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)

Myocardial ischemia is an indicator of adverse prognosis. In patients with stable angina and positive exercise tests, prolonged cumulative ischemia on ambulatory electrocardiographic monitoring identifies a high-risk group with severe coronary artery disease and poor survival. To determine whether features of the exercise test can accurately (1) predict the occurrence of ambulatory ischemia, and (2) classify patients into subgroups at varying levels of risk for ambulatory ischemia, we studied 48 patients with a history of angina and documented coronary disease who underwent the standard Bruce protocol and ambulatory monitoring. All patients had a positive exercise treadmill test, and 26 had ischemia on Holter monitoring (total of 2,922 minutes, 173 episodes, 94% with silent ischemia). The remaining 22 patients did not have ischemia. The exercise test parameters showing significant differences between the 2 groups were (1) time to > or = 1 mm ST-segment depression (p < 0.0003), (2) maximal ST-segment depression (p < 0.004), and (3) exercise capacity (p < 0.037). These data were used to develop a model for predicting the presence and the severity of ambulatory ischemia. Time to onset of > or = 1 mm ST-segment depression and maximal ST-segment depression on exercise treadmill testing can be used to determine the likelihood of mild (1 to 5 episodes or lasting < or = 60 minutes) or severe prolonged (> 5 episodes or lasting > 60 minutes) ambulatory ischemia. Patients with a very high or very low probability of ischemia on Holter monitoring can be identified by certain exercise test parameters and may not need to undergo monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Use of exercise test parameters to predict presence and duration of ambulatory ischemia in patients with coronary artery disease. 797 60

Diltiazem hydrochloride in a once-daily capsule formulation (DCD) has recently been approved in the United States for the treatment of mild to moderate hypertension and chronic stable angina pectoris. This trial evaluated the dose response of DCD in patients with chronic stable angina pectoris. In a multicenter, randomized, double-blind, parallel-design trial, the effects and tolerability of once-daily therapy with placebo or DCD (60, 120, 240, 360, or 480 mg) were evaluated 24 hours after dosing, following 3 weeks of therapy in 227 patients with reproducible stable exertional angina pectoris. A significant linear dose trend (p = 0.004) was present across the 6 treatment groups for the primary end point--time to exercise termination at 24 hours after dosing--using a standard Bruce treadmill exercise test. A significant linear dose trend was also seen for time to 1 mm ST-segment depression at 24 hours after dosing. Similar effects on exercise parameters were also seen at 4 hours after dosing. A linear dose trend (p = 0.04) was noted relative to the overall anginal attacks during daily activities and for anginal attacks during exercise (p = 0.02). Overall frequency of treatment-related adverse effects was dose-related and occurred in 24.4% and 17.5% of patients treated with DCD and placebo, respectively. At a dose up to 240 mg/day, improvement in exercise tolerance was achieved without an associated increase in the rate of treatment-related adverse events compared with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Dose-response evaluation of once-daily therapy with a new formulation of diltiazem for stable angina pectoris. Diltiazem CD Study Group. 801 16

The efficacy of intermittent (16 h on/8 h off) transdermal nitrate therapy (0.4 mg/h) was assessed in 46 patients with chronic stable angina, all but one of whom were on concomitant beta-blocker and/or calcium antagonist therapy. The study was a randomised, double-blind placebo-controlled crossover with two consecutive 7-day treatment periods, conducted at two centres. Prior to entry into the study patients were screened for exercise test reproducibility and nitrate response. Patch efficacy was determined by maximal symptom limited treadmill stress testing (Bruce protocol) and subjective diary card data. Analysis of variance showed that active treatment significantly improved time to onset of angina (P < 0.001), time to 1 mm ST-segment depression (P < 0.001) and total exercise duration (P < 0.001) compared with placebo from 385.7, 310.8 and 458.1 s to 455.7, 385.2 and 497.1 s, respectively. Nitrate patch therapy significantly reduced diastolic and systolic blood pressures without significantly increasing resting heart rate. There was a marginal reduction in the incidence of angina attacks and sublingual nitroglycerine consumption during active treatment. We conclude that intermittent transdermal nitrate therapy significantly improves exercise tolerance in patients with chronic angina pectoris and that this improvement occurs in addition to conventional anti-anginal therapy.
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PMID:Efficacy of intermittent (eight hours off) transdermal nitrate therapy in stable angina. 818 83

Betaxolol, a long-acting cardioselective beta-blocker, was tested alone and in combination with long-acting nitrates in a multicenter, double-blind, parallel, placebo-controlled study of 3 weeks duration in patients with stable angina pectoris. All patients underwent exercise tolerance tests (ETTs) using Bruce's protocol. During the 3- to 4-week single-blind placebo baseline phase, all other drugs except sublingual nitroglycerin and long-acting nitrates were withdrawn. Those patients (n = 115) whose time to onset of moderate angina was between 2.5 and 7.5 min and was within +/- 15% in 2 consecutive ETTs were randomized to betaxolol 20 mg/day (n = 54) or placebo (n = 53). Betaxolol, compared to placebo, increased time to onset of angina, time to 1 mm S-T segment depression, and total exercise time and decreased the double product, weekly anginal attacks, and sublingual nitroglycerin consumption (p < 0.01). Our results indicate that betaxolol given in fixed 20-mg daily doses was efficacious in stable angina pectoris and its combination with long-acting nitrates potentiated its effect.
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PMID:Betaxolol in the treatment of stable angina pectoris. 818 19

Two hundred and eighty healthy children from Naples, Italy (140 boys and 140 girls) aged 4-17 years were studied using Bruce walking treadmill protocol to voluntary exhaustion. Endurance time and double product increased with age. Systolic blood pressure increased linearly during the test. Multivariate analysis showed that body weight and age were the best predictors of endurance time. Endurance time averaged 15.2 +/- 2.8 min in boys and 13.7 +/- 2.3 min in girls (p = 0.00001). Mean +/- SD double product at peak exercise was 264.3 +/- 63 (boys) and 242 +/- 44 (girls) (p = 0.01). Sinus arrhythmia was present in 78% of the children and disappeared at a mean heart rate of 112 +/- 16 beats/min during exercise. The voltage of the R wave on V4 lead decreased in all but four children during the test (delta R = -0.25 +/- 0.24 mV). The P and T waves increased in almost all children. No ST depression or upward sloping was detected. The voltage of the PR isoelectric line remained constant. The J point was displaced downwards in 78% of children, unchanged in 11% and displaced upwards in the remaining 11% of the children. The present study gives reference parameters for a walking treadmill test in Southern European children.
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PMID:Treadmill exercise in Neopolitan children and adolescents. 819 59

A new intranasal spray formulation of propranolol was developed to provide beta-adrenergic blocking medication on an immediate basis to patients with angina pectoris. The effects of this spray or placebo were assessed in 16 patients with effort-induced angina in a blinded, randomized, cross-over design study that compared placebo with intranasal propranolol spray (5 mg/puff) 15 minutes before exercise on a treadmill (Bruce protocol). One week later, each patient, acting as his/her own control, received the alternative treatment and repeated exercise. Mean plasma propranolol level with active therapy was 20 ng/ml. Patients with active spray demonstrated a significant increase in total exercise time than patients taking placebo (530 +/- 197 vs 460 +/- 177 seconds, p = 0.05), an increase in the time to 1 mm ST-segment depression on the electrocardiogram (384 +/- 202 vs 327 +/- 144 seconds, p < 0.05), and an increase in time to onset of angina (452 +/- 149 vs 363 +/- 175 seconds, p = 0.0005). There was a blunting of maximal exercise heart rate with active therapy compared with placebo (120 +/- 13 vs 133 +/- 17 beats/min, p < 0.01), blunting of maximal exercise systolic blood pressure (185 +/- 22 vs 194 +/- 21 mm Hg, p < 0.05), and blunting of peak double product (p < 0.0005), with more modest effects on resting heart rate. Propranolol spray is an effective approach for providing immediate beta blockade and improving exercise tolerance in patients with angina pectoris.
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PMID:Improvement in exercise tolerance and immediate beta-adrenergic blockade with intranasal propranolol in patients with angina pectoris. 821

In the setting of stable effort angina a single-blind, randomized, cross-over study to evaluate the effects of gallopamil (GAL) and amlodipine (AML) on exercise tolerance and ischemic ST depression was conducted. Fifteen outpatients, 12 males and 3 females, aged 40-65 years (57 +/- 9), with documented coronary atherosclerosis and reproducible ST-segment depression on 2 consecutive baseline exercise stress tests, completed the study, which consisted of 4 periods: 1 and 3 placebo, 2 and 4 at random GAL (50 mg tid) and AML (10 mg/daily). At the end of each period a multistage treadmill exercise stress test (Bruce protocol) was performed. Both drugs significantly (p = 0.0001) increased the ischemia time (IT) (0.1 mV ST depression) as compared to placebo, from 416 +/- 165 s to 635 +/- 161 s (GAL) and 607 +/- 152 s (AML) with significant difference (p = 0.2) between the 2 drugs, and reduced significantly (p = 0.001) the maximal ST depression from -0.25 +/- 0.09 mV to -0.11 +/- 0.08 mV (GAL) and -0.12 +/- 0.09 mV (AML). At the IT, the systolic blood pressure increased from 178 +/- 23 mmHg to 185 +/- 20 mmHg (GAL) and remained unchanged during AML treatment (178 +/- 15 mmHg); similarly, the heart rate increased from 126 +/- 22 b/min to 139 +/- 21 b/min (GAL) and 138 +/- 19 b/min (AML). In conclusion, both GAL and AML showed a good anti-ischemic effect (IT = +52.6% during GAL and +45.9% during AML), even if GAL proved to be significantly more effective than AML.
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PMID:[An ergometric cross-over evaluation of the anti-ischemic efficacy of amlodipine and gallopamil in stable angina of effort]. 822 40

One hundred and fourteen patients (94 male) with chronic stable angina who had a positive exercise test after 4 weeks on atenolol alone were randomized to receive either atenolol alone or the fixed combination of atenolol and nifedipine slow release formulation for 4 weeks in a double-blind cross-over manner. Exercise stress testing (Bruce protocol) at the end of each treatment period demonstrated that the time to the onset of pain and occurrence of 1 mm ST segment depression improved significantly (P < 0.05 and P < 0.001 respectively) whilst on the fixed combination compared to atenolol alone. In order to achieve sufficient sensitivity in the analysis of the exercise times, novel statistical methods based on survival analysis were used. Maximum ST segment depression was 0.13 mm less (P < 0.04) while on the fixed combination. The incidence of withdrawals and adverse effects was similar on both treatments.
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PMID:Atenolol versus the fixed combination of atenolol and nifedipine in stable angina pectoris. 826 84

Coronary ostial stenosis with otherwise normal coronary vessels occurs in patients with syphilis or Takayasu's aortitis. Iatrogenic ostial stenosis may develop as a complication of coronary angiography or after coronary perfusion at the time of cardiac surgery. Isolated ostial stenosis in the absence of these factors has been reported infrequently and its unique clinical and angiographic profile has been noted recently. Hence, it is proposed that this type of isolated ostial stenosis may represent a clinical entity distinct from the usual atherosclerotic coronary disease. We report the case of a middle-aged woman with this type of isolated coronary ostial stenosis. A 55-year-old female was admitted with the complaint of exertional chest pain, which had appeared 2 months admission and which had gradually become more frequent. The ECG on admission was normal. She had no coronary risk factor. Treadmill exercise test was stopped at stage 2 of Bruce protocol because ischemic S-T segment depression appeared in II, III, aVF, V4-V6 and she complained of a chest pain. Coronary angiography showed a 90% stenosis of the left coronary ostium with normal distal vessels. The right coronary artery was normal. A coronary artery bypass graft to the left anterior descending branch was performed uneventfully and the patient remains asymptomatic.
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PMID:[A case of isolated coronary ostial stenosis in a middle-aged woman]. 833 37

The purpose of the present study was to evaluate the factors which influence the effect of heparin exercise treatment on treadmill capacity, and to examine the long-term efficacy of the treatment in 16 patients with chronic effort angina. Treadmill exercise was performed 20 times for 2 to 3 weeks according to standard Bruce protocol. A single intravenous dose of heparin (5,000 IU) was given 10 min before each exercise period. Exercise with heparin pretreatment increased the total exercise duration from 6.6 +/- 1.6 (SD) to 9.4 +/- 1.9 min (p < 0.05) and the maximal rate-pressure product from 19,200 +/- 4,700 to 24,700 +/- 5,900 mmHg.beats/min (p < 0.05). The rate-pressure product at the onset of angina was also increased by 32% (p < 0.05). The ST segment depression at the same exercise time as in control exercise was ameliorated from 0.16 +/- 0.05 to 0.12 +/- 0.06 mV (p < 0.05). Multivariate analysis of the determinants of the effect of the treatment on treadmill capacity indicated that the treatment is more effective in patients without previous myocardial infarction. All of the above-mentioned variables of treadmill capacity did not change significantly during a follow-up period of 13 +/- 7 months (range; 4-24 months). These findings lend further support to heparin exercise treatment as a possible therapeutic approach in patients with chronic stable effort angina, and particularly in those without previous infarction.
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PMID:Determinants of beneficial effect of heparin exercise treatment on treadmill capacity and long-term efficacy of the therapy in patients with chronic effort angina. 835 94


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