- 49.3 vs 157.4 +/- 32.4). Conversely, when considering the highest of the 4 RPP values in each patient, there was a significant difference between DET-negatives and DET-positives (280.3 +/- 63.9 vs 183.3 +/- 37.0; p less than 0.01). Thus, DET may provide a clinically useful tool for assessing in the individual the organic 'ceiling' of coronary reserve, by eliminating the variability in coronary tone, which may affect EST reproducibility and the correct evaluation of the impairment of organic coronary reserve.
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PMID:Dipyridamole-echocardiography test as a clue for assessing the organic 'ceiling' of individual coronary reserve. 381 37

In a previous study performed in patients with effort angina pectoris, we showed that the dipyridamole-echocardiography test (DET) is feasible and useful for the detection of coronary artery disease. The positivity of the test (consisting of two-dimensional echocardiography [2 DE] combined with dipyridamole infusion [0.14 mg/kg/min for 4 minutes]) is linked to the appearance of regional asynergy. In the present study, DET and exercise stress test (EST) were performed in 62 patients with angina at rest in the active phase. The overall sensitivity of DET and EST for the detection of coronary artery disease was 62% and 83%, respectively (p less than 0.05); the specificity of DET and EST was 100% and 64%, respectively (p less than 0.05). In 10 DET-positive patients, a spontaneous attack was also monitored by 2DE; the myocardial wall involved by ischemia was invariably the same both in patients with spontaneous and in those with dipyridamole-induced ischemia. Thus, in our population of patients with angina at rest (in whom an important functional component is also likely to be present during exercise), DET was significantly less sensitive but significantly more specific than EST in detecting coronary artery disease.
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PMID:Dipyridamole-echocardiography test in angina at rest: noninvasive assessment of coronary stenosis underlying spasm. 395 91

This study was undertaken to assess the diagnostic and prognostic value of ST depression equal to or more than 3 mm during exercise stress testing (EST). Out of 4050 EST performed over an 8 year period, 128 patients (3,2%) had this degree of ST depression. These changes were observed in leads V4 V6 in 92% of cases. Coronary angiography was performed in 56 patients: all had significant coronary artery disease (greater than 50% stenoses) with 50% three vessel, 30% two vessel and only 20% single vessel disease; all patients had at least one severe stenosis (greater than 75%) of a main coronary artery. The predictive value of EST was therefore 100% in the 56 patients undergoing coronary angiography. Angina or ventricular extrasystoles during EST or greater than 5 mm ST depression were predictive of multiple vessel disease. The following correlations were observed between EST and the extent of coronary artery disease: maximal heart rate and systolic pressure were lower, ischemic changes appeared sooner (less than 2 min) and lasted longer during the recovery phase (greater than 7 min) in patients with multiple vessel disease. The 5 year prognosis was studied in 58 patients; it was poor (death or infarction) in 31 cases (53%). The following factors were associated with a poor prognosis: low maximal heart rate and systolic blood pressure, early ischemic changes and frequent ventricular extrasystoles on EST; on the other hand, the development of anginal pain during EST was not of significant prognostic value in this series. ST depression greater than 3 mm on EST is rare.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Diagnostic and prognostic value of ST segment depression greater than or equal to 3 mm during exercise testing]. 642 95

The present study, selecting 39 patients undergoing elective coronary angioplasty (PTCA) with signs of myocardial ischemia during supine bicycle exercise stress test (EST) before PTCA and on medical therapy, was designed: to evaluate the efficacy of angiographically successful PTCA on functional capacity, in terms of work load, time of exercise and rate-pressure product (RPP), by comparing pre- and post-PTCA-EST performed in patients with post-PTCA disappearance (Group I, 44%) or persistence (Group II, 56%) of myocardial ischemia, and in the latter, to evaluate the effects of medical therapy, by repeating EST after its addition; to investigate the influence of PTCA on regional function, assessed by a 11 segment model and graded as usual, in the 25 patients group with pre-PTCA exercise-induced wall motion abnormalities, disappearing (Group A, 64%) or persisting (Group B, 36%) after the interventional procedure; to examine by a 12-month follow-up the eventuality of recurrent anginal symptoms, in the presence of myocardial ischemic signs in the territory supplied by the dilated vessel and/or of angiographic restenosis, in relation to the result of post-PTCA-EST. The results of our study showed a significant improvement in functional capacity after PTCA only in Group I patients, whereas in Group II patients effort tolerance significantly increased only after medical therapy, which was associated with the disappearance of myocardial ischemia. With regard to follow-up, exercise echocardiography showed a positive and negative predictive value for angina recurrence with angiographic restenosis of 78 and 92%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Usefulness of stress echocardiography in the evaluation of clinical and functional success of coronary angioplasty and prognostic stratification]. 766 5

Nitroglycerine (NTG) is still the most important angina relief drug. The aim of the study was to evaluate clinical effects and tolerance of sublingually nitroglycerine sub form Nitromint-spray in patients with exercise induced angina pectoris (AP) using treadmill electrocardiography stress test (EST). The study group consisted of 40 adults patients (mean age 57.4 +/- 10.08 years) hospitalised in our clinic with AP confirmed by clinically and electrocardiographically positive EST. Tests were performed using treadmill Marquette-Centra equipment, according to the modified Bruce protocol after 3 days wash-out period. On the fourth day two ESTs were performed: EST-0 and 30 minutes later EST-NTG after sublingual administration 0.8 mg of NTG. Among measured parameters after NTG exercise induced ST segment depression decline from 2.3 +/- 1.0 to 1.5 +/- 0.8 (p < 0.0001). EST after NTG became electrocardiographically negative in 11 patients. NTG increased workload, and time to angina pain oneset (p < 0.0001). Nitromint-spray proved to be clinically effective, well tolerated and easy to use.
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PMID:[Clinical evaluation of nitrates in exercise-induced angina]. 1181 37


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