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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It has been demonstrated in animal experiments that heparin accelerates the coronary collateral development induced by repeated coronary occlusion. We used this effect of heparin for the treatment of patients with stable effort angina. In 10 patients, treadmill exercise was performed according to standard Bruce protocol twice a day for 10 days. A single intravenous dose of heparin (5000 IU) was given 10 to 20 min before each exercise period. Exercise with heparin pretreatment increased the total exercise duration from 6.3 +/- 1.9 (SD) to 9.1 +/- 2.2 min (p less than .001) and the maximal double product (DP) from 18,900 +/- 5100 to 25,500 +/- 6800 mm Hg.beats/min (p less than .001). The DP at the onset of angina was also increased by 35% (p less than .01) and the DP at which ST depression (0.1 mV) first appeared was 19% (p less than .05) greater after treatment. Repeat coronary cineangiography revealed an increase in the extent of opacification of collaterals to the jeopardized myocardium. In an additional six patients, treadmill exercise was performed with no medication twice a day for 10 days. All of the above-mentioned variables of treadmill capacity remained unchanged, despite 20 exercise periods without heparin pretreatment. Thus, heparin accelerates exercise-induced coronary collateral development by promoting angiogenesis. The development of such a therapeutic modality will open a new field for the treatment of patients with ischemia.
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PMID:Improvement of treadmill capacity and collateral circulation as a result of exercise with heparin pretreatment in patients with effort angina. 283 15

This study was undertaken to determine whether it was possible to use a multivariate discriminant function analysis to assess the severity of coronary artery disease in patients with angina pectoris. One hundred and forty-three patients diagnosed as having angina pectoris who formed a 'learning group' were subjected to an exercise test on a treadmill using a Bruce protocol. The items of data from the test least likely to be influenced by beta blockade were considered for the analysis along with two discrete variables (the gender and the use of beta blockers). All the patients subsequently underwent coronary angiography and the severity of the coronary artery disease was graded according to a scoring system. In addition, patients in 'learning group' were classified into two 'Groups', (I) those with normal vessels or with disease in one or two of the major arteries, (II) those with disease in the left main stem or in all three major arteries. The multivariate analysis yielded a score based upon 4 factors: (i) gender, (ii) percentage increase in double product at the highest level of exercise achieved, (iii) duration of ST depression in the recovery period and (iv) the summation of the ST depression in the standard electrocardiogram excluding lead aVR. There was a significant overall correlation between the discriminant function score and the coronary artery score for severity of the disease. In addition, it was found that, of patients having discriminant function score below 0, 96% (69/72) were in Group I. The post-test risk of a positive test was 0.005.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Incremental value of the exercise treadmill test in determining the extent of coronary artery disease: a discriminant function analysis. 286 54

A submaximal treadmill exercise test performed before hospital discharge after an uncomplicated myocardial infarction is often utilized to estimate prognosis and guide management, but there is little experience with a maximal exercise test performed 6 months after infarction to identify prognosis later in the convalescent period. The performance characteristics during an exercise test 6 months after myocardial infarction were related to the development of death, recurrent nonfatal myocardial infarction and coronary artery bypass surgery in the subsequent 12 months (that is, 6 to 18 months after infarction) in 473 patients. Mortality was significantly greater in patients who exhibited any of the following: inability to perform the exercise test because of cardiac limitations, the development of ST segment elevation of 1 mm or greater during the exercise test, an inadequate blood pressure response during exercise, the development of any ventricular premature depolarizations during exercise or the recovery period and inability to exercise beyond stage I of the modified Bruce protocol. By utilizing a combination of four high risk prognostic features from the exercise test, it was possible to stratify patients in terms of risk of mortality, from 1% if none of these features were present to 17% if three or four were present. Recurrent nonfatal myocardial infarction was predicted by an inability to perform the exercise test because of cardiac limitations, but not by any characteristics of exercise test performance. Coronary artery bypass surgery was associated with the development of ST segment depression of 1 mm or greater during the exercise test. Although clinical evidence of angina and heart failure 6 months after infarction was predictive of subsequent mortality among all survivors, among the low risk group without severely limiting cardiac disease, the exercise test provided unique prognostic information not available from clinical assessment alone. Therefore, a maximal exercise test performed 6 months after myocardial infarction is a valuable, noninvasive tool to evaluate prognosis. It provides information that is independent of and additive to clinical evaluation performed at the same time.
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PMID:Prognostic significance of the treadmill exercise test performance 6 months after myocardial infarction. 287 18

To determine if a sustained-release form of the calcium entry blocker diltiazem would be a satisfactory substitute for the combination of beta-adrenergic blocking agent and thiazide diuretic in the treatment of systemic hypertension and angina pectoris, 38 patients were studied in a 4-center trial. Blood pressure and heart rate were measured in the supine position, immediately after and 5 minutes after standing. Modified Bruce protocol treadmill tests were performed to determine the time to onset of 1 mm ST-segment depression, time to onset of chest pain and time to termination of exercise. Diltiazem monotherapy resulted in equivalent blood pressure control in 28 of 38 patients (74%). In the remaining patients, blood pressure control was achieved with resumption of the diuretic. Blood pressure with beta blocker plus diuretic compared with diltiazem were, in the supine position 137 +/- 22/82 +/- 7 (+/- 1 standard deviation) versus 139 +/- 22/82 +/- 8 mm Hg, immediately after standing 131 +/- 20/84 +/- 9 versus 133 +/- 21/82 +/- 10 mm Hg and after standing for 5 minutes 134 +/- 19/85 +/- 8 versus 137 +/- 18/85 +/- 9 mm Hg (difference not significant for each). The heart rate with diltiazem was higher supine (67 +/- 11 versus 60 +/- 11 beats/min), standing (73 +/- 13 versus 64 +/- 14 beats/min) and 5 minutes after standing (73 +/- 14 versus 63 +/- 14 beats/min, p less than 0.01 for each).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Efficacy and safety of sustained-release diltiazem as replacement therapy for beta blockers and diuretics for stable angina pectoris and coexisting essential hypertension: a multicenter trial. 289 Dec 91

Women have a notoriously high rate of false positive exercise test results. Since the exercise ST segment response has low specificity in predicting CAD in women, we examined additional exercise parameters in 200 women with a history of chest pain compatible with angina and having ST segment depression greater than or equal to 1 mm recorded during a Bruce treadmill test. All subsequently had coronary arteriography. Two groups were compared: group A (n = 80) with CAD (greater than or equal to 70 percent stenosis of one or more coronary artery) and group B (n = 120) with angiographically confirmed normal coronary arteries (normal or minimal placquing). The exercise criteria analyzed included: (1) chest pain during exercise, (2) percent target heart rate, (3) extent of ST shift, (4) morphology of the ST segment slope, (5) time to normalization of the ST segment, and (6) total exercise duration. Multivariate analysis (using a stepwise logistic regression model) identified four independent exercise variables associated with the likelihood of CAD: (absence of MVP, p = .003; exercise duration less than 5 min, p = .02; ability to reach target heart rate, p = .027; time to ST normalization greater than or equal to 6 min, p less than .001). False positive exercise test results were more likely to occur when the following exercise test variables were present: ability to exercise to stage 3 of the Bruce protocol and a rapid (less than or equal to 4 minutes) normalization of ST shift after cessation of exercise. Attention to these additional exercise variables allows more careful selection of women requiring more definitive (and expensive) testing.
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PMID:Exercise testing in women with chest pain. Are there additional exercise characteristics that predict true positive test results? 290 29

Nicorandil therapy was compared with placebo therapy in 11 patients with chronic stable angina pectoris. A computer-assisted treadmill exercise test was performed after administration of either 10 or 30 mg of nicorandil. Analysis of variance showed a significant difference among placebo and nicorandil treatments (p less than 0.01). Ten milligrams of nicorandil prolonged time to onset of ischemia 36% (p less than 0.05) but increased the exercise duration only 15%. Thirty milligrams of nicorandil prolonged time to onset of ischemia 82% (p less than 0.01) and exercise duration 45% (p less than 0.01). Both time to onset of ischemia and exercise duration increased progressively from the 10-mg to the 30-mg dose (p less than 0.05). Heart rate at rest was significantly higher and systolic pressure at rest significantly lower with 30 mg of nicorandil than with placebo. After administration of 30 mg of nicorandil there was a significant reduction in ST depression associated with a slight decrease in the double product at the end of Bruce stage 2 exercise. The peak double product was greater after administration of 30 mg of nicorandil than after placebo, indicating an increased myocardial oxygen supply to the ischemic area. The plasma concentration of nicorandil averaged 78 +/- 83 ng/ml with the 10 mg and 313 +/- 142 ng/ml with 30 mg. There was an increase in exercise duration of more than 1 minute in 8 of 9 patients who had plasma nicorandil concentrations greater than 100 ng/ml.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparative efficacy of high-dose versus low-dose nicorandil therapy for chronic stable angina pectoris. 294 20

The diagnostic value of ST segment changes on exercise were reassessed by computerised analysis in 807 patients without myocardial infarction who underwent coronary angiography. All the stress tests were carried out according to Bruce's protocol with a system of continuous averaging of the ST segment in V5, V2 and VF. An abnormal response was defined by the association of the following three criteria: 1) ST depression less than or equal to 1 mm, 2) the algebraic sum of the depression + ST slope less than or equal to -1, 3) changes occurring during exercise or the first minute of recovery. A significant coronary lesion was defined as at least 50 per cent narrowing of the vessel lumen. In the study population the prevalence of lesions was 55 per cent in men and 18 per cent in women. The sensitivity of exercise stress testing was 69 per cent but the specificity was only 65 per cent. The positive predictive value was 70 per cent in men, 29 per cent in women; the negative predictive value was 90 per cent in women compared with 62 per cent in men. The predictive values depended on the interpretation of the amplitude, morphology and topography of the ST depression. The low sensitivity and specificity were independent of the coronary angiographic criteria and not related to the bias usually encountered in the correlation between stress testing and coronary angiography. These results show that the quantitative analysis of ST changes during computerised stress testing is not sufficiently accurate in itself to detect atherosclerotic coronary artery disease.
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PMID:[Value of the computerized analysis of ST segment depression during exercise without myocardial infarction. Apropos of 807 cases]. 310 1

A controlled (placebo) double blind trial of a 20 cm2 transdermal system delivering 10 mg of Trinitrin per 24 hours, was carried out in 18 patients with stable angina and significant coronary artery disease. The exercise stress tests were performed at the same time of day using Bruce's protocol and computerised analysis (Case Marquette) after a 48 hour wash out period. All patients had two basal positive and reproducible exercise tests interrupted because of induced anginal pain and/or greater than or equal to 3.5 mm ST depression. There was no significant difference between the basal exercise stress tests and those performed after placebo. With the active drug the onset of ischaemia was delayed (ST less than -1 mm = 217 +/- 122 sec vs 150 +/- 70 sec with placebo, p less than 0.01); the duration of exercise was prolonged (419 +/- 119 sec vs 328 +/- 94 sec with placebo, p less than 0.01); for the same theoretical maximal heart rate, the ST depression was less (-1.6 +/- 0.9 mm vs -2.1 +/- 0.7 mm with placebo, p less than 0.01). On the other hand, the double rate pressure product was unchanged at rest and on effort. These results obtained after a 48 hour therapeutic window show statistically significant benefits with an increase in exercise tolerance and a decrease in myocardial ischaemia 8 hours after the application of transdermal Trinitrin system.
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PMID:[Prevention of myocardial ischemia during exercise 8 hours after use of transdermal nitrate derivatives]. 310 6

The study objective was to assess the widespread applicability of ST/HR slope for the modified Bruce exercise test using a computerized electrocardiogram (ECG); compare the usefulness of the ST/HR slope with standard ECG criteria in detection of coronary artery disease (CAD) and identification of three-vessel or left main CAD; and then develop a new, modified ST/HR score (MSHS) for improving the diagnostic accuracy of ST/HR slope. The studies were retrospective and prospective in design, conducted in referral-based cardiology clinics at a national cardiovascular center. A selected sample of 142 patients underwent exercise ECG and coronary angiography, as did a normal control group of 402 patients who were apparently free from CAD. Sixty three other patients who underwent coronary angiography were also studied prospectively. No limitations of medical treatment were exacted for the test except digitalis treatment. Linear regression analysis, from which ST/HR slope was derived, was done with seven measurements of HR and ST displacement at 60 ms from J point in leads a VF and V5 during 6 min before the end of exercise. MSHS was derived from a multiple regression model with peak HR (% maximum HR), ST index (ST depression + ST slope), and ST/HR slope. Although the usual ST criteria (sensitivity = 63 percent, specificity = 73 percent), ST index (71 percent, 80 percent), and ST/HR slope (70 percent, 97 percent) were equally accurate in detection of CAD, MSHS showed significantly improved sensitivity (88 percent) with similar specificity (81 percent). In identification of three-vessel or left main CAD, when compared with other criteria, ST/HR slope and MSHS provided improved diagnostic accuracy: sensitivity (74 and 78 percent, respectively), specificity (88 and 93 percent) and overall test accuracy (85 and 89 percent). The improved accuracy of ST/HR slope and MSHS was prospectively validated in 63 other patients. ST/HR slope was applicable to computerized ECG data for the standard treadmill test, and showed improved accuracy in detection of three-vessel or left main CAD. The new, modified ST/HR score more accurately predicted not only the presence but also the severity of CAD.
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PMID:Improved accuracy of the exercise electrocardiogram in detection of coronary artery and three-vessel coronary disease. 316 70

To determine the prognosis of patients with painless strongly positive exercise electrocardiogram, the 6-year cumulative survival rate was computed for 298 medically treated patients who terminated their exercise test with or without angina. All had horizontal or downsloping ST depression greater than or equal to 2 mm during a treadmill exercise test according to the standardized multistage Bruce protocol. Of the 298 patients, 119 terminated the exercise test because of dyspnea or fatigue and 179 stopped because of angina. Among the 119 patients without angina, there were 18 deaths, 16 from coronary artery disease (CAD), of which 8 occurred suddenly. Among the 179 patients with exercise-induced angina, 36 died, 33 from CAD, of which 13 were sudden deaths. The overall 6-year survival rate was 85 +/- 3% for patients without angina and 80 +/- 3% in those with angina (p less than 0.05). However, patients without angina achieved a significantly longer duration of exercise and had higher maximal heart rate and systolic blood pressure during exercise. In both groups, survival decreased with decreasing duration of exercise. In patients without angina, the 6-year survival rate was 97 +/- 3% in those achieving stage IV (greater than or equal to 541 s), 87 +/- 4% in stage III (361 to 540 s), 64 +/- 13% in stage II (181 to 360 s) and 60 +/- 15% in stage I (less than or equal to 180 s).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Survival with painless strongly positive exercise electrocardiogram. 317 36


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