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

A follow-up study of 1,402 patients with a positive maximal treadmill stress test was made to evaluate the significance of angina during the test. Life tables were constructed and evaluated for significance of age, sex and work load at onset of angina. Coronary events (myocardial infarction, progression of angina and coronary death) were twice as frequent in subjects with angina and S-T segment depression as in those without angina. The increased incidence in 4 years held for all coronary events and was still doubled at 7 years for progression of angina and coronary death. The incidence of coronary events was more than twice as great when the angina was induced by a light work load (4 metabolic equivalents = METS) as when it was induced by a heavy work load (8 to 9 METS). Men aged 41 to 50 years having angina during exercise testing had a 3-fold greater incidence of coronary events and a 4-fold greater incidence of myocardial infarction compared with their counterparts who had S-T segment depression alone. In this study, angina during exercise testing identified 85% of true positive tests for coronary artery disease, whereas S-T depression alone identified only 64% of such tests. Thus, angina during exercise testing increases the sensitivity of the test and identifies cohorts of subjects at high risk for subsequent coronary events.
 ...
PMID:Significance of chest pain during treadmill exercise: correlation with coronary events. 62 16

Follow-up data on 2700 subjects who had had maximum stress tests were assembled in life tables. A positive test, characterized by ST-segment depression of 1.5 mm, 0.08 sec from the J point, predicted an incidence of some new coronary event of 9.5% a year, as compared with 1.7% in those with a negative test. The incidence of infarction and death was also significantly higher than in the negative responders. Early onset of ischemia occurring at moderate exercise (4 metabolic equivalents-METS) resulted in an incidence of all coronary events of 15% a year, while ischemia first manifested at the seventh minute of exercise (approximately 8 METS) results in an incidence of only 4% per year. The magnitude of ST depression and the age of onset of ischemia failed to influence the incidence of coronary events. A myocardial infarction previous to the test increased the incidence of events in both positive and negative responders. The positives with a previous infarction had more than double the incidence of coronary events than the positive responders with no pre-existing infarction. Those with chronotropic incompetence had a high incidence of coronary events even though the ECG response to exercise was normal.
 ...
PMID:Predictive implications of stress testing. Follow-up of 2700 subjects after maximum treadmill stress testing. 111 17

Recent investigations of SMI occurring during daily life have advanced our understanding of the pathophysiology of myocardial ischemia. These contributions have directed our attention away from "chest pain" alone and physical exertion as the central provoking factor toward transient myocardial ischemia and its broader triggers and consequences. Transient myocardial ischemic episodes, the majority of which are silent, are found in a subset of patients with any clinical manifestations of CAD (eg, stable angina, unstable angina, myocardial infarction, and sudden death), as well as in those patients with CAD who are and have been totally asymptomatic. These episodes are an independent predictor of increased risk for future cardiac events. Most medical therapy and revascularization therapies have the potential to prevent or relieve these silent episodes; however, we do not yet know which method is superior in reducing SMI episodes or preventing future cardiac events. Furthermore, the benefit of reducing SMI versus the cost and potential morbidity of these chosen therapies is not known. At least three trials are now underway to examine some of these concerns (Table 2). Focus on pain relief alone does not appear to be an adequate approach to alter outcome in patients with CAD and may prove insufficient to control SMI. Until these issues are resolved, we believe a conservative approach to the management of patients with CAD is warranted. Documentation of ischemia (painful or painless) is essential. Three general principles should be kept in mind. First, the presence of detectable ischemia is of central importance. This information should be used in the overall risk assessment of the patient. Second, the level of concern or aggressiveness of treatment should be based on the risk associated with the ischemic abnormalities documented (Table 3). The exercise stress test is the most useful to begin this process. The detection of ischemic-type ST-segment depression, either silent or painful, at a low workload (eg, less than or equal to 120 beats per minute or less than or equal to 6.5 metabolic equivalents [METS]) implies high risk for adverse outcome. Likewise, these ST-segment changes occurring in leads that reflect multiple coronary artery distribution, of greater than 2 mm in magnitude and persisting for greater than 6 minutes, are all markers for high risk. Thallium redistribution defects occurring at low work loads, in multiple areas, associated with increased lung uptake and enlargement of the cardiac pool all imply high risk.(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:Treatment strategies for daily life silent myocardial ischemia: a correlation with potential pathogenic mechanisms. 135 7

In this double blind randomised placebo controlled study, we investigated the antianginal efficacy of oral captopril in 33 patients of angiographically documented coronary artery disease (chronic stable angina). Apart from sublingual nitrates, all other antianginal drugs were withdrawn. Patients were then evaluated both subjectively by questionnaire and objectively by treadmill stress test. No patient had more than mild hypertension and all patients had good left ventricular function. One group of patients received oral captopril while the other group was given placebo. A repeat assessment was done after six weeks and the results compared with baseline. Anginal attacks decreased from 20.11 +/- 1.86 per week on placebo to 9.92 +/- 1.38 (p < 0.01) on captopril as also the number of sublingual nitrates (18.84 +/- 3.01 to 11.14 +/- 2.94, p < 0.01). Assessment by the treadmill stress test showed that in comparison to the pretreatment test, captopril therapy resulted in a significantly increased exercise duration (6.26 +/- 0.21 to 6.98 +/- 0.31 minutes, p < 0.05), total work done (6.76 +/- 0.26 METS to 7.48 +/- 0.29 METS, p < 0.05). In addition there was a significant increase in time to angina (6.16 +/- 0.18 to 6.85 +/- 0.24 min, p < 0.05) and time to 1mm ST depression (5.18 +/- 0.26 to 6.46 +/- 0.30 min, p < 0.01). We conclude that captopril is an effective monotherapy for patients with chronic stable angina and has both antianginal as well as anti-ischemic effects, possibly secondary to direct coronary vasodilation.
 ...
PMID:Use of captopril as an isolated agent for the management of stable angina pectoris--a double blind randomised trial. 142 46

Fifty six patients were studied while in the Coronary Care Unit: 17 with unstable angina and 39 with acute myocardial infarction. All patients underwent dobutamine stress testing (doses of 5, 10, 15 and 20 micrograms/kg/min every 5 min) and exercise testing (modified protocol to finish at an energy expenditure of approximately 5 METS): 4-5 days after the last crisis of angina or 6-8 days after the onset of noncomplicated acute myocardial infarction. The heart rate increased from 72 +/- 10 to 104 +/- 12 beat/min with dobutamine (p = 0.00001) and from 84 +/- 11 to 118 +/- 15 beat/min with exercise testing (p = 0.00001). The systolic blood pressure increased from 116 +/- 9 to 138 +/- 11 mmHg with dobutamine (p = 0.00001) and from 117 +/- 8 to 156 +/- 7 mmHg with exercise testing (p = 0.00001). Due to different reasons 33 patients did not finish the exercise protocol, while only 8 patients did not finish the dobutamine testing. The ST segment wast elevated in 22 cases with dobutamine and in 9 cases with exercise, eight of them coinciding in both tests. The ST segment was depressed in 36 cases with dobutamine and in 21 cases with exercise, 20 of them coinciding in both tests. Angina was present in 11 cases with dobutamine and in four exercise, three of them coinciding. If the unfinished tests or those with angina or ST segment depression are considered abnormal, there were 40 abnormal tests with dobutamine and 38 with exercise, 32 of them coinciding.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Usefulness of dobutamine in producing myocardial ischemia. Comparison with ergometry]. 277 72

The prognostic endpoint yield (PEY) of a low-level (less than or equal to 4.6 METS) vs a high-level graded exercise test administered soon after myocardial infarction was evaluated with 184 patients. Test endpoints considered prognostically significant for future cardiac events were (1) ST segment depression greater than or equal to 1mm, (2) angina pectoris, and (3) complex ventricular beats. Test endpoints were assigned to both low-level and high-level tests if they occurred less than or equal to 4.6 METS; test endpoints greater than 4.6 METS were assigned to the high-level test only. Allowing the 145 patients who were asymptomatic during the low-level test to continue into the high-level protocol revealed a 2.5 times greater occurrence of angina pectoris (38 vs 15), a 3.4 times greater occurrence of ST segment depression (27 vs 8), and twice the occurrences of ventricular beats (4 vs 2). This substantial increase in prognostic endpoint yield was demonstrated in the presence of a significantly longer exercise time with the high-level test (9.0 vs 5.1 min), with no significant difference between protocols for peak heart rate or systolic blood pressure. Therefore, a high-level graded exercise test appears to increase the yield of test endpoints with known prognostic importance.
 ...
PMID:Prognostic endpoint yield of high-level versus low-level graded exercise testing. 334 99

Exercise testing performed earlier than six weeks post-MI is accepted as "standard" medical practice. Although both heart rate-limited and symptom-limited exercise protocols are used with nearly equal frequency, the latter appears more valuable because the prognostic yield is greater without sacrificing patient safety. Treadmill or cycle ergometers are the preferred modes of testing because of higher exercise work loads imposed and increased sensitivity and specificity of results. The physiologic exercise responses to graded work loads among these acute MI survivors include a mean maximal heart rate range of 118 to 136 beats/min, a peak systolic blood pressure between 137 and 170 mmHg, a mean peak double product from 16,000 to 22,400, and a mean maximal work load between 4.8 and 7.0 METS. Exercise findings which are most clinically useful are greater than 1 mm ST segment depression from rest level, presence of angina pectoris during exercise, decrease in systolic blood pressure with increasing work, presence of complex or frequent VEBs, and exercise tolerance less than 4 METS. These exercise findings identify, in recent post-MI survivors, groups of patients that have significantly different estimated future cardiac morbidity and mortality rates. The most consistent indices of multi-vessel coronary heart disease are ST segment depression, angina pectoris, and poor exercise tolerance. The most important role of stress testing in this period post-MI is identification of individuals who urgently need evaluation for coronary bypass surgery. In addition to risk stratification, exercise testing provides valuable information regarding exercise prescription for cardiac rehabilitation, direct psychologic benefit for resuming an active lifestyle, and motivation for exercise participation. Although safety of the early post-MI stress test has not been systematically studied, reports from individual studies indicated low morbidity and mortality. Attesting to this is the frequency with which it is performed as a routine office procedure. Finally, there has been a growing use of this procedure not only among cardiologists but also among internists and family practice physicians.
 ...
PMID:Exercise testing early after myocardial infarction: historic perspective and current uses. 351 64

To elucidate the functional and prognostic significance of right ventricular dysfunction after acute inferior wall myocardial infarction, 74 consecutive patients with inferior infarction were prospectively evaluated with gated equilibrium blood pool imaging at rest, submaximal exercise thallium-201 scintigraphy and coronary angiography before hospital discharge. In addition, symptom-limited stress thallium-201 scintigraphy was performed in 61 patients at 3 months, and all patients were followed up clinically for 23 +/- 15 months. Utilizing predetermined radionuclide angiographic criteria, 47 patients (Group I) had normal right ventricular function, 12 patients (Group II) had mild to moderate dysfunction and 15 patients (Group III) had severe right ventricular dysfunction. There were no significant differences among the groups with regard to age, history of prior myocardial infarction, peak creatine kinase values, maximal Killip functional class, number or type of in-hospital complications, left ventricular ejection fraction, prevalence of multivessel disease or the distribution and severity of disease affecting the infarct-related vessel. Exercise tolerance as assessed by treadmill time, blood pressure-heart rate product and peak work load in METS was comparable among the three groups, both before hospital discharge and at 3 month follow-up. No differences in indicators of exercise-induced ischemia were noted among the groups, including the prevalence of redistribution thallium-201 defects, ST segment depression or symptoms of chest pain. Finally, cardiac mortality, reinfarction rate and the incidence of medically refractory angina pectoris were similar in the three groups. Thus, right ventricular dysfunction after acute inferior wall myocardial infarction does not appear to limit exercise tolerance or identify a subgroup of patients at higher risk for recurrent cardiac events.
 ...
PMID:A prospective clinical, scintigraphic, angiographic and functional evaluation of patients after inferior myocardial infarction with and without right ventricular dysfunction. 404 48

To assess the relative prognostic merits of 15 clinical and 10 predischarge exercise test variables, 226 patients who had sustained an acute myocardial infarction were studied. A submaximal treadmill test was performed on 205 patients to a mean work load of 5.7 +/- 2.9 METS. Testing was performed an average of 11.7 (range 6 to 33) days after myocardial infarction. During the first year of observation, major cardiac events were noted in 33 patients (16%), unstable angina in 7 (3.4%), recurrent myocardial infarction in 14 (6.8%) and death in 12 patients (5.9%). Cardiac mortality correlated with mean peak serum creatine kinase (CK) (p less than 0.05), history of previous myocardial infarction (p less than 0.01) and ST segment depression at rest (p less than 0.01). The only exercise variable that correlated with cardiac mortality was poor exercise endurance (p less than 0.05). Multivariate risk stratification of clinical and treadmill variables from these 205 patients using linear discriminant analysis produced a function that correctly classified 95% of those who were event-free and 80% of those who died. The first four discriminant variables that contributed independent information for the prediction of cardiac mortality were: 1) ST segment depression at rest; 2) CK greater than 1,280 IU/liter; 3) exercise duration less than 3 minutes; and 4) a history of previous myocardial infarction. ST segment depression on the predischarge treadmill test did not predict any event, nor did it improve the predictive accuracy of the clinical variables. It is concluded that a history of previous myocardial infarction and ST segment depression on the rest electrocardiogram indicate a poor prognosis after acute myocardial infarction. Poor endurance is the only exercise variable that suggests a future cardiac event. Prognosis after acute myocardial infarction is more accurately predicted by these clinical data than by variables derived from the predischarge treadmill test.
 ...
PMID:Comparison of clinical and treadmill variables for the prediction of outcome after myocardial infarction. 647 Mar 26

The significance of anterior ST segment depression (V1-V4) at the time of acute inferior myocardial infarction and exercise-induced anterior ST segment depression were studied in 30 patients. All patients carried out: two-dimensional echocardiography in the acute phase of myocardial infarction (Echo 1) and at predischarge (Echo 2); symptom-limited exercise test; coronary arteriography. According to ST segment changes, patients were divided into Group A (n = 15) with exercise-induced anterior ST segment depression and Group B (n = 15) with no ST segment depression during exercise. Group A showed a lower work physical capacity than Group B (6.8 +/- 3 METS and 9 +/- 2 METS, respectively). The wall motion index in Group A was 0.26 +/- 0.14 in the Echo 1 and 0.22 +/- 0.18 in the Echo 2 showing an improvement in wall motion abnormality; in Group B the same index was 0.35 +/- 0.19 in the Echo 1 and 0.34 +/- 0.18 in the Echo 2. Group A patients had a higher prevalence of multivessel disease compared with Group B patients and the right coronary artery was always involved. In conclusion, in inferior myocardial infarction the anterior ST segment depression, both in the acute phase and during the predischarge exercise test, reflects more extensive coronary disease and jeopardized myocardium.
 ...
PMID:[Anterior ST segment depression in acute inferior myocardial infarct: significance of its reproducibility during early ergometric test]. 788 91


1 2 Next >>