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

This study examined the merits of oral dipyridamole SPECT thallium-201 imaging in detecting CAD and multivessel CAD. The 65 patients included in this study (aged 62 +/- 11 years) were not candidates for exercise testing (for the usual reasons). Coronary arteriography revealed no significant CAD in 17 patients and greater than or equal to 50% narrowing of one or more vessels in 48 patients; 12 had one-vessel and 36 had multivessel CAD (high-risk group). Thallium-201 was injected intravenously 45 minutes after an oral dose of 375 mg of dipyridamole, and SPECT imaging was performed within 10 minutes and 4 hours after injection. There were no serious side effects; only six patients (8%) had ST segment depression and 18 patients (28%) had chest pain. The heart rate increased from 74 +/- 15 beats/min at rest to 84 +/- 14 beats/min at peak effect (p = 0.001); the systolic blood pressure did not change (130 +/- 18 and 128 +/- 20 mm Hg, respectively, p = NS). The thallium images were abnormal in 6 of 17 patients (35%) with no CAD, in 7 of 12 patients with one-vessel disease (58%), and in 34 of 36 patients with multivessel CAD (94%) (p = 0.001). Twenty-one of 25 patients (84%) with a perfusion abnormality in more than one vascular territory had multivessel CAD assessed by angiography. Thus oral dipyridamole SPECT thallium-201 imaging is a safe and inexpensive method for the detection of CAD in patients who are otherwise not candidates for exercise testing.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Use of oral dipyridamole SPECT thallium-201 imaging in detection of coronary artery disease. 281 86

This study was designed to compare the antihypertensive and anti-ischemic effects of the newly developed cardioselective beta-blocking agent, betaxolol, with the non-selective agent, nadolol, both of which have hydrophilic long acting properties, over a period of 48 hours. Additionally, the study was intended to determine whether betaxolol exerts a lesser influence on pulmonary function and whether beta-1- and beta-2-adrenergic blocking agents also induce a decrease in blood glucose levels during standard bicycle ergometry for three to nine minutes, similar to that reported in association with exercise of longer duration and, if so, whether this effect can be circumvented by the use of a selective agent. Ten patients with angiographically documented CAD, stable exercise angina pectoris and reproducible ST-segment depression of at least 1 mm received on day 1, in a single blind fashion, one tablet of placebo, on day 2 and day 7, in a double-blind, randomized and cross-over fashion, 20 mg betaxolol or 80 mg nadolol, respectively. Bicycle ergometry was performed before, four, 24 and 48 hours after drug with fixed work loads, blood glucose determination before and after ergometry four hours after drug and airway resistance and maximal ventilatory capacity studies were carried out five hours after drug administration. As compared with placebo, betaxolol and nadolol led to reductions of ST-segment depression of 65% (p less than 0.01) and 74% (p less than 0.005) at four hours, of 53% (p less than 0.025) and 56% (p less than 0.01) at 24 hours and 41% (p less than 0.05) and 44% (p less than 0.05) at 48 hours.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Comparison of the effect of a selective and a nonselective beta receptor blocker on the ischemic ST segment, lung function and stress-induced decrease in blood glucose]. 287 14

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

To assess the significance and accuracy of noninvasive tests in detecting significant coronary artery disease (CAD; greater than 50% stenosis), the Master's exercise test, treadmill exercise test and dipyridamole-loading myocardial perfusion scintigraphy were performed and their results were compared with coronary angiographic findings in 60 patients with angina but without myocardial infarction. Among these, 27 patients had significant CAD. The Master's test performed in outpatient clinics had an 85% sensitivity and a 76% specificity in detecting significant CAD, when the degree of ST depression was equal to or exceeded 1 mm. The sensitivity further improved to 96% by adding chest pain to the criteria; then all patients with multivessel disease or critical ischemia were identified by the Master's test. Treadmill tests performed after admission had a 78% sensitivity and a 67% specificity. When the severity of ischemia was judged either by exercise capacity or the degree of ST depression or the coronary T wave, the treadmill test was superior to the Master's test. Although patients without significant CAD had longer exercise capacity and the higher maximum heart rate in the treadmill test than did those in the Master's test, these trends were similar but less marked in patients with significant CAD. Dipyridamole-loading myocardial perfusion scintigraphy showed an excellent sensitivity and specificity; 96% and 94%, respectively, in detecting significant CAD. It was particularly useful in distinguishing false positive exercise results due to left ventricular hypertrophy and coronary spasm and that in women, from true positive results. In conclusion, the Master's test is a simple and useful method for screening CAD in community hospitals and in outpatient clinics.
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PMID:[Accuracy of the Master's exercise test in detecting significant coronary artery disease]. 326 34

One hundred forty-three subjects (107 with coronary artery disease [CAD], 23 without CAD [evaluated by coronary angiography] and 13 athletes) were selected for this study. All subjects underwent exercise testing to evaluate sensitivity, specificity and predictive value of Q wave, QX/QT ratio, QTc interval and ST depression. The Q-wave analysis revealed less sensitivity (49%) and less specificity (83%) than ST depression (71% and 97%, respectively). The QTc criterion had greater sensitivity (80%) than ST depression but less specificity (11%). The QX/QT criterion was no different in sensitivity (74%) but had less specificity (69%). To establish the statistical evaluation of the positive predictive value in CAD, variations in the prevalence of the disease were considered. A 90% prevalence gives the best positive predictive value on all evaluated measurements, between 100% for ST depression and 89% for the QTc criterion. A 5% prevalence, however, gives an acceptable positive predictive value only on ST-segment depression (57%).
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PMID:Sensitivity, specificity and predictive accuracy of Q wave, QX/QT ratio, QTc interval and ST depression during exercise testing in men with coronary artery disease. 331 55

Exercise-induced ST-segment depression is a marker of impaired prognosis in patients with suspected or manifest CAD. Whether ST-segment depression remains of prognostic importance, after exercise tolerance and extent of CAD have been considered, is unknown. We analysed the prognostic importance of exercise-induced ST-segment depression (greater than 0.15 mV) in 1250 medically treated patients with angiographically determined CAD (mean follow-up after angiography 4.5 years). Based on exercise tolerance (supine bicycle ergometry) patients were divided into two groups: group A patients (n = 677) with lower exercise tolerance (less than or equal to 75 W) and group B patients (n = 573) with better exercise tolerance (greater than 75 W). Group A patients had a lower 5-year survival rate than group B patients (81.5% versus 94%, P less than 0.00001). In group A, patients with ST-segment depression had a lower 5-year survival rate than patients without ST-segment depression (76% versus 85%, P = 0.01). In group B, patients with and without ST-segment depression had similar 5-year survival rates (90% versus 96%, P = 0.11). Subgroup analysis of groups A and B according to number of diseased vessels and presence or absence of ST-segment depression revealed that exercise-induced ST-segment depression (greater than 0.15 mV) was of additional prognostic importance only in patients with triple vessel disease. 5-year survival rates in group A with triple vessel disease were 71% with and 80% (P = 0.057) without ST-segment depression.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prognostic importance of exercise-induced ST-segment depression in patients with documented coronary artery disease. 344 15

Increased utilization of ambulatory ST segment monitoring mandates an appreciation of nonischemic variables that may influence the ST segment. While a greater frequency of ST segment depression has been reported with supine vs upright exercise, the relative false positive rate in both positions is not known. Thus, we compared the frequency of exercise ECG abnormalities during upright and supine bicycle exercise in two groups--17 normals and 46 patients with coronary artery disease. Exercise was performed in combination with radionuclide ventriculographic imaging. Peak exercise heart rate, peak systolic blood pressure, and exercise duration time were all slightly higher in the upright vs supine position (p less than 0.05). Nevertheless, the frequency of positive ST segment responses was more common in the supine position, both in the patients with coronary artery disease (54% vs 30%, p less than 0.05) and in the normal subjects (29% vs 6%, p = NS). The corresponding radionuclide ventriculographic responses, however, were normal during upright and supine exercise in 6 of the 11 CAD patients and in all five of the normal subjects with an abnormal ST segment response during supine exercise only. The frequency of exercise-induced chest pain was also similar in the two positions. Thus, we theorize that nonischemic factors may govern some positive ST segment responses in the supine position. This finding is of relevance for understanding the potential sources of physiologic false positive ST segment responses for ambulatory ST segment monitoring.
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PMID:Differences in the frequency of ST segment depression during upright and supine exercise: assessment in normals and in patients with coronary artery disease. 368 84

Exercise may induce ventricular arrhythmias (VA) in patients with coronary artery disease. Exercise-induced VA can identify a subset of patients at higher risk of cardiac sudden death. The role of myocardial ischaemia and/or left ventricular disease in the appearance of VA during exercise is not completely understood. The incidence of VA during exercise-induced myocardial ischaemia was investigated in patients with suspected CAD or those undergoing a stress exercise test after a previous myocardial infarction (MI). Patients were divided in four groups. Group A, 836 patients without a previous MI showing exercise-induced myocardial ischaemia associated with ST-segment depression--group B, 72 patients without a previous MI and exercise-induced ST-segment elevation--group C, 50 patients survivors of a recent (1 month) MI and exercise-induced ST-segment depression--group D, 580 patients with an old MI (greater than 3 months) and a positive exercise test associated with ST-segment depression. Exercise-induced VA were found to be significantly more frequent in patients of groups C (40.0%) and B (23.6%) as compared with groups A (5.1%) and D (7.06%) (P less than 0.001). Furthermore VA in groups B and C were more frequently complex (couplets, triplets, ventricular tachycardia and fibrillation). In all groups the appearance of VA during exercise-induced myocardial ischaemia did not appear to be related to exercise duration, maximal heart rate, maximal work capacity, left ventricular end diastolic pressure, ejection fraction or extent of coronary artery lesions.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cardiac arrhythmias during exercise-induced myocardial ischaemia in patients with coronary artery disease. 372 Jul 75

The heart rate response to standing, cough, hand grip, and deep breathing were examined in normal subjects and coronary artery disease patients (greater than 70% diameter narrowing). The heart rate responses to these maneuvers were reduced in coronary patients and in anginal patients with normal coronary angiograms, as compared to normals. Detection (with the heart rate response to standing) was determined by using an RR interval cutoff of 140 ms for males and 120 ms for females discriminated between normals and CAD patients. In men sensitivity was 0.58, specificity 0.87 and CCR 0.75, and in women sensitivity was 0.67, specificity 0.79 and CCR 0.75. These values are similar to those reported for ST segment depression in similar populations. When separating normals from those with 2 and 3 vessel disease--sensitivity is 0.67, specificity 0.87, predictive value 0.71 and CCR 0.80. The response to cough, hand grip, and deep breathing showed similar trends but had less specificity than the response to standing. Thus, the heart rate response to most autonomic maneuvers is blunted in subjects with coronary disease and in those with pain syndromes sent for coronary angiography. These findings need testing in larger populations but autonomic maneuvers fail to discriminate patients with coronary disease from those with normal angiograms presenting with chest pain syndromes.
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PMID:Autonomic responses in chest pain syndromes as compared to normal subjects. 381 52

The presence of "asymptomatic" ST segment depression during exercise testing places the patient with established CAD at higher risk. The prognosis of these patients is determined primarily by the severity of CAD, the left ventricular function, and the exercise capacity on an exercise test.
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PMID:The diagnostic and prognostic significance of an asymptomatic positive exercise test. 381 82


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