Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Analysis of the rate-related change in exercise-induced ST segment depression, the ST/HR slope, has been shown to significantly improve the accuracy of the exercise ECG for the identification of patients with coronary artery disease and for the recognition of patients with stable angina pectoris who have anatomically or functionally severe coronary artery obstruction. This method, in effect, normalizes the extent of ST segment depression for heart rate, which serves as an index of exercise-induced augmentation of myocardial oxygen demand. While preserving the specificity of the exercise ECG at greater than 90%, an ST/HR slope value of 1.1 microV/bpm as an upper limit of normal improved exercise test sensitivity from 57% to 91% in patients with stable angina who were examined using standard Bruce protocols and three monitoring leads. In addition, an ST/HR slope value of 6.0 microV/bpm was found to partition patients with and without three-vessel coronary artery disease with a sensitivity of 78%, specificity of 97%, positive predictive value of 93%, and overall test accuracy of 90%. No other criteria based on standard ECG interpretation performed as well as the ST/HR slope for the recognition of three-vessel disease in these patients. Further, patients with high ST/HR slopes who did not have three-vessel coronary disease could be shown to have functionally severe two-vessel disease by radionuclide cineangiography. These data suggest that the ST/HR slope can improve the evaluation and management of patients with possible coronary disease. Additional improvement in ST/HR slope accuracy and applicability is likely to result from modification of exercise protocols to reduce heart rate increments between stages, an increase in monitoring leads to include CM5, and computer analysis of the ST segment depression.
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PMID:Evaluation of coronary artery disease by an improved method of exercise electrocardiography: the ST segment/heart rate slope. 375 68

Twenty-four-hour, 2-channel Holter monitoring during daily activities was performed in 210 patients; during the same day a Bruce protocol treadmill test was also performed and the electrocardiogram was recorded using the same Holter system. Significant ST-segment depression was observed during daily activities in 97 patients, while similar changes were recorded during the treadmill test in 122 patients. Thus, 77% of patients with ST depression during the provocation of the treadmill test had ischemic episodes during their everyday life. On the other hand, 3 patients with proven significant coronary artery disease had spontaneous ischemic episodes during daily activities, but had a negative stress test. The ischemic changes during daily activity developed at a lower heart rate than during stress testing (94 beats/min vs 109 beats/min, respectively, p less than 0.05). A total of 351 ischemic episodes were recorded during daily activities, 241 (69%) of these were asymptomatic. In 46 patients all episodes were asymptomatic, in 15 all were symptomatic, while in 36 both symptomatic and silent episodes were detected. The mean duration of the symptomatic episodes was 13.7 minutes and that of the asymptomatic ones was 14.9 minutes (difference not significant). The degree of ST depression in these 2 groups was also similar. Because of more advanced symptomatology in 143 patients, coronary arteriography was performed; 43 had normal and 100 had pathologic coronary arteries. In this selected group, the sensitivity of Holter monitoring during daily activity was 87% and during stress 97%; the specificity during daily activity was 95% and during stress 88%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Myocardial ischemia during daily activities and stress. 375 3

The sensitivity of dipyridamole--2-dimensional (2-D) echocardiography was assessed for detection and localization of ischemia in 21 patients with severe chronic stable angina pectoris, a clearly positive exercise stress test response and multivessel coronary atherosclerosis. Regional wall motion during dipyridamole infusion (0.6 mg/kg intravenously over 4 minutes) was compared with control and recovery by 2 blinded observers in consensus. Transient regional wall motion abnormalities were observed in 11 patients. Angina and ST-segment changes occurred in 9 of these 11 patients with positive responses, but in none of those who showed no transient abnormality of regional wall motion. Localization of regional wall motion abnormalities correlated well with angiographic severity of coronary lesions. Endocardial area contraction, evaluated by a computerized system, was reduced significantly after dipyridamole administration in patients with a positive response (from 51 +/- 10% to 35 +/- 11%, p less than 0.001), whereas it did not change significantly in the others (from 43 +/- 6% to 42 +/- 8%). In the 11 patients with a positive response, coronary reserve assessed by exercise testing (modified Bruce protocol) was more impaired than in those with a negative response (time to 1 mm of ST depression 177 +/- 148 seconds and 472 +/- 179 seconds, respectively, p less than 0.01). In patients with severe angina and multivessel coronary artery disease, dipyridamole--2-D echocardiography appears to identify the vessel in which flow reserve is most limited. Although this information may be valuable, indications for the test are restricted to patients with severely limited exercise capacity.
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PMID:Limitations of dipyridamole-echocardiography in effort angina pectoris. 381 69

Abnormalities of the 12 lead electrocardiogram (ECG) are often used to localize the anatomic site of myocardial ischemia and vessel involvement in patients (pts) with coronary artery disease. This study is to determine if ischemia of specific vascular segments can be identified by exercise induced ST segment depression (STD) on 12-lead ECG. One hundred and forty three pts with a positive treadmill stress testing (TST) who had coronary arteriography within one month of TST were reviewed. There were 114 men and 29 women, aged 34-74 years (mean 55 years). The Bruce protocol was used for TST. Significant coronary stenosis was defined as obstruction of 70% or greater of the luminal diameter. The pattern of STD on 12 lead ECG during exercise was similar in pts with single vessel disease involving the left anterior descending artery (LAD), right coronary artery (RCA) or circumflex artery (Cx). This pattern of STD in single vessel disease was also comparable to 2-vessel, 3-vessel or left main stem disease. Twenty-two percent of pts with LAD disease had isolated STD in inferior leads. Twenty-five and 29% of pts with RCA and Cx disease respectively had STD in the anterior leads alone during exercise testing. It is concluded that exercise induced STD in 12 lead ECG can not predict ischemia of specific vascular segments or specific vessel involvement.
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PMID:Localization of coronary artery disease with exercise induced ST segment depression: coronary angiographic correlation. 385 Jul 71

The effects of bepridil, a calcium antagonist with a half-life of approximately 42 hr, were assessed in a double-blind, randomized, placebo-controlled crossover trial. Forty-four patients (39 men, five women) with exercise-induced angina pectoris and ST segment depression with exercise testing (modified Bruce protocol) were studied. Compared with placebo bepridil (400 mg daily) increased total exercise time, time to onset of angina, time to 1 mm of ST segment depression, time to 2 mm of ST segment depression, and total work achieved (all p less than or equal to .001). Both frequency of angina and nitroglycerin consumption decreased during the bepridil compared with the placebo period (p = .02 and .03, respectively). Minor side effects were noted during both the bepridil and placebo phases. Four patients experienced side effects that limited therapy (dizziness in three and abnormal results of liver function tests in one) and one patient died during the bepridil phase. This study suggests that bepridil, 400 mg daily, is effective for the treatment of exercise-induced myocardial ischemia and angina pectoris.
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PMID:Effect of bepridil in patients with chronic stable angina: results of a multicenter trial. 388 May 21

The safety and efficacy of bepridil plus propranolol therapy were investigated in a placebo-controlled, parallel-design, double-blind trial in 56 patients who were not responding to propranolol alone. Patients entering the study were receiving an average propranolol dosage of 131 mg/day (range 20 to 240). For the first 2 weeks of the study they were given placebo in addition to their propranolol dose, and then were randomized to receive continued placebo plus propranolol or bepridil plus propranolol therapy. The bepridil dosage was adjusted over the 8 weeks of active treatment to an average of 273 mg/day (range 200 to 400). The double-blind treatment period was followed by a 3-week washout period during which all patients received propranolol and placebo. The effects of treatment on the frequency of angina attacks, nitroglycerin consumption, exercise performance (treadmill-modified Bruce protocol) and Holter electrocardiogram (ECG) were assessed. Propranolol and bepridil plasma levels also were obtained. Improved antianginal efficacy and reduced nitroglycerin consumption were noted when bepridil was added to propranolol (p less than 0.01). During 8 weeks of combination treatment, exercise tolerance increased 1.0 +/- 1.2 minutes from a baseline of 7.3 +/- 2.2 with bepridil plus propranolol compared with an increase of 0.02 +/- 1.3 minutes from a baseline of 7.6 +/- 2.9 with placebo plus propranolol (p less than 0.01). With bepridil plus propranolol, there were also increases in exercise time to onset of angina (p less than 0.04), exercise time to 1-mm electrocardiographic ST-segment depression (p less than 0.06) and total work (p less than 0.03) compared with placebo plus propranolol therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Combination propranolol and bepridil therapy in stable angina pectoris. 388 41

Exercise electrocardiographic stress testing was performed in 81% of the 780 patients randomized in the Coronary Artery Surgery Study at entry. The cumulative survival at the end of 7 year follow-up was 90% for those assigned to surgical treatment and 88% for those assigned to medical therapy (p = NS). These survival rates did not differ significantly from either those of the entire randomized cohort or those of the 149 patients who did not have a qualifying exercise test at baseline. No differences in important baseline characteristics existed between those who were exercised and not exercised at entry. Stratification of patients according to the degree of ST segment depression (less than 1 mm, greater than or equal to 1 mm, greater than 2 mm) and final exercise stage achieved during a Bruce protocol treadmill test (final stage less than or equal to 1, stage 2 and greater than or equal to stage 3) failed to show any significant differences in 7 year survival rates between medically and surgically assigned patients. Additionally no differences in survival were noted within either the medical or surgical groups regardless of the degree of ST segment depression or the final stage achieved. The presence of exercise-induced angina, however, identified patients who had a survival advantage if assigned to surgical therapy, with a 7 year survival rate of 94% compared with 87% for medically assigned patients (p = .007).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Exercise testing in the Coronary Artery Surgery Study randomized population. 390 57

The short-term effect of oral nifedipine on effort tolerance was tested in 10 patients with effort angina pectoris and a positive effort test (GXT). The patients had four symptom-limited GXTs, using the Bruce protocol, on each day of the study at 0800, 1000, 1400, and 1800 hours. They received four doses of 10 mg oral nifedipine on one day and four doses of placebo on the other, each dose given half an hour prior to each GXT. Values with nifedipine were compared to values with placebo at the same time during each day. Nifedipine improved effort tolerance by 0.5 +/- 0.6 min (p = NS) on the first GXT (mean +/- SEM), by 1.2 +/- 0.6 min (p = NS) on the second GXT, by 1.0 +/- 0.3 min (p less than 0.01) on third GXT, and by 1.3 +/- 0.3 min (p less than 0.01) on the fourth GXT. Improvement of effort tolerance was associated with a fall in resting blood pressure and less ST depression; these changes were statistically significant only on the fourth GXT, which may indicate a cumulative effect of subsequent doses of nifedipine.
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PMID:Short-term effect of nifedipine on effort tolerance in patients with angina pectoris. 394 42

The rate of depression of the ST segment with increasing heart rate (HR) during exercise has been claimed to predict the extent of coronary artery disease (CAD). To determine whether the maximal ST/HR slope is better than the Bruce treadmill exercise test for predicting the presence of CAD, the maximal ST segment/HR slope was calculated in 81 patients and compared with the results of a standard 12-lead exercise test. In 21 patients (26%), the ST/HR slope could not be calculated. In 60 patients with ST/HR slope values, the extent of CAD was predicted in 24 patients (40%). The sensitivity and specificity of the ST/HR slope in predicting the presence of CAD in the 60 patients with slope values were 91% and 27%, respectively. The sensitivity and specificity of the modified Bruce treadmill exercise test in the 81 patients were 81% and 64%, respectively. Thus, the use of the ST/HR slope does not provide additional information that cannot be obtained using the standard Bruce exercise test.
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PMID:Comparison of the ST/heart rate slope with the modified Bruce exercise test in the detection of coronary artery disease. 395 38

To compare a propranolol-verapamil with a propranolol-nifedipine combination in patients with severe angina of effort, 16 patients (11 men and 5 women, aged 56 +/- 8 years [mean +/- standard deviation]) with more than 5 episodes/week of angina and a positive exercise tolerance test despite propranolol (229 +/- 44 mg/day [range 180 to 360]) were maintained on this dose of propranolol and, in addition, received verapamil (360 mg/day) and nifedipine (60 mg/day) for 3 weeks each in a double-blind, randomized fashion. In comparison with propranolol alone, anginal frequency and nitroglycerin usage were reduced by propranolol-verapamil but not by propranolol-nifedipine. Exercise time (standard Bruce protocol) was similar for the 2 combinations (6.4 +/- 2.0 minutes with propranolol-verapamil, 6.6 +/- 2.1 minutes with propranolol-nifedipine, difference not significant), but the magnitude of ST-segment depression at peak exercise was less (p less than 0.05) during propranolol-verapamil (0.03 +/- 0.06 mV) than during propranolol alone (0.18 +/- 0.07 mV) and propranolol-nifedipine (0.08 +/- 0.07 mV). Left ventricular ejection fraction at rest was higher (p less than 0.05) with propranolol-nifedipine (0.62 +/- 0.10) than with propranolol-verapamil (0.58 +/- 0.10), but neither differed from ejection fraction at rest with propranolol alone (0.59 +/- 0.08). Ejection fraction at peak exercise was similar during all 3 periods. In 2 patients, verapamil caused weakness, lightheadedness, and severe sinus bradycardia (40 to 48 beats/min), and the dosage was reduced (blindly) to 240 mg/day, with the alleviation of bradycardia and associated symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Propranolol-verapamil versus propranolol-nifedipine in severe angina pectoris of effort: a randomized, double-blind, crossover study. 396 62


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