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Boivin-Proulx LA, Marquis-Gravel G, Rousseau-Saine N, Harel F, Jolicoeur EM, Pelletier-Galarneau M. Hyperventilation testing in the diagnosis of vasospastic angina: A clinical review and meta-analysis. Eur J Clin Invest 2024; 54:e14178. [PMID: 38348627 DOI: 10.1111/eci.14178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND Given the limited access to invasive vasospastic reactivity testing in Western Countries, there is a need to further develop alternative non-invasive diagnostic methods for vasospastic angina (VSA). Hyperventilation testing (HVT) is defined as a class IIa recommendation to diagnose VSA by the Japanese Society of Cardiology. METHODS In this systematic review and meta-analysis reported according to the PRISMA statement, we review the mechanisms, methods, modalities and diagnostic accuracy of non-invasive HVT for the diagnostic of VSA. RESULTS A total of 106 articles published between 1980 and 2022 about VSA and HVT were included in the systematic review, among which 16 were included in the meta-analysis for diagnostic accuracy. Twelve electrocardiogram-HVT studies including 804 patients showed a pooled sensitivity of 54% (95% confidence intervals [CI]; 30%-76%) and a pooled specificity of 99% (95% CI; 88%-100%). Four transthoracic echocardiography-HVT studies including 197 patients revealed a pooled sensitivity of 90% (95% CI; 82%-94%) and a pooled specificity of 98% (95% CI; 86%-100%). Six myocardial perfusion imaging-HVT studies including 112 patients yielded a pooled sensitivity of 95% (95% CI; 63%-100%) and a pooled specificity of 78% (95% CI; 19%-98%). Non-invasive HVT resulted in a low rate of adverse events, ventricular arrhythmias being the most frequently reported, and were resolved with the administration of nitroglycerin. CONCLUSIONS Non-invasive HVT offers a safe alternative with high diagnostic accuracy to diagnose VSA in patients with otherwise undiagnosed causes of chest pain.
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Affiliation(s)
| | | | | | - François Harel
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - E Marc Jolicoeur
- CHUM Research Center and Cardiovascular Center, Montreal, Quebec, Canada
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Dikic AD, Dedic S, Jovanovic I, Boskovic N, Giga V, Nedeljkovic I, Tesic M, Aleksandric S, Cortigiani L, Ciampi Q, Picano E. Noninvasive evaluation of dynamic microvascular dysfunction in ischemia and no obstructive coronary artery disease patients with suspected vasospasm. J Cardiovasc Med (Hagerstown) 2024; 25:123-131. [PMID: 38064348 PMCID: PMC10754482 DOI: 10.2459/jcm.0000000000001562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/31/2023] [Accepted: 09/03/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION In patients with ischemia and no obstructive coronary artery disease (INOCA), a dynamic coronary microvascular dysfunction (CMD) is frequent but difficult to capture by noninvasive means.The aim of our study was to assess dynamic CMD in INOCA patients with stress echocardiography after vasoconstrictive and vasodilator stimuli. METHODS In this prospective single-center study, we have enrolled 40 INOCA patients (age 56.3 ± 13 years, 32 women). All participants underwent stress echocardiography with hyperventilation (HYP), followed by supine bicycle exercise (HYP+EXE) and adenosine (ADO). Stress echocardiography included an assessment of regional wall motion abnormality (RWMA) and coronary flow velocity (CFV) in the distal left anterior descending (LAD) coronary artery. RESULTS HYP induced a 30% increase in rate pressure product (rest = 10 244 ± 2353 vs. HYP = 13 214 ± 3266 mmHg x bpm, P < 0.001) accompanied by a paradoxical reduction in CFV (HYP< rest) in 21 patients (52%). HYP alone was less effective than HYP+EXE in inducing anginal pain (6/40, 15% vs. 10/40, 25%, P = 0.046), ST segment changes (6/40, 15% vs. 24/40, 60%, P < 0.001), and RWMA (6/40, 15% vs. 13/40, 32.5%, P = 0.008). ADO-induced vasodilation was preserved (≥2.0) in all patients. CONCLUSION In patients with INOCA, a coronary vasoconstriction after HYP is common, in absence of structural CMD detectable with ADO. HYP+EXE test represents a more powerful ischemia inducer than HYP alone. Stress echocardiography with LAD-CFV may allow the noninvasive assessment of dynamic and structural coronary microcirculation during stress.
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Affiliation(s)
- Ana Djordjevic Dikic
- University of Belgrade Faculty of Medicine, Serbia, Belgrade
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Srdjan Dedic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Jovanovic
- University of Belgrade Faculty of Medicine, Serbia, Belgrade
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nikola Boskovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Vojislav Giga
- University of Belgrade Faculty of Medicine, Serbia, Belgrade
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ivana Nedeljkovic
- University of Belgrade Faculty of Medicine, Serbia, Belgrade
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milorad Tesic
- University of Belgrade Faculty of Medicine, Serbia, Belgrade
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Srdjan Aleksandric
- University of Belgrade Faculty of Medicine, Serbia, Belgrade
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Quirino Ciampi
- Fatebenefratelli Hospital of Benevento, Benevento, Italy
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3
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Hung MY, Hung MJ. Relationship between Inflammation and Vasospastic Angina. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020318. [PMID: 36837519 PMCID: PMC9960836 DOI: 10.3390/medicina59020318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/29/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Coronary artery spasm (CAS) is a dynamic coronary stenosis causing vasospastic angina (VSA). However, VSA is a potentially lethal medical condition with multiple presentations, including sudden cardiac death. Despite investigations to explore its pathogenesis, no single mechanism has been found to explain the entire process of VSA occurrence. The roles of elevated local and systemic inflammation have been increasingly recognized in VSA. Treatment strategies to decrease local and systemic inflammation deserve further investigation.
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Affiliation(s)
- Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
| | - Ming-Jui Hung
- Section of Cardiovascular Imaging, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taoyuan 333, Taiwan
- Correspondence:
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4
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Seitz A, Pereyra VM, Sechtem U, Ong P. Update on coronary artery spasm 2022 – A narrative review. Int J Cardiol 2022; 359:1-6. [DOI: 10.1016/j.ijcard.2022.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/07/2022] [Accepted: 04/04/2022] [Indexed: 12/31/2022]
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5
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Suzuki K, Hirano Y, Yamada H, Murata M, Daimon M, Takeuchi M, Seo Y, Izumi C, Akaishi M. Practical guidance for the implementation of stress echocardiography. J Echocardiogr 2018; 16:105-129. [PMID: 29876799 PMCID: PMC6132937 DOI: 10.1007/s12574-018-0382-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/07/2018] [Accepted: 05/16/2018] [Indexed: 01/01/2023]
Abstract
Exercise stress testing has been widely undertaken for the diagnosis of heart diseases. The accurate assessment of clinical conditions can be conducted by comparing the findings obtained from the results of stress echocardiography with the changes in the blood/heart rate and electrocardiograms. Numerous overseas studies have reported the utility of stress echocardiography in diagnosing myocardial ischemia; in Japan, the use of this modality for this purpose was included in the national health insurance reimbursable list in 2012. Nevertheless, stress echocardiography is far from being a widespread practice in Japan. This might be due to insufficient equipment (e.g., ergometers, space for test implementation) at each medical institution, shortage of technicians and sonographers who are well experienced and who are responsible for obtaining images during stress testing. The other possible reasons include the limited evidence available in Japan and the lack of a standardized testing protocol. Further dissemination of the practice of exercise stress echocardiography in this country is deemed necessary to establish satisfactory evidence for the use of stress echocardiography in the Japanese population. To this end, efforts are underway to develop a standardized protocol and report format to be adopted throughout Japan. We here present a guideline created by the Guideline Development Committee of the Japanese Society of Echocardiography that describes safe and effective stress echocardiography protocols and report formats. The readers are encouraged to perform exercise stress echocardiography using the proposed template for consensus document and report attached to this guideline.
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Affiliation(s)
- Kengo Suzuki
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yutaka Hirano
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Hirotsugu Yamada
- Department of Cardiology, Tokushima University Hospital, Tokushima, Japan
| | - Mitsushige Murata
- Department of Laboratory Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Masao Daimon
- Department of Clinical Laboratory, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshihiro Seo
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Chisato Izumi
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Akaishi
- Tokai University Tokyo Hospital, 1-2-5 Yoyogi Shibuya-ku, Tokyo, Japan.
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6
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Abstract
Breathing training is widely used as an aid in reducing anxiety states, but several other applications also show promise. This article reviews evidence that normalizing breathing patterns may offer help in some cases of essential hypertension, angina, functional chest disorder, chronic obstructive pulmonary disease (COPD), and cardiac rehabilitation. Hyperventilation and hypo-ventilation, inhibited breathing, and breath suspension are all deviations from an optimal breathing pattern in which breathing volume is closely matched to metabolic needs. Such disordered breathing has varying effects on acid/base balance, arterial diameter, and sodium retention by the kidneys. Therefore, a chronic breathing imbalance can contribute to pathophysiology, which may be remediable to an extent by altering habitual breathing patterns.
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7
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Angina Pectoris and Myocardial Ischemia in the Absence of Obstructive Coronary Artery Disease: Practical Considerations for Diagnostic Tests. JACC Cardiovasc Interv 2014; 7:453-63. [DOI: 10.1016/j.jcin.2014.01.157] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/03/2014] [Accepted: 01/16/2014] [Indexed: 01/09/2023]
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8
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Guidelines for diagnosis and treatment of patients with vasospastic angina (coronary spastic angina) (JCS 2008): digest version. Circ J 2010; 74:1745-62. [PMID: 20671373 DOI: 10.1253/circj.cj-10-74-0802] [Citation(s) in RCA: 195] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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9
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Abstract
Carbon dioxide is a waste product of aerobic cellular respiration in all aerobic life forms. PaCO2 represents the balance between the carbon dioxide produced and that eliminated. Hypocapnia remains a common - and generally underappreciated - component of many disease states, including early asthma, high-altitude pulmonary edema, and acute lung injury. Induction of hypocapnia remains a common, if controversial, practice in both adults and children with acute brain injury. In contrast, hypercapnia has traditionally been avoided in order to keep parameters normal. More recently, advances in our understanding of the role of excessive tidal volume has prompted clinicians to use ventilation strategies that result in hypercapnia. Consequently, hypercapnia has become increasingly prevalent in the critically ill patient. Hypercapnia may play a beneficial role in the pathogenesis of inflammation and tissue injury, but may hinder the host response to sepsis and reduce repair. In contrast, hypocapnia may be a pathogenic entity in the setting of critical illness. The present paper reviews the current clinical status of low and high PaCO2 in the critically ill patient, discusses the insights gained to date from studies of carbon dioxide, identifies key concerns regarding hypocapnia and hypercapnia, and considers the potential clinical implications for the management of patients with acute lung injury.
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Affiliation(s)
- Gerard Curley
- Department of Anaesthesia, Clinical Sciences Institute, National University of Ireland, Galway, Ireland
- Lung Biology Group, National Centre of Biomedical Engineering Sciences, National University of Ireland, Galway, Ireland
| | - John G Laffey
- Department of Anaesthesia, Clinical Sciences Institute, National University of Ireland, Galway, Ireland
- Lung Biology Group, National Centre of Biomedical Engineering Sciences, National University of Ireland, Galway, Ireland
| | - Brian P Kavanagh
- Departments of Critical Care Medicine and Anesthesia and the Program in Physiology and Experimental Medicine, The Hospital for Sick Children, University of Toronto, 555 university Avenue, Toronto, ON M5G 1X8, Canada
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Hwang HJ, Chung WB, Park JH, Oh SS, Chung JW, Choi YS, Youn HJ. Estimation of Coronary Flow Velocity Reserve Using Transthoracic Doppler Echocardiography and Cold Pressor Test Might Be Useful for Detecting of Patients with Variant Angina. Echocardiography 2010; 27:435-41. [DOI: 10.1111/j.1540-8175.2009.01038.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Cianciulli TF, Lax JA, Masoli OH, Redruello MF, Saccheri MC, Candiello A, Redruello HJ, Dorelle AN, Prezioso HA, Vidal LA. Absence of Myocardial Dysfunction during Cold Pressor Stress Echocardiography in Patients with Endothelial Dysfunction. Echocardiography 2008; 25:600-8. [DOI: 10.1111/j.1540-8175.2008.00663.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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12
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Takagi A, Arai K, Hosaka M, Komatsu Y, Gunnji K, Tanimoto K, Ishizuka N, Tsurumi Y, Hagiwara N. Noninvasive Prediction of Angiographic Spasm Provocation Using Trans-Thoracic Doppler Echocardiography in Patients With Coronary Spastic Angina. Circ J 2008; 72:1640-4. [DOI: 10.1253/circj.cj-08-0393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Atsushi Takagi
- Department of Cardiology, Tokyo Women's Medical University
| | - Kotaro Arai
- Department of Cardiology, Tokyo Women's Medical University
| | - Motoko Hosaka
- Department of Cardiology, Tokyo Women's Medical University
| | - Yuki Komatsu
- Department of Cardiology, Tokyo Women's Medical University
| | - Kazue Gunnji
- Department of Cardiology, Tokyo Women's Medical University
| | - Kyomi Tanimoto
- Department of Cardiology, Tokyo Women's Medical University
| | - Naoko Ishizuka
- Department of Cardiology, Tokyo Women's Medical University
| | - Yukio Tsurumi
- Department of Cardiology, Tokyo Women's Medical University
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Hirano Y, Uehara H, Nakamura H, Ikuta S, Nakano M, Akiyama S, Ishikawa K. Diagnosis of vasospastic angina: Comparison of hyperventilation and cold-pressor stress echocardiography, hyperventilation and cold-pressor stress coronary angiography, and coronary angiography with intracoronary injection of acetylcholine. Int J Cardiol 2007; 116:331-7. [DOI: 10.1016/j.ijcard.2006.03.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Accepted: 03/25/2006] [Indexed: 10/24/2022]
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14
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Kim HK, Sohn DW, Lee SE, Kim YJ, Oh BH, Park YB. Coronary blood flow after cold exposure and the effect of warm-up exercise. J Am Soc Echocardiogr 2006; 19:386-90. [PMID: 16581477 DOI: 10.1016/j.echo.2005.11.006] [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] [Received: 09/17/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cold pressor test (CPT) results indicate that coronary blood flow (CBF) increases after sudden cold exposure. Traditionally, warm-up exercise (WEx) has been recommended before cold exposure; however, the physiologic effects of WEx on CBF have not been elucidated. Therefore, this study was undertaken to evaluate the effect of WEx on CBF after cold exposure. METHODS Fifteen healthy young men were enrolled in this study. CBF at the distal left anterior descending coronary artery was assessed by transthoracic Doppler echocardiography at baseline and after CPT. The same measurements were made with WEx and weight-bearing exercise before CPT after a 20-minute recovery period between each measurement. In the CBF velocities, the time-velocity integral of diastolic flow (Dtvi) was measured in addition to blood pressure and heart rate (HR). RESULTS The product of Dtvi x HR increased significantly after CPT. Increments in Dtvi x HR after CPT with WEx before CPT were significantly higher than CPT alone (130 +/- 82% vs 68 +/- 37%, P < .05). However, increments in Dtvi x HR after CPT with weight-bearing exercise before CPT were not significantly different from those observed for CPT alone (74 +/- 50% vs 68 +/- 37%, P = not significant). CONCLUSION Our study suggests that WEx can augment an increased CBF after cold exposure. This augmentation of CBF increase after cold exposure may help the body meet increased physiologic demands imposed on it by cold exposure. However, this phenomenon was not observed for anaerobic weight-bearing exercise.
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Affiliation(s)
- Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Chongno-gu, Seoul, Korea
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15
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Hirano Y, Uehara H, Nakamura H, Ikuta SI, Nakano M, Akiyama S, Ishikawa K. Efficacy of Ultrasound-assisted Stress Testing Using a Hand-carried Ultrasound Device for Diagnosis of Coronary Artery Disease. J Am Soc Echocardiogr 2006; 19:536-9. [PMID: 16644437 DOI: 10.1016/j.echo.2006.01.006] [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] [Received: 11/01/2005] [Indexed: 11/15/2022]
Abstract
BACKGROUND Exercise echocardiography is an effective means of noninvasively detecting coronary artery disease (CAD), and hand-carried cardiac ultrasound (HCU) devices are now being used to diagnose CAD in emergency rooms and at bedsides. OBJECTIVE To compare the efficacies of exercise echocardiography with an HCU device (EchoCG-HCU) and exercise electrocardiography (ECG) in the diagnosis of CAD. METHODS Fifty-eight patients underwent symptom-limited treadmill exercise testing. Two-dimensional echocardiographic images were obtained from standard parasternal and apical windows at rest and immediately after exercise using an HCU device (180 PLUS SonoSite Inc, Bothell, Wash). Wall motion was scored for each of 16 left ventricular segments using a 5-point grading system. The development of new or worsening wall motion was considered to be indicative of ischemia. RESULTS When identifying CAD using exercise ECG, the sensitivity ws 63%, the specificity was 72%, and the diagnostic accuracy was 69%. By comparison, with exercise EchoCG-HCU the sensitivity was 68%, the specificity was 90%, and the diagnostic accuracy was 83%. Moreover, the specificity of exercise EchoCG-HCU was significantly higher than that of exercise ECG (p < .05). CONCLUSION Exercise EchoCG-HCU is at least as useful as exercise ECG for diagnosing CAD.
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Affiliation(s)
- Yutaka Hirano
- Department of Cardiology, Kinki University School of Medicine, Osaka, Japan.
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Mehta SB, Wu WC. Management of Coronary Heart Disease: Stable Angina, Acute Coronary Syndrome, Myocardial Infarction. Prim Care 2005; 32:1057-81. [PMID: 16326227 DOI: 10.1016/j.pop.2005.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Stable angina should first be treated medically, particularly with aspirin and beta-blockers. Diagnostic stress tests are used in patients who have intermediate probability of CHD to further assess the likelihood of disease,with catheterization reserved for patients who have symptoms despite optimal medical therapy or are at risk for multivessel CHD. The work-up for low-risk unstable angina can involve medical management followed by stress testing. Moderate-to-high risk unstable angina and NSTEMI should be treated with an integrated approach, using medical therapy, cardiac catheterization, and revascularization. Patients who have STEMI require urgent reperfusion either with thrombolytic agents or primary angioplasty. Follow-ing a diagnosis of CHD, patients should undergo intense coronary risk-fac-tor modification to reduce the risk of future events.
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Abstract
The aim of this review was to consider the effects of induced hypocapnia both on systemic physiology and on the physiology of the intracranial system. Hyperventilation lowers intracranial pressure (ICP) by the induction of cerebral vasoconstriction with a subsequent decrease in cerebral blood volume. The downside of hyperventilation, however, is that cerebral vasoconstriction may decrease cerebral blood flow to ischemic levels. Considering the risk-benefit relation, it would appear to be clear that hyperventilation should only be considered in patients with raised ICP, in a tailored way and under specific monitoring. Controversy exists, for instance, on specific indications, timing, depth of hypocapnia, and duration. This review has specific reference to traumatic brain injury, and is based on an extensive evaluation of the literature and on expert opinion.
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Kudaiberdieva G, Timuralp B, Ata N, Unalir A, Gorenek B, Cavusoglu Y, Goktekin O, Birdane A. Cold exposure and left ventricular diastolic performance in coronary artery disease. Angiology 2003; 54:187-93. [PMID: 12678194 DOI: 10.1177/000331970305400208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It is known that cold exposure is accompanied by coronary artery vasoconstriction and ischemia in patients with coronary artery disease (CAD). The aim of the present study was to evaluate the response of left ventricular (LV) diastolic and systolic functions, estimated by means of Doppler echocardiography, to cold pressor test (CPT) in patients with CAD. Twenty-five male patients (mean age 50.8 +/- 8.1 years) with documented CAD underwent CPT with Doppler echocardiographic assessment of LV diastolic and systolic functions. According to the development of ischemic response to CPT, all patients were divided into 2 groups: group 1, 10 patients with ischemia and group 2, 15 patients without ischemia during CPT. Cold exposure caused significant increase in blood pressure with no changes in heart rate in all CAD patients. Patients with signs of ischemia during cold exposure had lower transmitral flow velocity during early filling (p < 0.001), prolonged isovolumic relaxation time (p < 0.04), shortened deceleration time of early transmitral flow velocity (p < 0.001), and higher values of Doppler-derived index of myocardial performance (p < 0.0001) than those without ischemic response to CPT. Cold exposure in CAD patients through stimulating of vasoconstriction and ischemia was associated with derangements in LV myocardial performance, manifested by delayed relaxation, impaired stiffness, and reduced contractility.
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