Effect Of Percutaneous Transluminal Coronary Angioplasty (PTCA) On Cardiopulmonary Responses During Exercise

Abstract

Background In a recent study, Inbar et al. (Adv. Exerc. Sports Physiol. 11:545–551, 2005) demonstrated that certain cardiopulmonary-related variables measured during an exercise test (Cardiopulmonary Exercise Test - CPET) significantly improved the predictive accuracy for identifying coronary artery disease (CAD) in undiagnosed individuals. PURPOSE To examine by means of PTCA whether such variables are sensitive to the widening of blocked blood vessels in patients with CAD. METHODS Participating in the study were 14 subjects (13 males and one female), aged 42–72, who had been referred for cardiac cineangiography on the basis of symptoms and cardiological test results. For eight of the subjects, PTCA intervention was performed during cineangiography to widen one blood vessel (experimental group). The other six subjects did not undergo PTCA, either because it was not feasible or because it was considered unnecessary (control group). The subjects performed CPET about two weeks before and three weeks after cineangiography with (the experimental group) or without (the control group) PTCA. Results The results of ECG analysis reveal a very low sensitivity (45%) to identifying coronary heart disease or anatomical changes caused by the PTCA. On the contrary, the changes resulting from PTCA in the experimental group for peakVO2 (17.49 to 20.75 ml · kg1 min1), ventilatory anaerobic threshold (VAT) (12.15 to 14.39 ml · kg1 · min1), peak O2Pulse (11.76 to 13.27 ml beat1), and O2Pulse Slope (7.05 to 9.25, slope category) were significantly greater than the respective differences in the control group (all ps< 0.005). In contrast, at peak effort, no significant differences were found in the changes manifested by the experimental group and the control group in HR, RQ, RPE, or systolic and diastolic BP. CONCLUSIONS The findings of the present study indicate that unlike stress ECG, VO2peak, VAT, peak O2Pulse and O2Pulse Slope were found to be highly sensitive to changes in cardiac function caused by the widening of constricted coronary arteries. Therefore, it is recommended that CPET be used not only as a screening tool for CAD, but also when testing the efficacy of cardiac rehabilitation programs. This test can also be used to evaluate various treatments for coronary heart disease, from pharmaceutical ones to PTCA and bypass surgery.