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Silent Ischemia. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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What is the mechanism of abnormal blood pressure response on exercise in hypertrophic cardiomyopathy?: Reply. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)00411-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shimizu M, Ino H, Okeie K, Yamaguchi M, Nagata M, Hayashi K, Itoh H, Iwaki T, Oe K, Konno T, Taki J, Mabuchi H. Systolic dysfunction and blood pressure responses to supine exercise in patients with hypertrophic cardiomyopathy. JAPANESE CIRCULATION JOURNAL 2001; 65:325-9. [PMID: 11316132 DOI: 10.1253/jcj.65.325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Left ventricular function and blood pressure responses were evaluated in 56 patients with non-obstructive hypertrophic cardiomyopathy (HCM) and 12 control subjects by using a radionuclide ventricular function monitor during supine ergometer exercise. Patients with HCM were divided into 2 groups: (i) group A had no decrease in ejection fraction (EF) during exercise; and (ii) group B had a decrease in EF during exercise. During exercise, the change in end-diastolic volume did not differ between the 3 groups. In contrast, the change in end-systolic volume differed between the 3 groups (p<0.0001). The change in systolic blood pressure (SBP) also differed significantly between the 3 groups. The change in SBP in group B was smaller than that in the control group and group A, and changes in the EF and changes in the SBP between rest and peak exercise showed a significant correlation (p<0.005). These results suggest that exercise-induced systolic dysfunction in patients with non-obstructive HCM may contribute to abnormal blood pressure response in those patients.
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Affiliation(s)
- M Shimizu
- Second Department of Internal Medicine, School of Medicine, Kanazawa University, Japan.
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Shimizu M, Ino H, Okeie K, Emoto Y, Yamaguchi M, Yasuda T, Fujino N, Fujii H, Fujita S, Mabuchi T, Taki J, Mabuchi H. Exercise-induced ST-segment depression and systolic dysfunction in patients with nonobstructive hypertrophic cardiomyopathy. Am Heart J 2000; 140:52-60. [PMID: 10874263 DOI: 10.1067/mhj.2000.106642] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND ST-segment depression is common in patients with hypertrophic cardiomyopathy (HCM). However, it is not clear whether exercise-induced ST-segment depression in patients with HCM and patent coronary arteries is associated with changes in left ventricular function. METHODS Left ventricular function was continuously evaluated in 53 patients with nonobstructive HCM during supine ergometer exercise with a radionuclide ventricular function monitor equipped with a cadmium telluride detector. On the basis of the ST-segment changes during exercise, the patients were divided into 2 groups: group N had no ST-segment depression, and group D had >/=0.1 mV ST-segment depression. RESULTS Exercise duration, blood pressure, heart rate, and rate-pressure product during exercise did not differ between the 2 groups. End-diastolic volume at rest and at peak exercise did not differ between groups D and N. In contrast, the end-systolic volume in group N decreased during exercise, whereas in group D it increased. As a result, the left ventricular ejection fraction in group D decreased from 70% +/- 7% to 59% +/- 15% (P <.0001), whereas ejection fraction in group N increased from 65% +/- 8% to 71% +/- 11% (P =.0002). There was a strong correlation between exercise-induced ST-segment depression and changes in ejection fraction from rest to peak exercise (P <.0001). CONCLUSIONS These results suggest that the exercise-induced ST-segment depression seen in patients with nonobstructive HCM is associated with systolic dysfunction during exercise.
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Affiliation(s)
- M Shimizu
- Second Department of Internal Medicine, School of Medicine, Kanazawa University, Japan.
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Goldberg AD, Becker LC, Bonsall R, Cohen JD, Ketterer MW, Kaufman PG, Krantz DS, Light KC, McMahon RP, Noreuil T, Pepine CJ, Raczynski J, Stone PH, Strother D, Taylor H, Sheps DS. Ischemic, hemodynamic, and neurohormonal responses to mental and exercise stress. Experience from the Psychophysiological Investigations of Myocardial Ischemia Study (PIMI). Circulation 1996; 94:2402-9. [PMID: 8921780 DOI: 10.1161/01.cir.94.10.2402] [Citation(s) in RCA: 179] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The pathophysiology of mental stress-induced myocardial ischemia, which occurs at lower heart rates than during physical stress, is not well understood. METHODS AND RESULTS The Psychophysiological Investigations of Myocardial Ischemia Study (PIMI) evaluated the physiological and neuroendocrine functioning in unmedicated patients with stable coronary artery disease and exercise-induced ischemia. Hemodynamic and neurohormonal responses to bicycle exercise, public speaking, and the Stroop test were measured by radionuclide ventriculography, ECG, and blood pressure and catecholamine monitoring. With mental stress, there were increases in heart rate, systolic blood pressure, cardiac output, and systemic vascular resistance that were correlated with increases in plasma epinephrine. During exercise, systemic vascular resistance fell, and there was no relationship between the hemodynamic changes and epinephrine levels. The fall in ejection fraction was greater with mental stress than exercise. During mental stress, the changes in ejection fraction were inversely correlated with the changes in systemic vascular resistance. Evidence for myocardial ischemia was present in 92% of patients during bicycle exercise and in 58% of patients during mental stress. Greater increases in plasma epinephrine and norepinephrine occurred with ischemia during exercise, and greater increases in systemic vascular resistance occurred with ischemia during mental stress. CONCLUSIONS Mental stress-induced myocardial ischemia is associated with a significant increase in systemic vascular resistance and a relatively minor increase in heart rate and rate-pressure product compared with ischemia induced by exercise. These hemodynamic responses to mental stress can be mediated by the adrenal secretion of epinephrine. The pathophysiological mechanism involved are important in the understanding of the etiology of myocardial ischemia and perhaps in the selection of appropriate anti-ischemic therapy.
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Affiliation(s)
- A D Goldberg
- Henry Ford Heart and Vascular Institute, Detroit, MI 48202, USA.
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Freeman MR, de Yang L, Langer A, Foley B, Armstrong PW. Frequency of transient reductions in left ventricular ejection fraction at rest in coronary artery disease. Am J Cardiol 1994; 74:137-43. [PMID: 8023777 DOI: 10.1016/0002-9149(94)90086-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To determine the prevalence of decreases in left ventricular (LV) ejection fraction (EF) at rest in patients with coronary artery disease (CAD), including those with stable angina (n = 21), unstable angina (n = 13), and recent myocardial infarction (n = 11), continuous assessment of LV function for 162 +/- 136 minutes was performed using a new nuclear device. The results were compared with those of a group of normal subjects (n = 10) monitored for 80 +/- 28 minutes. Episodes of EF reduction of > 7% from baseline for a total duration of > 5% monitored time occurred in 0 of 10 normal subjects; episodes were more frequent in patients with stable angina (10 of 21, 48%; p = 0.01), with recent myocardial infarction (7 of 11, 64%; p = 0.004), and with unstable angina (11 of 13, 85%; p = 0.0001). The number of EF decreases per hour in patients after myocardial infarction (1.7 +/- 2.5 [SD]) and unstable angina (1.2 +/- 0.7) was significantly more frequent than in normal subjects (0.3 +/- 0.4), but was not different from that in patients with stable angina (0.8 +/- 1.0). The duration of the decrease in EF, expressed as minutes per hour of monitored time in normal subjects (0.7 +/- 1.0%), was significantly less than in patients with unstable angina (10 +/- 8%). Patients with stable angina (6 +/- 9%) and recent myocardial infarction (6 +/- 6%) were not significantly different from normal subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
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Taki J, Nakajima K, Muramori A, Yoshio H, Shimizu M, Hisada K. Left ventricular dysfunction during exercise in patients with angina pectoris and angiographically normal coronary arteries (syndrome X). EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1994; 21:98-102. [PMID: 8162945 DOI: 10.1007/bf00175754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Left ventricular function during exercise and recovery was investigated in patients with angina pectoris, ST segment depression during exercise and angiographically normal coronary arteries (syndrome X) using a continuous left ventricular function monitor with cadmium telluride detector (CdTe-VEST). Fourteen patients with syndrome X and 14 patients with atypical chest pain without ST segment depression during exercise and normal coronary arteries (control group) performed supine ergometric exercise after administration of 740-925 MBq of technetium-99m labelled red blood cells, and left ventricular function was monitored every 20 s using CdTe-VEST. Left ventricular ejection fraction (EF) response was impaired (< or = 5% increase from rest to peak exercise) in 11 or 14 patients with syndrome X but in none of the control patients. Resting EF was similar in the two groups (62.1% +/- 6.7% in patients with syndrome X, 61.9% +/- 6.2% in controls); however, EF increase from rest to peak exercise was lower in syndrome X (-3.1 +/- 9.5% vs 14.7% +/- 7.4%, P < 0.001). After cessation of exercise, all patients showed rapid EF increase over baseline and this EF overshoot was lower (19.3% +/- 8.3% vs 26.4% +/- 7.3%, P < 0.001) with the time to EF overshoot longer (114 +/- 43 s vs 74 +/- 43 s, P < 0.05) in patients with syndrome X. Thus, in patients with syndrome X, left ventricular dysfunction was frequently observed during exercise in spite of normal epicardial coronary arteries.
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Affiliation(s)
- J Taki
- Department of Nuclear Medicine, Kanazawa University School of Medicine, Japan
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Jacobs DH, Lawhorn SL, Ziegler DK, Wilson DB, Haffey KA, Baxter KG, Robinson RG. Screening cerebrovascular patients for silent myocardial ischemia with stress testing and ambulatory left ventricular function monitor. J Stroke Cerebrovasc Dis 1994; 4:81-5. [PMID: 26487607 DOI: 10.1016/s1052-3057(10)80114-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Patients with symptomatic cerebrovascular disease suffer a high mortality from myocardial ischemia, which may occur during rest or following the conclusion of exercise. In a pilot study, we screened 11 patients with transient cerebral ischemic attack or stroke for silent myocardial ischemia using bicycle ergometer stress testing with electrocardiographic (EKG) monitoring and ambulatory left ventricular function monitoring (VEST). Three of 11 patients had nondiagnostic exercise EKGs due to failure to achieve their target heart rates during exercise but had positive VEST tests during and after exercise. One patient was falsely positive. VEST may be useful in combination with stress EKG for the detection of silent myocardial ischemia in cerebrovascular patients, but further assessment of the sensitivity and specificity in this patient population needs to be accomplished.
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Affiliation(s)
- D H Jacobs
- From the Department of Neurology, University of Kansas School of Medicine, Kansas City, KS, U.S.A
| | - S L Lawhorn
- The Department of Medicine, University of Kansas School of Medicine, Kansas City, KS, U.S.A
| | - D K Ziegler
- From the Department of Neurology, University of Kansas School of Medicine, Kansas City, KS, U.S.A
| | - D B Wilson
- The Department of Medicine, University of Kansas School of Medicine, Kansas City, KS, U.S.A
| | - K A Haffey
- The Department of Medicine, University of Kansas School of Medicine, Kansas City, KS, U.S.A
| | - K G Baxter
- The Department of Diagnostic Radiology, University of Kansas School of Medicine, Kansas City, KS, U.S.A
| | - R G Robinson
- The Department of Diagnostic Radiology, University of Kansas School of Medicine, Kansas City, KS, U.S.A
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Yoshio H, Shimizu M, Kita Y, Ino H, Taki J, Takeda R. Left ventricular functional reserve in patients with syndrome X: evaluation by continuous ventricular function monitoring. J Am Coll Cardiol 1993; 22:1465-9. [PMID: 8227806 DOI: 10.1016/0735-1097(93)90558-i] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate cardiac functional reserve in patients with syndrome X. BACKGROUND Syndrome X is characterized by stress-induced anginal pain and ST segment depression, normal findings on coronary angiography and normal left ventricular function at rest. Reduced coronary vasodilative reserve and abnormal myocardial lactate metabolism have been described in such patients. METHODS To assess left ventricular functional reserve in patients with syndrome X, continuous radionuclide monitoring of left ventricular end-diastolic volume, end-systolic volume and ejection fraction was performed in 12 patients and 13 normal control subjects during supine bicycle ergometer exercise. RESULTS In control subjects, end-diastolic volume increased at peak exercise from 100% to 106.5% (p < 0.01), end-systolic volume decreased from 39.1% to 22.6% (p < 0.01) and ejection fraction increased from 60.9% to 78.6% (p < 0.01). In patients with syndrome X, end-diastolic volume increased at peak exercise from 100% to 106% (p < 0.01), and end-systolic volume decreased at ST segment depression < or = 0.5 mm (the ST point) from 37% to 28.8% (p < 0.01) but increased at peak exercise to 44.7% (p < 0.01 vs. the ST point). Thus, ejection fraction increased at the ST point from 63% to 72.7% (p < 0.01) but decreased at peak exercise to 57.7% (p < 0.01 vs. the ST point and control subjects) in proportion to the degree of ST segment depression. In nine patients (75%), ejection fraction at peak exercise was lower than baseline values. All patients and control subjects showed a rapid ejection fraction increase just after exercise during the recovery period. The degree of ejection fraction "overshoot" in patients was similar to that in control subjects, but the interval from the end of exercise to the overshoot in patients was significantly longer than that in control subjects (118 vs. 65 s, p < 0.01). CONCLUSIONS In patients with syndrome X subjected to exercise stress, left ventricular function remained normal before the onset of ST segment depression. Once ST segment depression appeared, left ventricular function deteriorated in proportion to the degree of depression, and reduced left ventricular function persisted into the recovery period. Continuous ventricular function monitoring is thus a useful predictor of reduced left ventricular functional reserve in patients with syndrome X.
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Affiliation(s)
- H Yoshio
- Second Department of Internal Medicine and Nuclear Medicine, School of Medicine, Kanazawa University, Japan
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Kawasuji M, Tedoriya T, Takemura H, Sakakibara N, Taki J, Watanabe Y. Flow capacities of arterial grafts for coronary artery bypass grafting. Ann Thorac Surg 1993; 56:957-62. [PMID: 8215674 DOI: 10.1016/0003-4975(93)90363-m] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The flow capacities of arterial and saphenous vein grafts in 100 patients who had coronary artery bypass grafting were compared under exercise conditions by continuous ventricular function monitoring, which records serial beat-to-beat radionuclide data and calculates left ventricular ejection fractions every 20 seconds. Ejection fraction profiles during graded bicycle exercise were divided into four types. In type A, the ejection fraction continued to increase. In type B, the ejection fraction initially increased, but decreased during the late exercise stage. In type C, the ejection fraction did not change. In type D, the ejection fraction continued to decrease throughout exercise. A decrease in ejection fraction, observed in type B or D, is an early indicator of myocardial ischemia. Before operation, 10 patients showed type A, 30 type B, 11 type C, and 49 type D responses. After operation, 68 patients showed type A, 21 type B, and 11 type C responses. Patients were divided into three groups according the type of bypass graft. Group 1 included 21 patients with two arterial grafts and vein grafts; group 2, 61 patients with an internal thoracic artery graft and vein grafts; group 3, 18 patients with only vein grafts. All of the grafts were patent on angiography. Eight patients (38%) in group 1 and 13 (21%) in group 2 showed a postoperative type B response, but none of the patients in group 3 had a postoperative type B response (p < 0.02). Seven of 8 patients in group 1 with postoperative type B responses had only arterial grafts to the left-side coronary arteries.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Kawasuji
- Department of Surgery (I), Kanazawa University School of Medicine, Japan
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Taki J, Yasuda T, Flamm SD, Hutter A, Gold HK, Leinbach R, Strauss HW. Comparison of painful and painless left ventricular dysfunction recorded during ambulatory ventricular function monitoring in angina pectoris secondary to coronary artery disease. Am J Cardiol 1992; 70:1555-8. [PMID: 1466322 DOI: 10.1016/0002-9149(92)90456-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Left ventricular (LV) function and the electrocardiogram of 55 patients with coronary artery disease and angina were monitored for a mean of 3.2 +/- 1.9 hours with an ambulatory LV function monitor. During the monitoring interval, patients performed daily activities such as sitting, walking, climbing stairs, and eating. Sixty episodes of transient reduction in ejection fraction of > 5% lasting > 60 seconds were observed in 24 patients; 13 episodes were associated with typical angina, but 47 were asymptomatic. Asymptomatic episodes had a shorter duration of ventricular dysfunction (116 +/- 49 vs 189 +/- 113 seconds; p < 0.05), and smaller increases in relative end-diastolic and end-systolic volumes (end-diastolic 0.9 +/- 5.4% vs 4.6 +/- 4.9% [p < 0.05], and end-systolic 21 +/- 11% vs 35 +/- 20% [p < 0.05]) than did symptomatic ones. When a subset of patients with both symptomatic and asymptomatic episodes were analyzed, similar results were observed: in asymptomatic episodes, duration was shorter (82 +/- 31 vs 200 +/- 110 seconds; p < 0.005), ejection fraction decrease was smaller (-7.3 +/- 2.6% vs -11.0 +/- 4.7%; p < 0.05), and end-systolic volume increase was smaller (23 +/- 12% vs 37 +/- 19%; p < 0.05). The data suggest that asymptomatic transient LV dysfunction is less severe and of shorter duration in patients with angina pectoris.
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Affiliation(s)
- J Taki
- Department of Radiology, Massachusetts General Hospital, Boston
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Kawasuji M, Takemura H, Tedoriya T, Sawa S, Taki J, Iwa T. Exercise response assessed by continuous monitoring of ventricular function in patients with coronary bypass operations. J Thorac Cardiovasc Surg 1992. [DOI: 10.1016/s0022-5223(19)34906-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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