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Nitter-Hauge S. Correlation studies between employability, left ventricular hemodynamics and exercise ECG before and after aortocoronary bypass surgery. ACTA MEDICA SCANDINAVICA. SUPPLEMENTUM 2009; 645:1-7. [PMID: 6972153 DOI: 10.1111/j.0954-6820.1981.tb02594.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Desideri A, Candelpergher G, Zanco P, Suzzi G, Terlizzi R, Borsato N, Colangeli G, Daskalakis C, Chierichetti F, Celegon L. Exercise technetium 99m sestamibi single-photon emission computed tomography late after coronary artery bypass surgery: long-term follow-up. Clin Cardiol 2009; 20:779-84. [PMID: 9294670 PMCID: PMC6656104 DOI: 10.1002/clc.4960200913] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND HYPOTHESIS The prognostic value of exercise technetium 99m sestamibi single-photon emission computed tomography (SPECT) imaging in patients with previous bypass surgery is unknown. The aim of our study was to assess the prognostic information obtained with exercise scintigraphy performed for routine follow-up or reappearance of symptoms. METHODS We studied 75 patients referred to our Center at a mean of 38 +/- 53 months from the revascularization procedure and prospectively followed them for 38 +/- 24 months. RESULTS Fifteen patients (20%) had events at follow-up: there were 4 cardiac deaths, 3 nonfatal acute myocardial infarctions, 8 late revascularization procedures (4 percutaneous transluminal angioplasty and 4 repeat bypass surgery). Univariate analysis identified a history of typical angina (p = 0.001), a clinically positive ergometric test (p = 0.009), peak exercise heart rate (p = 0.0003), percentage of maximal predicted heart rate (p = 0.0001), peak exercise double product (p = 0.048), therapy during exercise (p = 0.003), scintigraphic summed reversibility score (i.e., the summation of the segmental differences between stress and rest) (p = 0.014), as significant predictors of events. Three multivariate models were built, with clinical variables (Model 1, chi square 15.97), ergometric variables (Model 2, chi square 19.66), and with scintigraphic variables added to clinical/ergometric variables (Model 3, chi square 31.13). The scintigraphic variable selected in the model as significant predictor of events was the summed reversibility score (p = 0.008). CONCLUSIONS Exercise sestamibi SPECT scintigraphy provides optimal prognostic information after clinical and ergometric parameters in patients with previous bypass surgery.
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Affiliation(s)
- A Desideri
- Coronary Care Unit, S. Giacomo Hospital, Castelfranco Veneto, Italy
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Chalela WA, Kreling JC, Falcão AM, Hueb W, Moffa PJ, Pereyra PLA, Ramires JAF. Exercise stress testing before and after successful multivessel percutaneous transluminal coronary angioplasty. Braz J Med Biol Res 2006; 39:475-82. [PMID: 16612470 DOI: 10.1590/s0100-879x2006000400007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Controversy exists regarding the diagnostic accuracy, optimal technique, and timing of exercise testing after percutaneous coronary intervention. The objectives of the present study were to analyze variables and the power of exercise testing to predict restenosis or a new lesion, 6 months after the procedure. Eight-four coronary multi-artery diseased patients with preserved ventricular function were studied (66 males, mean age of all patients: 59 +/- 10 years). All underwent coronary angiography and exercise testing with the Bruce protocol, before and 6 months after percutaneous coronary intervention. The following parameters were measured: heart rate, blood pressure, rate-pressure product (heart rate x systolic blood pressure), presence of angina, maximal ST-segment depression, and exercise duration. On average, 2.33 lesions/patient were treated and restenosis or progression of disease occurred in 46 (55%) patients. Significant increases in systolic blood pressure (P = 0.022), rate-pressure product (P = 0.045) and exercise duration (P = 0.003) were detected after the procedure. Twenty-seven (32%) patients presented angina during the exercise test before the procedure and 16 (19%) after the procedure. The exercise test for the detection of restenosis or new lesion presented 61% sensitivity, 63% specificity, 62% accuracy, and 67 and 57% positive and negative predictive values, respectively. In patients without restenosis, the exercise duration after percutaneous coronary intervention was significantly longer (460 +/- 154 vs 381 +/- 145 s, P = 0.008). Only the exercise duration permitted us to identify patients with and without restenosis or a new lesion.
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Affiliation(s)
- W A Chalela
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Korpilahti K, Engblom E, Hämäläinen H, Syvänne M, Hietanen E, Arstila M, Puukka P, Rönnemaa T. Significance of graft occlusion and coronary atherosclerosis 5 years after coronary artery bypass grafting. A quantitative angiographic study with serial exercise testing. J Intern Med 1999; 245:545-52. [PMID: 10363756 DOI: 10.1046/j.1365-2796.1999.00453.x] [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: 11/20/2022]
Abstract
OBJECTIVE To evaluate the relative importance of graft occlusions and progression of atherosclerosis in coronary arteries as causes of the occurrence of angina pectoris and impairment of physical performance 5 years after coronary artery bypass surgery. DESIGN A 5-year follow-up study. SETTING University hospital in south-western Finland. SUBJECTS Altogether, 174 consecutive electively operated bypass patients. MAIN OUTCOME MEASURES Serial clinical evaluation and bicycle exercise tests (pre-operatively, at 6 months, and at 1 and 5 years). Quantitative coronary angiography pre-operatively and 5 years after the surgery. RESULTS Subjects with patent grafts had fewer angina pectoris symptoms at the 5-year follow-up (24 vs. 52%, P = 0.001) and were treated less frequently with long-acting nitrates (3 vs. 15%, P = 0.037) than subjects with graft occlusions. Fewer of them were in classes II-III of the functional classification of the Canadian Cardiovascular Society (39 vs. 74%, P = 0.001). The exercise test was interrupted less often because of chest pain (23 vs. 41%, P = 0.03) and improvement in exercise test variables during the follow-up period was significantly greater in subjects with patent grafts (P<0.002). Amongst patients without graft occlusions, those with new > or =50% diameter stenoses in coronary arteries were more often in functional classes II-III (59 vs. 32%, P = 0.03) than those without new stenoses, but the groups were similar with respect to angina pectoris and exercise tests variables. In patients with graft occlusions, those with and without new > or =50% diameter stenoses were similar with respect to functional class, angina pectoris and exercise test variables. CONCLUSIONS Angina pectoris and impairment of physical capacity 5 years after coronary artery bypass grafting are mainly due to occlusion of bypass grafts and not to progression of atherosclerosis in coronary arteries.
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Affiliation(s)
- K Korpilahti
- Department of Medicine, Central Hospital of Vaasa, Finland
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Marwick TH, Zuchowski C, Lauer MS, Secknus MA, Williams J, Lytle BW. Functional status and quality of life in patients with heart failure undergoing coronary bypass surgery after assessment of myocardial viability. J Am Coll Cardiol 1999; 33:750-8. [PMID: 10080477 DOI: 10.1016/s0735-1097(98)00642-1] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate whether preoperative clinical and test data could be used to predict the effects of myocardial revascularization on functional status and quality of life in patients with heart failure and ischemic LV dysfunction. BACKGROUND Revascularization of viable myocardial segments has been shown to improve regional and global LV function. The effects of revascularization on exercise capacity and quality of life (QOL) are not well defined. METHODS Sixty three patients (51 men, age 66+/-9 years) with moderate or worse LV dysfunction (LVEF 0.28+/-0.07) and symptomatic heart failure were studied before and after coronary artery bypass surgery. All patients underwent preoperative positron emission tomography (PET) using FDG and Rb-82 before and after dipyridamole stress; the extent of viable myocardium by PET was defined by the number of segments with metabolism-perfusion mismatch or ischemia. Dobutamine echocardiography (DbE) was performed in 47 patients; viability was defined by augmentation at low dose or the development of new or worsening wall motion abnormalities. Functional class, exercise testing and a QOL score (Nottingham Health Profile) were obtained at baseline and follow-up. RESULTS Patients had wall motion abnormalities in 83+/-18% of LV segments. A mismatch pattern was identified in 12+/-15% of LV segments, and PET evidence of viability was detected in 30+/-21% of the LV. Viability was reported in 43+/-18% of the LV by DbE. The difference between pre- and postoperative exercise capacity ranged from a reduction of 2.8 to an augmentation of 5.2 METS. The degree of improvement of exercise capacity correlated with the extent of viability by PET (r = 0.54, p = 0.0001) but not the extent of viable myocardium by DbE (r = 0.02, p = 0.92). The area under the ROC curve for PET (0.76) exceeded that for DbE (0.66). In a multiple linear regression, the extent of viability by PET and nitrate use were the only independent predictors of improvement of exercise capacity (model r = 0.63, p = 0.0001). Change in Functional Class correlated weakly with the change in exercise capacity (r = 0.25), extent of viable myocardium by PET (r = 0.23) and extent of viability by DbE (r = 0.31). Four components of the quality of life score (energy, pain, emotion and mobility status) significantly improved over follow-up, but no correlations could be identified between quality of life scores and the results of preoperative testing or changes in exercise capacity. CONCLUSIONS In patients with LV dysfunction, improvement of exercise capacity correlates with the extent of viable myocardium. Quality of life improves in most patients undergoing revascularization. However, its measurement by this index does not correlate with changes in other parameters nor is it readily predictable.
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Affiliation(s)
- T H Marwick
- Department of Cardiology, Cleveland Clinic Foundation, Ohio, USA.
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6
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Visser FC, van Campen L, de Feyter PJ. Value and limitations of exercise stress testing to predict the functional results of coronary artery bypass grafting. INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1993; 9 Suppl 1:41-7. [PMID: 8409543 DOI: 10.1007/bf01143145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
To assess the value of exercise stress testing to predict the functional result of revascularization, 90 patients were evaluated by coronary angiography and exercise testing pre and postoperatively. Patients were classified on the basis of the postoperative angiogram in a group with successful surgery and a group with unsuccessful surgery. The predictive accuracy positive of ST segment depression to detect unsuccessful surgery was 67% The predictive accuracy negative was 61%. The best predictor of unsuccessful surgery was residual angina pectoris after revascularization with predictive value positive and negative of 85% and 60%, respectively. Thus exercise stress testing has limited value to accurately predict the degree of revascularization.
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Affiliation(s)
- F C Visser
- Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands
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Ambulatory Electrocardiography Evaluation of the Post-Coronary Artery Bypass Graft and Post-Percutaneous Transluminal Coronary Angioplasty Patient. Cardiol Clin 1992. [DOI: 10.1016/s0733-8651(18)30224-8] [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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Marwick TH, Nemec JJ, Lafont A, Salcedo EE, MacIntyre WJ. Prediction by postexercise fluoro-18 deoxyglucose positron emission tomography of improvement in exercise capacity after revascularization. Am J Cardiol 1992; 69:854-9. [PMID: 1550012 DOI: 10.1016/0002-9149(92)90782-t] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The extent of ischemic and hibernating myocardium, which may be detected by increased postexercise uptake of fluoro-18 deoxyglucose (FDG) using positron emission tomography, may determine the degree of functional benefit after revascularization. This study examined the influence of the amount of this FDG-avid myocardium on changes in left ventricular function and exercise parameters after revascularization. Echocardiography and exercise testing were performed before and after intervention in 23 patients who had undergone positron emission tomography for the evaluation of myocardial perfusion (using rubidium-82), and postexercise FDG imaging in the fasting state. Follow-up echocardiography (22 +/- 14 weeks after revascularization) was compared with preoperative FDG activity in 7 myocardial regions per patient. Systolic function improved after intervention in 19 of 26 malperfused, dysfunctional FDG-avid regions (73%), and did not improve in 35 of 47 dysfunctional regions without increased FDG uptake (74%). The influence of the amount of FDG-avid tissue on changes in functional state was examined by comparing 9 patients with multiple (greater than or equal to 2) FDG-avid regions with the remainder. Those with multiple FDG-avid regions demonstrated improvement in peak rate-pressure product (20 +/- 4 to 26 +/- 4 x 10(3), p less than 0.02), and percentage of maximal heart rate achieved at peak (84 +/- 10% to 93 +/- 6%, p = 0.04), neither of which changed significantly in the remaining patients. Exercise capacity increased from 5.6 +/- 2.7 to 7.5 +/- 1.7 METS in the group with multiple FDG-avid regions; this increase of 55 +/- 18% exceeded the increase of 13 +/- 10% in the remainder (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- T H Marwick
- Department of Cardiology, Cleveland Clinic Foundation, Ohio
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9
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Dubach P, Lehmann KG, Froelicher VF. Comparison of exercise test responses before and after either percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. Am J Cardiol 1989; 64:1039-41. [PMID: 2683707 DOI: 10.1016/0002-9149(89)90805-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- P Dubach
- Long Beach Veterans Administration Medical Center, California 90822
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10
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Lewis RL, Videll JS, Strong MD, Maranhao V, Lumia FJ. Exercise radionuclide assessment of left ventricular function before and after coronary bypass surgery. Angiology 1987; 38:601-8. [PMID: 3498383 DOI: 10.1177/000331978703800804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The effects of elective saphenous vein coronary artery bypass surgery on left ventricular ejection fraction were assessed by using exercise first-pass radionuclide angiography in 66 consecutive patients. All patients with left main coronary artery or concomitant valvular disease were eliminated from the study. Before surgery, 7 patients had normal postexercise left ventricular function (Group 1), 33 had normal resting left ventricular function with an abnormal response to exercise (Group 2), and 26 had an abnormal resting left ventricular ejection fraction with an abnormal response to exercise (Group 3). Following surgery, patients in all three groups had no change in mean resting left ventricular ejection fraction; however, patients in Groups 2 and 3 had significant improvement in mean postexercise left ventricular ejection fraction (p less than 0.0001 and p less than 0.0054 respectively), whereas patients in Group 1 did not. Previous studies reported improvement in postexercise ejection fraction in patients with reduced resting left ventricular function and with an ischemic response to exercise (Group 3). But this is the first study to confirm improvement in postexercise function in patients with normal resting function and an ischemic response to exercise (Group 2).
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11
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Crea F, Kaski JC, Fragasso G, Hackett D, Stanbridge R, Taylor KM, Maseri A. Usefulness of Holter monitoring to improve the sensitivity of exercise testing in determining the degree of myocardial revascularization after coronary artery bypass grafting for stable angina pectoris. Am J Cardiol 1987; 60:40-3. [PMID: 3496778 DOI: 10.1016/0002-9149(87)90981-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
To assess whether Holter monitoring improves the sensitivity of exercise testing in identifying incomplete myocardial revascularization, both tests were performed in 45 patients from 3 to 5 months after elective coronary artery bypass grafting (CABG) for stable angina pectoris. Coronary angiography revealed incomplete revascularization in 26 patients. Six of these 26 had 52 episodes of ST-segment depression during Holter monitoring and myocardial ischemia during exercise testing. Their exercise capacity was significantly lower than that of 10 other patients in whom the results of exercise testing only were positive (heart rate at 0.1 mV ST-segment depression 112 +/- 9 vs 123 +/- 15 beats/min, p less than 0.001). In the other 10 patients with incomplete myocardial revascularization the results of both investigations were negative. The graft patency rate was lower in patients with a positive response to exercise testing than in those with a negative response (52% vs 71%, p less than 0.005). Myocardial revascularization was angiographically complete in 19 patients. In 18 of these 19 patients the findings of both investigations were negative; in 1 patient Holter monitoring revealed episodes of ST-segment elevation suggestive of variant angina. Thus, after CABG for stable angina pectoris the results of Holter monitoring do not improve the sensitivity of exercise testing in identifying patients with angiographically incomplete myocardial revascularization because findings are positive only in patients with low exercise capacity. Both tests fail to show evidence of myocardial ischemia in most patients with angiographically complete myocardial revascularization.
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12
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Effects of physical exercise training on cardiac function and graft patency after coronary artery bypass grafting. J Thorac Cardiovasc Surg 1987. [DOI: 10.1016/s0022-5223(19)36476-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Hultgren H, Peduzzi P, Shapiro W, van Heeckeren D. Veterans Administration Cooperative Study of medical versus surgical treatment for stable angina--progress report. Section 7. Effect of medical versus surgical treatment on exercise performance at five years. Prog Cardiovasc Dis 1986; 28:279-84. [PMID: 3511511 DOI: 10.1016/0033-0620(86)90005-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Hossack KF, Bruce RA, Ivey TD, Kusumi F. Changes in cardiac functional capacity after coronary bypass surgery in relation to adequacy of revascularization. J Am Coll Cardiol 1984; 3:47-54. [PMID: 6140278 DOI: 10.1016/s0735-1097(84)80429-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Seventy patients having aortocoronary vein bypass grafting surgery for angina pectoris underwent preoperative invasive exercise testing to symptom limits and again 6 to 14 months postoperatively. Cardiac output was measured using the direct Fick principle. Postoperatively at maximal exercise, there was a 3.11 liters/min (p less than 0.0001) increase in cardiac output in men (n = 61) and a 2.04 liters/min (p less than 0.01) increase in women (n = 9). Patients with complete revascularization showed a significantly greater improvement in cardiac output postoperatively than did those with incomplete revascularization (26 versus 6%, p less than 0.0001). The major reason for the increased maximal cardiac output was a marked increase in heart rate while stroke volume was maintained at the same preoperative level. These findings were true irrespective of preoperative use of beta-adrenergic blocking drugs.
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Hossack KF, Bruce RA, Kusumi F, Kannagi T. Prediction of maximal cardiac output in preoperative patients with coronary artery disease. Am J Cardiol 1983; 52:721-6. [PMID: 6605083 DOI: 10.1016/0002-9149(83)90405-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Of 100 patients (89 men, 11 women) studied preoperatively to determine their aerobic and hemodynamic profiles at rest and during upright treadmill exercise. The mean maximal cardiac output (CO), measured using the direct Fick principle, was 57 +/- 14% of average normal values. The reduction in maximal heart rate (63 +/- 13% of normal) was a greater factor in the reduction in CO than stroke volume (88 +/- 16% of normal). Maximal oxygen consumption (VO2max) was 48 +/- 15% of normal and the greater reduction in VO2max compared with CO was due to lower peripheral extraction in the coronary patients. Variables that correlated with maximal CO in a univariate analysis included angina severity (r = -0.45), VO2max (r = 0.67), maximal heart rate (r = -0.31), left ventricular dysfunction (r = -0.45), maximal systolic blood pressure (r = -0.31) and number of vessels with greater than or equal to 50% diameter reduction (r = -0.3). Resting ejection fraction did not correlate with maximal CO. In a multivariate analysis, 4 variables correlated significantly (r = 0.77) with maximal CO: in order, VO2max, number of vessels with greater than or equal to 50% stenosis, magnitude of ST depression and sex.
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16
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Taylor NC, Barber RW, Crossland P, English TA, Wraight EP, Petch MC. Effects of coronary artery bypass grafting on left ventricular function assessed by multiple gated ventricular scintigraphy. Heart 1983; 50:149-56. [PMID: 6603856 PMCID: PMC481388 DOI: 10.1136/hrt.50.2.149] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The effect of coronary artery bypass grafting on global left ventricular ejection fraction and regional contraction was studied in 56 consecutive patients with chronic stable angina pectoris by means of multiple gated ventricular scintigraphy at rest and during dynamic supine exercise before and six weeks after myocardial revascularisation. Before operation, exercise induced a significant fall in ejection fraction and regional wall motion score. Six weeks after operation 52 patients were symptomless. Resting ejection fraction and regional wall motion score were unchanged but during exercise ejection fraction increased significantly, and the previous exercise induced regional wall motion abnormalities were abolished. All four patients with persisting angina showed the same pattern as before operation, with a fall in left ventricular ejection fraction and regional wall motion score during exercise. Multiple gated ventricular scintigraphy affords a safe, objective, reproducible, and non-invasive means of assessing serial ventricular function at rest and during exercise in patients with ischaemic heart disease. The technique confirms that coronary bypass surgery abolishes exercise induced abnormalities of left ventricular function, but has no influence on resting function.
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Waites TF, Watt EW, Fletcher GF. Comparative functional and physiologic status of active and dropout coronary bypass patients of a rehabilitation program. Am J Cardiol 1983; 51:1087-90. [PMID: 6601451 DOI: 10.1016/0002-9149(83)90350-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
To assess the benefits of regular participation in a medically supervised cardiac rehabilitation program, 22 patients who had undergone coronary artery bypass (2 groups of 11 each) were studied retrospectively. Group I (mean age 53 years) was currently enrolled in the rehabilitation program. Group II (mean age 56 years) had begun but had discontinued the program. The stated reasons for discontinuation were not medical. There was no difference in entry exercise tests, and presurgical catheterization data in both groups were comparable. Mean peak oxygen consumption (VO2) by modified Douglas bag technique, heart rate X systolic blood pressure product, and treadmill duration time were recorded in a single testing period. Results revealed that Group I had higher peak VO2 (30 ml/kg/min) than Group II (24) (p less than 0.005) and greater treadmill time (11 minutes) than Group II (8) (p less than 0.01). Nine of 11 subjects in Group I were fully employed, versus 4 of 11 in Group II (p less than 0.01). One of 11 subjects in Group I had been rehospitalized versus 5 in Group II. None in Group I but 4 of 11 subjects in Group II smoked. Thus, based on the sampling and methodology of this study, it is concluded that coronary artery bypass patients in rehabilitation programs have greater peak VO2 and treadmill test time, smoke less, are less often rehospitalized, and are more often fully employed than those who are not in such programs.
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18
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Austin EH, Oldham HN, Sabiston DC, Jones RH. Early assessment of rest and exercise left ventricular function following coronary artery surgery. Ann Thorac Surg 1983; 35:159-69. [PMID: 6337569 DOI: 10.1016/s0003-4975(10)61454-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Radionuclide assessment of rest and exercise left ventricular function was performed in 14 patients before, eight days after, and three months after coronary artery bypass grafting (CABG). Resting function was unaltered after operation, although mild increases in heart rate and end-diastolic volume were observed on the eighth postoperative day. In contrast, exercise function was significantly improved at both postoperative time periods. Exercise ejection fraction was 0.54 +/- 0.10 before operation, 0.73 +/- 0.12 at eight days, and 0.64 +/- 0.13 at three months. Before CABG, the exercise-induced increase in stroke volume was achieved by an increase in end-diastolic volume, whereas eight days after CABG this increase was achieved by an increase in contractility (systolic blood pressure/end-systolic volume). By three months, both contractility and end-diastolic volume increased with exercise. Thus, improvement in left ventricular function during exercise can be documented as early as eight days after coronary revascularization. This change may be less pronounced after three months of convalescence, but considerable improvement in ventricular function persists compared to preoperative assessment.
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19
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Luksic IY, Raffo JA, Mary DA, Watson DA, Deverall PB, Linden RJ. Use of exercise tests in assessment of the functional result of aortocoronary bypass surgery. Thorax 1981; 36:428-34. [PMID: 6976014 PMCID: PMC471528 DOI: 10.1136/thx.36.6.428] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The value of an objective exercise test for the assessment of the functional results of aortocoronary bypass was investigated in 19 patients who were studied before and six months after the operation. For positive tests the end point was defined as a net ST segment depression of 0·1 mv 80 ms after the J point of the ECG. For negative tests the end point was 85% of the age-predicted maximal heart rate response. One patient who was not able to attain either of these points after the operation was excluded. In the remaining 18 patients three indices were used in the analysis. First, the heart rate (HR) and the product of heart rate and systolic blood pressure (RPP) were measured at the defined level of ST segment depression during positive exercise tests to yield HR/ST and RPP/ST threshold respectively. Second, the HR and RPP were measured at the end point of the negative tests. Third, the duration of exercise till the end point of the tests was measured. In each patient the duration of the postoperative test was longer than that of the preoperative test. While all the patients had a positive exercise test before the operation, the test was negative in 11 after it. In 10 of these 11 patients the HR and RPP attained at the end point of the postoperative test had increased; the HR and RPP remained unchanged in one patient. Positive tests were still present in seven of the 18 patients. In five of these the HR/ST threshold and RPP/ST threshold were greater after than before operation, and they remained unchanged in two. An improvement in myocardial blood supply after aortocoronary bypass was suggested indirectly by the ability to attain, during exercise, a higher HR and RPP at the end point of the test. The test proved especially valuable in patients who retained a positive exercise test after the operation.
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20
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Weiner DA, McCabe CH, Roth RL, Cutler SS, Berger RL, Ryan TJ. Serial exercise testing after coronary artery bypass surgery. Am Heart J 1981; 101:149-54. [PMID: 6970516 DOI: 10.1016/0002-8703(81)90657-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
To determine the duration of functional benefit from coronary bypass surgery, 111 patients with angina pectoris were serially evaluated by standard exercise testing prior to and for up to 4 years after surgery. Exercise testing 6 to 18 months after surgery showed greater heart rate-blood pressure product at peak work load, improved work capacity, and less symptomatic and electrocardiographic evidence of ischemia than was demonstrated preoperatively. Twenty patients were tested 37 to 48 months postoperatively and showed improved exercise performance in comparison with preoperative results, but the frequency of positive tests during this period no longer differed. Thus, improved exercise performance appears to persist for at least 4 years after coronary bypass surgery.
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21
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Hossack KF, Bruce RA, Green B, Kusumi F, DeRouen TA, Trimble S. Maximal cardiac output during upright exercise: approximate normal standards and variations with coronary heart disease. Am J Cardiol 1980; 46:204-12. [PMID: 7405834 DOI: 10.1016/0002-9149(80)90059-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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22
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Jennings G, Pitt A, Stirling G, Korner P. Effects of beta blockade on work--delta ST segment curves during exercise, and relation to subsequent results of coronary artery bypass surgery. Heart 1980; 43:419-25. [PMID: 6967324 PMCID: PMC482303 DOI: 10.1136/hrt.43.4.419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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23
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Newman GE, Rerych SK, Jones RH, Sabiston DC. Noninvasive assessment of the effects of aorta-coronary bypass grafting on ventricular function during rest and exercise. J Thorac Cardiovasc Surg 1980. [DOI: 10.1016/s0022-5223(19)37929-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Sivertssen E, Semb G, Benestad AM. Functional evaluation of aortocoronary bypass surgery by exercise testing. SCANDINAVIAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 1980; 14:61-6. [PMID: 6966423 DOI: 10.3109/14017438009109856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Exercise stress test was performed prior to and after aortocoronary bypass surgery in 91 male patients in an attempt to quantitate the change of physical capacity after operation and to correlate this to clinical improvement and late shunt angiography. The mean maximal work load was significantly higher after than prior to surgery in all groups. In average the maximal work load increased 65%. No difference was found between patients who were operated on for stable angina pectoris and those with unstable angina or impending myocardial infarction. Patients, who subjectively were without symptoms or much better after surgery, had a higher maximal work load after operation than those who were subjectively less improved or worse. In a sub-group of patients the maximal oxygen consumption was calculated in per cent of normal values for the age. The mean maximal oxygen consumption increased from 59% prior to surgery to 76% of normal values after surgery.
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25
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Corne RA, Gotsman MS, Baron J, Salomon J, Vaknine R, Rod J, Weiss A, Atlan H. Radionuclide assessment of aortocoronary bypass surgery. Ann Thorac Surg 1979; 28:522-9. [PMID: 316313 DOI: 10.1016/s0003-4975(10)63172-4] [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: 12/14/2022]
Abstract
Rest and exercise thallium 201 myocardial scintigraphy and multiple gated radionuclide angiography were correlated with the results of clinical status, exercise electrocardiography, coronary arteriography, and contrast left ventriculography in a series of 12 prospectively studied consecutive patients before and after aortocoronary bypass operation. Patients were divided into two groups based on a comparison between preoperative and postoperative 201T1 scintigrams. Group 1 (6 patients) demonstrated improved or normal postoperative perfusion scintigrams and excellent correlation between the site of a patent graft and the improvement in myocardial perfusion on the postoperative exercise scintigrams. Regional wall motion remained normal in 3 patients and improved in 3. In Group 2 (6 patients) the postoperative 201T1 scintigrams were unchanged or worse. Each patient demonstrated graft occlusion, graft stenosis, distal disease, or a perioperative myocardial infarction. No improvement in regional wall motion occurred in 4 of these 6 patients. Neither the symptomatic response to aortocoronary bypass operation nor the response to exercise testing successfully predicted graft patency.
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26
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Fox K, Selwyn A, Jonathan A, Westerby S, Shillingford J. Electrocardiographic mapping after exercise for evaluation of coronary bypass graft surgery. Am J Cardiol 1979; 44:1251-6. [PMID: 315702 DOI: 10.1016/0002-9149(79)90437-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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27
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Robinson PS, Williams BT, Webb-Peploe MM, Crowther A, Coltart DJ. Thallium-201 myocardial imaging in assessment of results of aortocoronary bypass surgery. Heart 1979; 42:455-62. [PMID: 315784 PMCID: PMC482182 DOI: 10.1136/hrt.42.4.455] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Thirty-six patients were assessed by thallium-201 myocardial imaging before and after aortocoronary bypass operations and the results were compared with evaluation based on symptomatic assessment, exercise testing, and electrocardiography. After operation, the majority of patients were free from symptoms or symptomatically improved with increased exercise duration. Perioperative myocardial damage was shown in eight patients and myocardial ischaemia in 15 patients when assessed by thallium imaging during exercise. Thallium imaging proved more sensitive than electrocardiography in the demonstration of perioperative infarction and in the detection of postoperative ischaemia. Exercise electrocardiography may be misleading after aortocoronary bypass operations. Thallium imaging offers a simple, objective evaluation of the results of revascularisation procedures, throws light on the mechanisms of relief of angina by operation, and helps in the assessment of the patient whose progress is unsatisfactory after operation.
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28
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Hammermeister KE, DeRouen TA, English MT, Dodge HT. Effect of surgical versus medical therapy on return to work in patients with coronary artery disease. Am J Cardiol 1979; 44:105-11. [PMID: 313147 DOI: 10.1016/0002-9149(79)90258-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The proportion of medically and surgically treated patients with coronary artery disease working full time 1 year after cardiac catheterization or surgery, respectively, was assessed by questionnaire in a registry of patients who had had coronary angiography. The proportion of medically and surgically treated patients working 3 months before catheterization or surgery was 74 percent (148 of 201) and 75 percent (899 of 1,198), respectively, whereas 62 percent (125 of 201) and 62 percent (747 of 1,198), respectively, were working full time 1 year after catheterization or surgery. Multivariate analysis identified five variables predictive of return to work. In order of significance these were: working status 3 months before surgery or catheterization, years of education, age, functional class before surgery or catheterization and period of not working before surgery or catheterization. Work status 3 months before surgery or catheterization was clearly the best predictor of continued employment 15 months later. Surgical therapy was not more effective than medical therapy in maintaining full-time employment in this registry of patients with coronary artery disease.
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29
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Stuart RJ, Ziprick DA, Ellestad MH. The value of exercise stress testing in predicting benefit from aorto coronary bypass surgery. Angiology 1979; 30:416-24. [PMID: 313171 DOI: 10.1177/000331977903000605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A total of 142 saphenous vein bypass patients who underwent pre- and postoperative treadmill stress tests were analyzed. The double product at the onset of ischemia improved in 15 of 25 females (68%) and 67 of 117 males (58%). In patients with a history of preoperative angina, 103 of 132 (78%) were relieved after operation, but only 81 of 132 (61%) improved their double product. In those with preoperative angina during treadmill stress testing, 48 of 79 (61%) improved. In patients without preoperative angina on treadmill stress testing, 40 of 65 (62%) improved their double product. When ST depression developed at a workload of 4 METS on the preoperative treadmill stress test, 54 of 87 (62%) improved. When ST depression developed at 6 METS, 20 of 34 (58%) improved their double product at the point of ischemia. The patient's sex, angina during treadmill stress testing, and the workload associated with ischemia did not help identify those who would benefit from bypass surgery. Treadmill stress testing does demonstrate the disparity be tween symptomatic and functional improvement and provides an important parameter for evaluation of aortocoronary bypass.
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30
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Kloster FE, Kremkau EL, Ritzmann LW, Rahimtoola SH, Rösch J, Kanarek PH. Coronary bypass for stable angina: a prospective randomized study. N Engl J Med 1979; 300:149-57. [PMID: 310511 DOI: 10.1056/nejm197901253000401] [Citation(s) in RCA: 84] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To evaluate the effects of coronary-artery bypass, 100 patients with stable, disabling angina were randomized to medical (49) or surgical (51) therapy. There was no statistical difference in major cardiac events after three years (death in five medical vs. four surgical, infarction in eight vs. 10, and unstable angina requiring operation or reoperation in eight vs. three cases). Surgical patients with three-vessel disease had fewer major events (P less than 0.05) than the comparable medical group and less unstable angina requiring operation (P less than 0.02). All unstable angina was less frequent in the surgical group (15 vs. six, P less than 0.01). Functional classification improved more in surgical patients at six months (P less than 0.01) and at late followup examination (P less than 0.05). After six months, surgical patients achieved significantly higher exercise work loads (P less than 0.01), exercise heart rates (P less than 0.05), maximum paced heart rates (P less than 0.01) and myocardial lactate extraction (P less than 0.01). On the basis of this interim report of a relatively small group of patients, we conclude that bypass results in greater functional improvement and less unstable angina than medical therapy. The likelihood of death and myocardial infarction is unchanged by operation.
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31
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Serruys PW, Rousseau MF, Cosyns J, Ponlot R, Brasseur LA, Detry JM. Haemodynamics during maximal exercise after coronary bypass surgery. Heart 1978; 40:1205-15. [PMID: 309763 PMCID: PMC483553 DOI: 10.1136/hrt.40.11.1205] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Fifty patients underwent an objective measurement of physical working capacity by means of a multistage test of maximally tolerated exertion before and after coronary bypass surgery; 29 patients also had haemodynamic measurements during maximal exercise before and after coronary bypass surgery. The patients were divided into 3 groups according to the degree of revascularisation: adequate (n = 20), partial (n = 17), or none (n = 13). Adequate revascularisation induces a large increase in physical working capacity because of an increased maximal heart rate and maximal cardiac output; stroke volume during maximal exercise and ejection fraction at rest were not modified, suggesting no major changes in left ventricular function. After unsuccessful coronary bypass surgery, the physical working capacity was unchanged despite an increased maximal heart rate; maximal cardiac output was unchanged and stroke volume during maximal exercise was significantly lower. These undesirable results are often associated with perioperative myocardial infarction and are attended by a decreased ejection fraction at rest; these data suggest an impaired left ventricular function after unsuccessful coronary bypass surgery. The results of partial revascularisation are intermediate but appear to be determined by the incidence of partial graft failure which is also often associated with perioperative myocardial infarction. From individual changes in data collected during maximal exercise testing, it is often impossible to predict the degree of revascularisation.
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32
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Donaldson RM, Honey M, Sturridge MF, Wright JE, Balcon R. Results of aortocoronary bypass operations. Follow-up in 343 patients. BRITISH HEART JOURNAL 1978; 40:1200-4. [PMID: 309762 PMCID: PMC483552 DOI: 10.1136/hrt.40.11.1200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Three hundred and forty-three patients who had aortocoronary bypass graft operations for disabling angina were followed up for from 6 months to 5 years (average 2 years). 80 per cent had multiple grafts and 20 per cent had additional endarterectomy. The overall mortality within one month of operation was 5 per cent, and in those who had vein graft procedures only was 4 per cent. 11 per cent had a postoperative myocardial infarction (6% perioperative) and there were 3 per cent late deaths. At 3 years 90 per cent are surviving. 80 per cent are asymptomatic without treatment. The mean angina grade was 0.3 at the latest follow-up, compared with 2.5 before operation; maximum exercise tolerance was also significantly improved (P less than 0.001). When angina recurred, it did so in 80 per cent of the cases within 12 months of operation and was usually attributable to inadequate revascularisation. Ventricular function as assessed by preoperative ventriculography was the factor most clearly related to survival rate and the early excellent results of coronary bypass operations seem to be maintained up to 5 years. It is, therefore, reasonable to continue to advise operation if only for relief of angina.
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33
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Codd JE, Wiens RD, Kaiser GC, Barner HB, Tyras DH, Mudd JG, Willman VL. Late sequelae of perioperative myocardial infarction. Ann Thorac Surg 1978; 26:208-14. [PMID: 752291 DOI: 10.1016/s0003-4975(10)63672-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The late suquelae of myocardial injury occurring at the time of direct myocardial revascularization are unknown. Fifty of 500 consecutive patients undergoing aortocoronary bypass grafting developed both electrocardiographic and enzymatic evidence of myocardial injury. They were matched with 50 patients of similar age, sex, history of previous infarction, severity of angina, degree of coronary arteriosclerosis, and level of ventricular function as determined by preoperative angiographic studies. The conduct of the operation was identical in each group except for prolongation of total cross-clamp time in those patients with myocardial injury. The total number of vessels grafted, the conduit used, and the operative mean graft flow were similar. Results of treadmill stress testing at 24 to 36 months were not significantly different between groups. Angina status, long-term survival, graft patency, and ventricular function were not adversely affected by intraoperative myocardial injury. However, postoperative ventricular function and stress test performance were related to graft patency.
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34
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Greenberg BH, Hart R, Botvinick EH, Werner JA, Brundage BH, Shames DM, Chatterjee K, Parmley WW. Thallium-201 myocardial perfusion scintigraphy to evaluate patients after coronary bypass surgery. Am J Cardiol 1978; 42:167-76. [PMID: 308304 DOI: 10.1016/0002-9149(78)90896-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To determine the utility of thallium-201 stress scintigraphy in assessing the results of coronary bypass surgery, chest pain, stress electrocardiograms and scintigrams were evaluated in 27 patients postoperatively. These findings were compared with coronary angiographic data in which a significant postoperative lesion was defined as 75 percent or more stenosis in a graft, its distal vessel or in an ungrafted native vessel. As an indicator of postoperative coronary lesions, chest pain lacked sensitivity (60 percent) and was nonspecific (20 percent). The stress electrocardiogram had poor sensitivity (60 percent) and good specificity (86 percent) but was not helpful in six patients who had equivocal or suboptimal tests. The scintigram had good sensitivity (77 percent) and was highly specific for the diagnosis of coronary stenosis. It was significantly more specific than chest pain (P less than 0.01), gave excellent localizing information and added to the accuracy of both conclusive and inconclusive stress tests. In nine patients with preoperative stress scintigrams, comparison of pre- and postoperative studies reflected the éffects of bypass surgery on coronary perfusion. Scintigraphy is a useful technique for the noninvasive evaluation of the patient after coronary bypass surgery, and postoperative scintigraphy alone is of great value in documenting surgical results.
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35
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Huret J, Agier B, Rosier S, Gueret P, Kahn J, Ben Farhat M, Bardet J, Bourdarias J. Delayed semielective coronary bypass surgery for unstable angina pectoris. J Thorac Cardiovasc Surg 1978. [DOI: 10.1016/s0022-5223(19)41279-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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36
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Diamond GA, Forrester JS, deLuz PL, Wyatt HL, Swan HJ. Post-extrasystolic potentiation of ischemic myocardium by atrial stimulation. Am Heart J 1978; 95:204-9. [PMID: 622954 DOI: 10.1016/0002-8703(78)90464-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The response of acutely ischemic myocardium to post-extrasystolic potentiation (PESP) was evaluated in 11 mongrel dogs. Mercury-in-silastic length gauges were sutured to the epicardial surface of the left ventricle; left ventricular pressure was determined via an apical large-bore catheter-transducer system and controlled by volume manipulation. The anterior descending coronary artery was then ligated, and single premature atrial contractions were introduced via an external stimulator. Thirty minutes after occlusion, shortening during ejection had decreased an average of 81 +/- 8 per cent, from 1.30 +/- 0.29 to 0.32 +/- 0.05 mm. PESP initially induced a marked restoration toward normal segmental contraction as systolic shortening increased significantly to 1.14 +/- 0.23 mm. Additionally, paradoxic systolic expansion, when present, reverted to a normal pattern of contraction during PESP. Responsiveness to PESP deteriorated progressively with time over 3 hours following occlusion until the muscle became essentially totally unresponsive to this stimulus. It is concluded that a single premature atrial beat may be used to induce PESP and provides an effective stimulus for contractile reserve of acutely dysfunctional ischemic myocardium. Loss of responsiveness to PESP may represent the progression to nonviability following acute ischemia.
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37
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Block TA, Murray JA, English MT. Improvement in exercise performance after unsuccessful myocardial revascularization. Am J Cardiol 1977; 40:673-80. [PMID: 920604 DOI: 10.1016/0002-9149(77)90181-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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38
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Bode RF, Zajtchuk R. Evaluation of saphenous vein bypass surgery with multistage treadmill test and ventricular function studies. J Thorac Cardiovasc Surg 1977. [DOI: 10.1016/s0022-5223(19)41409-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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39
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Mnayer M, Chahine RA, Raizner AE. Mechanisms of angina relief in patients after coronary artery bypass surgery. BRITISH HEART JOURNAL 1977; 39:605-9. [PMID: 301743 PMCID: PMC483287 DOI: 10.1136/hrt.39.6.605] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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40
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Padmanabhan VT, Gulotta SJ. Submaximal treadmill exercise testing of patients with coronary artery disease. Postgrad Med 1977; 61:215-8, 221-2, 225 passim. [PMID: 857249 DOI: 10.1080/00325481.1977.11712199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The submaximal treadmill exercise test is a valuable noninvasive tool for the diagnosis of overt or latent coronary artery disease (CAD). When submaximal heart rates of 80% to 90% of the predicted maximal rates are attained and when ST-segment depression of at least 1 mm is taken as a criterion of ischemia, testing by any of the various exercise protocols with continuous ECG monitoring affords reasonable specificity and sensitivity. The objectives of testing are to (1) diagnose and determine the severity of CAD, (2) assess functional capacity, (3) observe the natural history of disease, (4) evaluate the effects of medical and surgical treatment, and (5) evaluate responses to physical conditioning or to programs directed toward prevention of CAD. Proper precautions and safety standards minimize the risk of exercise testing.
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41
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Abstract
Because of previous reports of the beneficial effect of vitamin E in angina pectoris patients, 48 patients, with both stable angina and positive (chest pain plus ishemic ST depression) maximal exercise treadmill tests, participated in a double-blind cross-over study of 6 months of vitamin E and 6 months of placebo therapy, separated by a 2 month no treatment period. All 48 patients had positive selective coronary arteriograms (75 per cent obstruction of at least a major coronary artery) and/or Q wave ECG evidence of previous myocardial infarction (Minnesota criteria). Evaluation of drug effectiveness was based on performance of serial maximal exercise treadmill tests, serial systolic time interval measurements, and daily angina diaries. No statistically significant differences between the two treatment studied. It is concluded that a large dose of vitamin E (1,600 I.U. of d-alpha-tocopherol succinate daily) for 6 months in patients with stable angina pectoris fails to increase the exercise capacity, improve left ventricular function, or reduce the frequency of chest pain.
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42
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43
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Abstract
Subjective symptomatic improvement is experienced by 90% of patients after coronary bypass surgery. Objective exercise testing reduces this incidence to 70%. An analysis of the multifactorial genesis of pain relief based on data of non-randomized trials reveals that graft patency plays a dominant but not unique role in causing improved symptomatology. In a number of cases, intra-operative myocardial infarctions seem to explain the pain relief but may also have opposite effects. Changes in left ventricular function operate bidirectionally but data on this variable in relation to changes in symptomatology are not amenable for detailed analysis. Progression in native vessel lesions apparently opposes pain relief and has its greatest impact in connection with graft closure. Residual post-operative angina is evidently related also to incomplete revascularization.
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44
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Chesebro JH, Ritman EL, Frye RL, Smith HC, Connolly DC, Rutherford BD, Davis GD, Danielson GK, Pluth JR, Barnhorst DA, Wallace RB. Videometric analysis of regional left ventricular function before and after aortocoronary artery bypass surgery: correlation of peak rate of myocardial wall thickening with late postoperative graft flows. J Clin Invest 1976; 58:1339-47. [PMID: 1086858 PMCID: PMC333305 DOI: 10.1172/jci108589] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The peak rate of systolic wall thickening (pdTw/dt) in regions of the left ventricle was determined by biplane roentgen videometry in 60 patients before and a median of 14 mo after aorto-coronary bypass graft surgery. The left ventricular ejection fraction, stroke volume, and end-diastolic volume and pressure did not change significantly after surgery in the presence of patent or occluded grafts (P greater than 0.05). Statistically significant increases occurred in the peak rate of systolic wall thickening regions supplied by patent bypass grafts, and significant decreases occurred in regions with occluded grafts (P less than 0.01). Of 42 preoperatively hypokinetic regions (pdTw/dt greater than 0 less than 5.0 cm/s) supplied by a patent graft, 30 improved by an average of 2.6 cm/s after operation; 18 returned to normal. Failure of 24 hypokinetic regions to improve to normal was associated with myocardial infarction in 11 or with late postoperative graft blood flows of less than 60 ml/min measured by videodensitometry, in 10. All seven preoperatively akinetic (pdTw/dt=0) or dyskinetic (pdTw/dt less than 0) regions did not improve after the operation despite the fact that, in five of the seven, coronary bypass flows were over 60 ml/min. All eight preoperatively hypokinetic regions supplied by coronary artery graft flows of less than or equal 40 ml/min failed to improve to normal after operation. All nine preoperatively hypokinetic regions supplied by coronary artery graft flows of over 60 ml/min improved to normal after surgery. Late postoperative coronary artery bypass graft flows, the functional status of the myocardium, the status and distribution of the native coronary circulation, and decreased regional function elsewhere in the ventricle must all be considered when regional left ventricular function is interpreted.
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45
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46
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Barry WH, Pfeifer JF, Lipton MJ, Tilkian AR, Hultgren HN. Effects of coronary artery bypass grafting on resting and exercise hemodynamics in patients with stable angina pectoris: a prospective, randomized study. Am J Cardiol 1976; 37:823-30. [PMID: 1083668 DOI: 10.1016/0002-9149(76)90105-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In this prospective randomized study, resting and exercise hemodynamics were determined in the nonmedicated state before ("entry") and 1 year after coronary bypass surgery in 38 patients, and at entry and 1 year in 40 patients treated medically. The surgical group showed a significant decrease in mean pulmonary arterial wedge pressure during exercise (entry 23.5 +/- 6.1 [standard error of the mean] mm Hg, 1 year 18.9 +/- 1.0, P less than 0.02); an increase in cardiac index during exercise (entry 4.3 +/- 0.1 liter/min per m2, 1 year 4.6 +/- 0.1, P less than 0.05); an increase in resting mean arterial pressure (entry 94.5 +/- 2.2 mm Hg, 1 year 100.2 +/- 2.2, P less than 0.02); and an increase in resting heart rate (entry 68.5 +/- 1.9 beats/min, 1 year: 76.0 +/- 2.0, P less than 0.01). Maximal treadmill exercise performance also improved significantly in the surgical group of patients (entry 285 +/- 24 seconds, 1 year 382 +/- 24, P less than 0.002). There were no significant changes in these variables in the medically treated "control" group. The improvement in pulmonary arterial wedge pressure during exercise and in maximal treadmill exercise time in the surgical group as a whole was due to striking improvement in these variables in a subgroup of 16 surgical patients who had a more than 10 mm Hg increase in pulmonary arterial wedge pressure during exercise in their entry study. In this subgoup, considered to contain those patients with marked "ischemicdysfunction," pulmonary arterial wedge pressure during exercise fell from 31.4 +/- 1.5 mm Hg (entry) to 19.l +/- 1.8 (1 year) (P less than 0.0001) and treadmill time increased from 217 +/- 24 seconds (entry) to 357 +/- 37 (1 year) (P less than 0.001). Thus, hemodynamic evidence of ischemic left ventricular dysfunction during stress may identify those patients who will show objective improvement in ventricular performance after bypass graft surgery.
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47
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Clausen JP. Circulatory adjustments to dynamic exercise and effect of physical training in normal subjects and in patients with coronary artery disease. Prog Cardiovasc Dis 1976; 18:459-95. [PMID: 6992 DOI: 10.1016/0033-0620(76)90012-8] [Citation(s) in RCA: 319] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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48
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Tucker SC, Kemp VE, Holland WE, Horgan JH. Multiple lead ECG submaximal treadmill exercise tests in angiographically documented coronary heart disease. Angiology 1976; 27:149-56. [PMID: 1078310 DOI: 10.1177/000331977602700302] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
One hundred patients underwent submaximal exercise tolerance testing and coronary cineangiography. Sixty-six percent of the exercise tests were diagnostic including 48 positive and 18 negative tests; 34 patients had indeterminate test results. The occurrence of exercise induced ventricular premature beats was not related to significant coronary artery disease. Ventricular asynergy was significantly more frequent in patients with positive exercise tests (p less than .0001). Application of the age-adjusted target heart rate criterion recommended from Scandinavia and Myrtle Beach to patients with indeterminate results due to failure to reach target heart rate resulted in six false negative tests and lowered sensitivity. The number of positive diagnostic responses achieved using a multiple electrocardiographic lead system was compared with positive diagnostic responses detected in a single lead (V5) and the number of positive tests identified by the additional leads was highly significant (p less than .0001). A high incidence of indeterminate test results due to failure to achieve target heart rate is noted.
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Affiliation(s)
- S C Tucker
- Health Sciences Division, Virginia Commonwealth University, Richmond 23298
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Cohn PF. Clinical, angiographic, and hemodynamic factors influencing selection of patients for coronary artery bypass surgery. Prog Cardiovasc Dis 1975; 18:223-36. [PMID: 1103234 DOI: 10.1016/0033-0620(75)90012-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Kouchoukos NT, Oberman A, Russell RO, Jones WB. Surgical versus medical treatment of occlusive disease confined to the left anterior descending coronary artery. Am J Cardiol 1975; 35:836-42. [PMID: 1079398 DOI: 10.1016/0002-9149(75)90120-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The results of saphenous vein bypass grafting and medical treatment were compared in 53 patients with stable angina pectoris, high grade occlusive disease confined to the left anterior descending coronary artery and normal or minimally impaired left ventricular function. Survival, incidence of myocardial infarction, relief of angina and response to exercise testing were evaluated. In the 29 surgically treated patients, followed up a mean of 24 months, there were two late deaths (7 percent) and five myocardial infarctions (17 percent). Twelve patients (41 percent) were free of angina and the majority had increased exercise performance when tested up to 18 months postoperatively. In the 24 medically treated patients, there were no deaths and one myocardial infarction (4 percent) in a mean follow-up period of 37 months. Six patients (25 percent) were free of angina. Less improvement in exercise performance was observed than in the surgically treated group. This subset of patients with isolated left anterior descending coronary artery disease has a favorable prognosis that is not enhanced by bypass grafting. Surgical treatment is more effective than medical treatment in relieving angina and improving exercise performance in the early years after coronary arteriography.
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