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

During the course of chronic airflow obstruction the effect of the pathological process and compensatory mechanisms that take place in the lungs to limit these effects express themselves by easily indentifiable clinical signs. The limitations of expiratory flow is responsible for the prolongation of the duration of maximal expiration: Pursed lipped breathing is probably the method used by certain patients to limit airway collapse; the increase in the residual volume and functional residual capacity results in distortion of the thorax and a change in the configuration of the inspiratory muscles, reducing their capacity to generate pressures (Hoover's sign: respiratory pulse, hypertrophy of the accessory respiratory muscles, thoraco-abdominal asynchrony); the considerable increase in the inspiratory thoracic depression accounts for the inspiratory descent of the trachea and the sub-sternal "tug". Finally the ventilatory pattern is different, ventilation being rapid and superficial, probably in order to adapt to the constraints imposed by the pathological process.
Rev Mal Respir 1985
PMID:[Physical signs reflecting mechanical changes in the respiratory system in chronic obstructive pneumopathy]. 293 6

Although exercise stress testing does not allow certain diagnosis of coronary artery disease, its interpretation should not necessarily be vague. By using the Bayes theorem and the many studies available we can now quantify the probability of a correct result for each individual case. Three parameters need to be known to undertake this calculation; the prevalence of the disease and the sensitivity and specificity of the investigation. The prevalence of the disease is beginning to be recognised taking into account the character of the pain. Four groups of increasing prevalence can thereby be defined: absence of chest pain, non-anginal pain, atypical pain and typical pain. Within each of these groups the prevalence of coronary disease is higher in men and increases with age. Information about the prevalence of multivessel disease after infarction is more limited. Only two groups can be distinguished which do not take symptoms, age or sex into consideration. The prevalence is 57% after anterior and 65% after inferior infarction. The sensitivity and specificity of stress testing can be determined by comparison with coronary angiography or, when this is available, by following up the patients. These parameters depend mainly on the methodology which should be strictly defined. When only significant ST depression is considered, the overall sensitivity and specificity of exercise stress testing is 70% and 80% respectively. These results vary according to the particular context; in women, the sensitivity and specificity are 72% and 75% respectively; in asymptomatic subjects the sensitivity and specificity are 50% and 85% respectively. With regards to the detection of multivessel disease after anterior infarction, the sensitivity and specificity are 58 and 85% respectively and after inferior infarction, 85 and 84% respectively. The use of diagnostic probability based on these parameters should lead to unambiguous practical management of patients related to the degrees of probability obtained. The underlying principles of this diagnostic approach cannot be questioned as they are based on a well established mathematical formula. However, much work remains to be done, on the one hand to determine the exact prevalence of coronary disease, and on the other hand to improve the sensitivity of exercise stress testing.
Arch Mal Coeur Vaiss 1986 Feb
PMID:[The diagnostic exercise test in coronary disease. Proposal for a more rigorous and efficacious interpretation]. 308 19

The antianginal effect of trimetazidine was assessed by a controlled multicentre double-blind versus placebo trial. The study included 32 males, average age 59.5 years, with stable angina of effort. The stability of angina was determined by two exercise stress tests performed at the beginning and at the end of a 15 day pre-selection period under placebo. The patients included in the trial were given 3 tablets a day of either trimetazidine (20 mg per tablet) or of placebo for one month. At the end of the treatment period the patients underwent a third exercise stress test. Comparing the results of exercise testing before and after treatment by a Mann and Whitney test, a statistically significant improvement with trimetazidine was demonstrated with respect to placebo for three parameters: total work increased from 4200 +/- 372 to 5620 +/- 387 Kpm in the trimetazidine group compared to 4191 +/- 399 to 4564 +/- 431 Kpm for placebo (p = 0.012); the duration of exercise increased from 10.2 +/- 0.5 to 12.1 +/- 0.5 minutes with trimetazidine compared to 10.2 +/- 0.5 to 10.7 +/- 0.5 with placebo (p = 0.016); the period to 1 mm ST depression increased from 8.3 +/- 0.6 to 9.8 +/- 0.5 minutes with trimetazidine compared to 8.4 +/- 0.5 to 9.0 +/- 0.7 minutes with placebo (p = 0.034). These results show that signs of ischaemia are delayed by trimetazidine. There were no significant changes in peripheral haemodynamics at rest or on effort. The antianginal action of trimetazidine seems therefore to be unrelated to a chronotropic or vasomotor effect and could be related to a mechanism of cellular regulation.
Arch Mal Coeur Vaiss 1986 Aug
PMID:[The effects of trimetazidine on ergometric parameters in exercise-induced angina. Controlled multicenter double blind versus placebo study]. 310 36

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.
Arch Mal Coeur Vaiss 1986 Dec
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.
Arch Mal Coeur Vaiss 1986 Dec
PMID:[Prevention of myocardial ischemia during exercise 8 hours after use of transdermal nitrate derivatives]. 310 6

Myocardial metabolism was studied during rapid atrial pacing in 22 patients with angina and angiographically normal coronary arteries. Pyruvate, non esterified fatty acid and lactate levels were measured in the coronary arteries and veins under basal conditions, at the peak of atrial pacing and during the recovery phase. A control group of 8 patients had neither angina, ST depression, or lactate production during atrial pacing. A correlation was observed between the coronary arterio-venous difference and arterial pyruvate and non esterified fatty acid levels in the 22 patients during the 3 periods of study. The control patients did not differ significantly from the rest of the population. There was a correlation between the coronary arterio-venous difference and arterial lactate levels under basal conditions in all of the study and control groups. This correlation remained significant during atrial pacing and the recovery period only in the control group. It was possible to distinguish a group of 14 patients (64 p. 100) (Group A) with a correlation coefficient of lactate production similar to the control group (+/- 2 standard deviations) during atrial pacing, from a second group of 8 patients (36 p. 100) (Group B) with abnormal myocardial metabolism. The arterial lactate concentrations were similar in both groups in the 3 periods of study. A coefficient of lactate extraction less than 10 p. 100 was observed in 2 patients in Group A and in 7 patients in Group B (88 p. 100, p less than 0.01). One patient in Group B had a coefficient of lactate extraction greater than 10 p. 100 (+ 13 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1987 Jan
PMID:[Myocardial metabolism in angina with angiographically normal coronary arteries]. 310 90

In order to determine the value of inversion of the U wave during exercise for the diagnosis of coronary insufficiency, the stress tests of 227 patients were reviewed and confronted with the results of coronary angiography which showed 93 subjects with angiographically normal arteries and 134 subjects with left anterior descending disease; 37 patients had single vessel disease (Group I), 38 had double vessel disease (Group II) and 59 had triple vessel disease (Group III). When compared to the two classical criteria, anginal pain and less than or equal to 1 mm ST depression, inversion of the U wave was more specific: 82.8 +/- 7.6 p. 100 vs 77.4 p. 100 for anginal pain, and 66.7 +/- 9.6 p. 100 for ST depression. The sensitivity of this new sign for the detection of coronary insufficiency was 26.9 +/- 7.5 p. 100 vs 80.6 +/- 6.7 p. 100 for ST depression and 56.7 +/- 8.4 p. 100 for anginal pain. The positive predictive value of U wave inversion on effort was 70.9 +/- 12 p. 100 compared to 77.7 +/- 6.9 p. 100 for ischaemic ST depression and 78.3 +/- 8.2 p. 100 for induced anginal pain. Conversely, in angiographically normal coronary arteries, the absence of U wave inversion had a negative predictive value of 44.8 +/- 7.4 p. 100 compared to 70.5 +/- 9.5 p. 100 for the absence of ischaemic ST changes and 55.4 +/- 8.5 for the absence of anginal pain. These results confirm previously published data.(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1987 Jan
PMID:[Value of the negative U wave during exercise test in the diagnosis of coronary insufficiency]. 310 92

The significance of a "reciprocal" ST depression (ST(-)) in the acute phase of myocardial infarction remains controverted. This may be due to ST(-) not having the same determinants when studied at an early stage (less than 6 hours) or later (greater than 6 hours). The purpose of this study was to find out whether "reciprocal" ST(-) correlates with the same parameters when measured on very early ECG's (before 6 hours) or at a distance from the onset of infarction. The parameters concerned are coronary lesions, extent of the infarction and left ventricular function. ECG was performed in 46 patients with inferior infarct aged from 26 to 70 years (mean 50.8 +/- 9.2 years) between 2-6 h, 6-12 h, 12-24 h and 24-48 h from the beginning of pain. The sum of ST(-) on V1V2V2V4 (V1-4), D1aV1V1 to V6 and L1aV1V5V6, and the sum of ST elevation on L2L3aVf were measured at each period of time. The extent of global and anterior territory hypokinesia, the ejection fraction and the left coronary impairment were evaluated between the 2nd and 4th weeks. At 2-6 hours (a) the sum of ST(-) was greater (though not significantly), and the sum of ST elevation on L2L3aVf was significantly greater (p less than 0.001) when the left anterior descending artery (LAD) was not involved than when it was involved; (b) there was no difference between patients with and without ST depression (on all lead groups) in the degree of left ventricular hypokinesia and ejection fraction value.(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1987 Jun
PMID:[Reciprocal changes in the ST segment in acute inferior myocardial infarction. Value of delay in appearance]. 311 40

An ergonovine test (ET) was performed in 1,200 patients-742 men, 458 women aged from 34 to 73 years (mean: 49.5 years)-either during (850 cases) or after (350 cases) coronary arteriography. Another ET made more sensitive by blocking the cardiac autonomous nervous system (CANS) with labetalol 0.04 and 2 mg/kg was performed in 291 of these patients. The ET test was positive in 10.7 p. 100 (127) of all patients and in 11.2 p. 100 (127/1125) of patients presenting with retrosternal pain. In the group where spontaneous angina could be confirmed by ECG recordings during the attack, the percentage of positive responses rose significantly to 53.7 p. 100 patients with ST depression and 56.6 p. 100 of patients with ST elevation. When the anginal nature of the retrosternal pain was not confirmed before the test, the proportion of positive responses was 6.6 p. 100. In patients who had the sensitized test the positive response rate increased in all groups and globally rose significantly from 7.9 p. 100 to 18.6 p. 100 (p less than 0.01). Thus, the usually low frequency of positive ergonovine tests differs according to the population selected and increases after CANS blockade.
Arch Mal Coeur Vaiss 1987 Jul
PMID:[Ergometrine test in 1200 consecutive patients presenting with normal coronary vessels]. 312 Jun 62

The systemic and coronary haemodynamic effects of intravenous nicardipine were investigated in 10 patients with a more than 70 p. 100 stenosis of the left coronary artery. Two brief atrial pacing tests (ST1 and ST2) were performed. ST2 was performed 30 minutes after an intravenous injection of nicardipine 2.5 mg over 5 minutes. Nicardipine produced a 25 p. 100 decrease in ventricular systolic pressure and a substantial increase in cardiac index (from 2.74 +/- 0.48 to 3.46 +/- 0.35 l/min/m2, p less than 0.001). Measurement of the coronary flow rate by the thermodilution method showed a 40 p. 100 increase in sinus blood flow while coronary resistance decreased not only in territories with normal supply but also in myocardial territories distal to the coronary stenosis (from 2.76 +/- 2.3 to 1.83 +/- 1.5 mmHg/ml, p less than 0.02). With the same paced heart rate the ventricular function parameters were significantly improved during ST2 (cardiac index ST2 3.56 +/- 0.65 vs ST1 2.8 +/- 0.48, p less than 0.001; dp/dt max ST2 2143 +/- 369 vs ST1 1874 +/- 301 mmHg/sec, p less than 0.05), reflecting a lower degree of myocardial ischaemia. This was confirmed by the lower amplitude of electrocardiographic depression and by a higher lactate extraction coefficient (LE ST1 6 +/- 7 p. 100 vs LE ST2 12 +/- 12 p. 100, p less than 0.05). Mean arterial blood pressure and coronary sinus blood flow rate values were identical during the two atrial pacing tests.(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1987 Sep
PMID:[Systemic and coronary hemodynamic effects of intravenous nicardipine at rest and in ischemia induced by rapid atrial stimulation]. 312 11


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