Exercise ECG Test Research Articles

Impaired Heart Rate Recovery Index in Patients With Sarcoidosis

Sarcoidosis, an inflammatory granulomatous disease, is associated with various cardiac disorders, including threatening ventricular arrhythmias and sudden cardiac death. Heart rate recovery (HRR) after exercise is a function of vagal reactivation, and its impairment is an independent prognostic indicator for cardiovascular and all-cause mortality. The aim of our study was to evaluate HRR in patients with sarcoidosis. The study population included 56 patients with sarcoidosis (23 men, mean age = 47.3 ± 13.0 years, and mean disease duration = 38.4 ± 9.7 months) and 54 healthy control subjects (20 men, mean age = 46.5 ± 12.9 years). Basal ECG, echocardiography, and treadmill exercise testing were performed on all patients and control participants. The HRR index was defined as the reduction in the heart rate at peak exercise to the first-minute rate (HRR(1)), second-minute (HRR(2)), third-minute (HRR(3)), and fifth-minute (HRR(5)) after the cessation of exercise stress testing. There are significant differences in HRR(1) and HRR(2) indices between patients with sarcoidosis and the control group (25 ± 6 vs 34 ± 11; P < .001 and 45 ± 10 vs 53 ± 12; P < .001, respectively). Similarly, HRR(3) and HRR(5) indices of the recovery period were lower in patients with sarcoidosis when compared with indices in the control group (53 ± 12 vs 61 ± 13; P < .001 and 60 ± 13 vs 68 ± 13; P < .001, respectively). Exercise capacity was notably lower (9.2 ± 2.1 vs 11.6 ± 2.8 METs; P = .001, respectively) and systolic pulmonary arterial pressure at rest was significantly higher in patients with sarcoidosis compared with the control group (29.7 ± 5.5 mm Hg vs 25.6 ± 5.7 mm Hg, P = .001, respectively). Furthermore, HRR indices were found to be different among radiographic stage groups. The HRR index was impaired in patients with sarcoidosis as compared with control subjects. When the prognostic significance of the HRR index is considered, these results may partially explain the increased occurrence of arrhythmias and sudden cardiac death in patients with sarcoidosis. Our findings suggest that the HRR index may be clinically helpful in identifying high-risk patients with sarcoidosis.

Prognosis in patients achieving ≥10 METS on exercise stress testing: Was SPECT imaging useful?

BackgroundThe benefit of myocardial perfusion imaging (MPI) over exercise ECG stress testing alone is unclear in individuals attaining a workload of ≥10 METS. The purpose of this prospective study is to determine mortality and nonfatal cardiac events in patients at either intermediate pretest risk for CAD or patients with known CAD, achieving ≥10 METS regardless of peak exercise heart rate. The authors previously reported a low prevalence of significant ischemia in this patient cohort. MethodsBaseline characteristics, ECG stress test findings, and perfusion and function results from quantitative gated 99mTc-SPECT MPI were compared by achievement of a maximum age-predicted heart rate ≥85% in 509 consecutive patients who reached ≥10 METS. Events including all-cause and cardiac mortality, non-fatal myocardial infarction (MI), and late revascularization (>4 weeks after MPI) were prospectively collected. ResultsOf the 509 patients achieving ≥10 METS, follow-up for mortality was obtained in 463 (91%). Those lost to follow-up were older and had higher rates of tobacco use. The prevalences of CAD risk factors, prior known CAD, and MPI abnormalities were higher for the 68 patients failing to reach 85% of their target heart rate. The rate of ≥10% left-ventricular (LV) ischemia by MPI remained very low irrespective of attained heart rate (0.6% (3/463)). Six (1.2%) had an LVEF < 40%. Death occurred in 12 (2.6%) patients, one of which was classified as cardiac (0.1%/year). The other 11 deaths were related to cancer. Additionally, there were three nonfatal MIs (0.7 %) and one late revascularization (0.2%). Only one of these patients had any ischemia on MPI. No cardiac event patient had exercise ST depression or ≥5% LV ischemia. ConclusionsThus, patients at intermediate risk for CAD or known CAD achieving ≥10 METS have a very low prevalence of ≥10% LV ischemia and very low rates of cardiac mortality, nonfatal MI, and late revascularization, irrespective of heart rate achieved. Cardiac events did not correlate with abnormalities on the index MPI study. These results suggest that patients who attain ≥10 METS during exercise stress have an excellent prognosis over an intermediate term of follow-up, regardless of peak exercise heart rate achieved. The added value of MPI to standard exercise ECG testing in this population is questionable.

The pre-participation examination for leisure time physical activity: general medical and cardiological issues.

There is current debate on the appropriate type and extent of medical testing for amateur and hobby athletes before they engage in sports. In particular, views diverge on the value of an ECG at rest. We selectively searched the Medline and Embase databases for relevant publications that appeared from 1990 to 2008. The most pertinent ones are discussed here along with current reviews and guidelines that give recommendations on pre-participation testing for amateur athletes. History-taking and physical examination are standard around the world. The American guidelines on pre-participation examination do not recommend an ECG at rest, yet the guidelines for most European countries explicitly recommend it. No prospective cohort studies have been performed to date that might provide high-grade evidence (class and level) to support this practice. We discuss the pros and cons of an ECG at rest and also present the guideline recommendations on exercise-ECG testing for amateur athletes over age 40. In accordance with the current European recommendations, and in consideration of the risks of athletic activity, we recommend that all persons participating in sports should undergo a pre-participation examination that includes an ECG at rest. Although primary-prevention campaigns advise physically inactive persons to get regular exercise, prospective studies are still lacking as a basis for recommendations in this group.

Relationship between obstructive coronary artery disease and abnormal stress testing in patients with paroxysmal or persistent atrial fibrillation

Atrial fibrillation (AF) has been linked to the presence of underlying coronary artery disease (CAD). However, whether the higher burden of CAD observed in AF patients translates into higher burden of myocardial ischemia is unknown. In 87 patients (71% male, mean age 61 ± 10 years) with paroxysmal or persistent AF and without history of CAD, MSCT coronary angiography and stress testing (exercise ECG test or myocardial perfusion imaging) were performed. CAD was classified as obstructive (≥50% luminal narrowing) or not. Stress tests were classified as normal or abnormal. A population of 122 patients without history of AF, similar to the AF group as to age, gender, symptomatic status and pre-test likelihood, served as a control group. Based on MSCT, 17% of AF patients were classified as having no CAD, whereas 43% showed non-obstructive CAD and the remaining 40% had obstructive CAD. A positive stress test was observed in 49% of AF patients with obstructive CAD. Among non-AF patients, 34% were classified as having no CAD, while 41% showed non-obstructive CAD and 25% had obstructive CAD (P = 0.013 compared to AF patients). A positive stress test was observed in 48% of non-AF patients with obstructive CAD. In conclusion, the higher burden of CAD observed in AF patients is not associated to higher burden of myocardial ischemia.

LEFT VENTRICULAR REMODELING AND ARRHYTHMOGENIC POTENTIAL IN ARTERIAL HYPERTENSION: PP.26.52

Objective: To determine the rate of cardiac arrhythmias in hypertensive patients subject to left ventricular remodeling pattern (LVRP) in the absence of coronary artery disease. Design and Methods: The study cohort consisted of 79 patients with proved essential hypertension. The average age of patients was 50,2 ± 10,6 years. All patients were studied using mono- and two-dimensional echocardiography, 24-h dynamic Holter monitoring and exercise ECG testing in order to exclude coronary artery disease. Subject to LVRP the patients were divided into four groups. The first group (n = 5) consisted of the patients with normal geometry; the second group (n = 9) included the patients with concentric remodeling; the third group (n = 45) involved the patients with concentric left ventricular hypertrophy (LVH); the fourth group (n = 20) embraced the patients with eccentric LVH. Ventricular arrhythmias were categorized according to Lown-Wolf classification. Results: The average number (median) of premature atrial contructions (PAC) per hour was 0,4 ± 0,44 (0,29) in the first group; 2,15 ± 5,0. (0,25) in the second group; 13 ± 61,9 (2,2) in the third group and 12,4 ± 27,3 (3,1) in the fourth group. The frequency of PAC was different in the groups (p = 0,0038). The third group patient PAC occured more frequently than the same in the first (ð = 0,01) and in the second group (ð = 0,02). The frequency of complex atrial arrythmias (atrial couplets and runs of supraventricular tachycardia) was not different (p = 0,46; ð = 0,39). Average number (median) of ventricular premature complexes (VPC) per hour was 0,04 ± 0,05 (0,04) in the first group; 0,02 ± 0,03 (0) in the second group; 8 ± 21,8 (0,1) in the third group and 12,4 ± 27,3 (3,1) in the fourth group. The obtained data indicated intergroup differences in VPC frequency (p = 0,004). The third group patient VPC occured more frequently than the same in the second group (p = 0,0007) and the fourth group patients as compared to the second group (ð = 0,01). There were no intergroup differences in high gradation ventricular arrhythmias frequency (p = 0,08). Conclusions: The highest arrhythmogenic potential is detected in hypertensive patients with concentric and eccentric LVH.

Effects of GIK (glucose–insulin–potassium) on stress-induced myocardial ischaemia

Despite the evidence in experimental animal models that insulin, or GIK (glucose-insulin-potassium), improves left ventricular function and perfusion during both acute and chronic ischaemia, clinical studies have generated conflicting results. We tested the hypothesis that pretreatment with GIK attenuates the vascular and functional effects of stress-induced myocardial ischaemia in humans. Twenty-two patients with evidence of inducible myocardial ischaemia were enrolled; 11 patients with normal ventricular function underwent two dipyridamole echocardiography tests, and 11 with regional contractility defects from previous myocardial infarction were submitted to two ECG exercise tests combined with 201Tl myocardial perfusion scintigraphy; the tests were preceded by 60 min of either normal saline or an isoglycaemic GIK infusion. On a stress echocardiogram, a 30% reduction in the severity of ischaemia was observed. On ECG ergometry, GIK infusion slightly increased the time to ischaemia (+0.6 min, P=0.07); however, the higher workload (+8%, P=0.07) was achieved at a similar rate-pressure plateau. On scintigraphy, an increase in ischaemic segments (+48%, P<0.001) was imaged mainly at the expense of viable (but non-ischaemic) and non-viable segments, which were reduced by 60%. GIK affected stress-induced left ventricular underperfusion only marginally (GIK: 39.7+/-2.5 compared with saline: 35.4+/-2.2 units, P<0.05), but significantly improved its acute reversibility (-42+/-4 compared with -25+/-4%, P<0.001). We conclude that GIK pretreatment attenuates the effect of ischaemia on myocardial contractility, slightly improves exercise tolerance and causes a more rapid and diffuse recovery of post-ischaemic reperfusion.

Prognostic role of myocardial single photon emission computed tomography in the elderly

The increase in average life expectancy will move the burden of coronary artery disease (CAD) to older patients. Myocardial perfusion imaging by single photon emission computed tomography (SPECT) has been extensively validated for diagnosis and prognostic evaluation in large population series. Yet, its use is usually limited in elderly patients in whom, despite increased absolute cardiovascular risk, diagnostic and therapeutic work-up is often underperformed. American College of Cardiology/American Heart Association guidelines recommend exercise ECG testing as the initial noninvasive method for assessment of CAD in patients with a normal or near-normal resting ECG, regardless of age. However, a considerable proportion of elderly patients is unable to reach an adequate workload during the exercise test and the majority of those undergoing for standard exercise treadmill score are classified as intermediate risk. In elderly patients, SPECT imaging may provide valuable diagnostic and prognostic information for clinical management. In particular, normal or near normal SPECT identifies elderly patients at low risk of major adverse cardiac events at the short-term follow-up.

Analysis of ST/HR hysteresis improves long-term prognostic value of exercise ECG test

ST/HR hysteresis is one of the better diagnostic exercise ECG variables for coronary artery disease. This study evaluates the long-term prognostic value of ST/HR hysteresis in predicting acute myocardial infarction (AMI) and all-cause mortality in men and women. The study population consisted of 8317 patients who had undergone routine exercise test on bicycle ergometer at one Swedish centre. Information on AMI and all-cause mortality was obtained from national Swedish registers covering a mean follow-up period of 9.5 years. The adjusted hazard ratio for AMI at a diagnostic cut point of ≤-20 µV for ST/HR hysteresis was 1.88 (95% CI, 1.62-2.17) in men and 2.31 (95% CI, 1.83-2.91) in women. For all-cause death the adjusted hazard ratio was 1.72 (95% CI, 1.52-1.96) in men and 1.90 (95% CI, 1.57-2.29) in women. The corresponding hazard ratios for ST-segment depression with horizontal or down-sloping ST-segment, ST-segment depression, ST/HR index, and ST/HR slope were lower. For comparison, the adjusted hazard ratio for AMI using maximal workload in percent of predicted was 2.02 (95% CI, 1.77-2.32) in men and 2.14 (95% CI, 1.71-2.67) in women. Area under the ROC curves for prediction of AMI was significantly larger using ST/HR hysteresis than using any of three other evaluated ECG indicators. ST/HR hysteresis appears to improve the prognostic ability of an exercise ECG test for AMI and all-cause mortality in a long-term perspective compared to conventional ST-segment and ST/HR indicators in both genders and clearly more markedly in women.

The International Olympic Committee (IOC) Consensus Statement on Periodic Health Evaluation of Elite Athletes: March 2009

The International Olympic Committee (IOC) Consensus Statement on Periodic Health Evaluation of Elite Athletes: March 2009

Does myocardial perfusion scintigraphy predict improvement in symptoms and exercise capacity following successful elective percutaneous coronary intervention?

BackgroundElective percutaneous coronary intervention (PCI) without inducible ischaemia may not be beneficial. We investigated the prevalence of inducible hypoperfusion using myocardial perfusion scintigraphy (MPS) in patients undergoing PCI, and its ability to predict functional outcome. Methods and ResultsOne hundred and twenty-three patients listed for elective PCI underwent MPS, using treadmill exercise where possible. Seventy-seven patients (63%) described chest pain in daily life. Seventy-four of 103 (72%) exercise ECG tests were positive. Ninety-one (74%) had inducible hypoperfusion on MPS (extensive in 25; 20%). Interventionalists were blinded to the scintigraphic results, and PCI was performed as planned. Six months later, Seattle Angina Questionnaire physical limitation score had improved from 66 to 76 (P < 0.0001), and peak treadmill workload from 7.2 ± 2.3 to 9.0 ± 2.7 METS (P < 0.0001). Sex, limiting chest pain on baseline exercise testing, and MPS summed difference score (SDS) were independent predictors of improvement. Patients with both limiting chest pain and SDS ≥ 7 demonstrated an increase of 3.3 ± 1.8 METS, compared with ≈1.5 METS for other subgroups (P < 0.05). ConclusionsMany patients undergoing elective PCI in a UK centre have little or no evidence of inducible hypoperfusion. The combination of limiting chest pain during exercise testing and significant inducible hypoperfusion on MPS predicts a large increase in exercise capacity after PCI.

Lack of Correlation Between Noninvasive Stress Tests and Invasive Coronary Vasomotor Dysfunction in Patients With Nonobstructive Coronary Artery Disease

Despite a nonobstructive coronary angiogram, many patients may still have an abnormal coronary vasomotor response to provocation and to myocardial demand during stress. The ability of noninvasive stress tests to predict coronary vasomotor dysfunction in patients with nonobstructive coronary artery disease is unknown. All patients with nonobstructive coronary artery disease who had invasive coronary vasomotor assessment and a noninvasive stress test (exercise ECG, stress echocardiography, or stress nuclear imaging) within 6 months of the cardiac catheterization with provocation at our institution were identified (n=376). Coronary vasomotor dysfunction was defined as a percentage increase in coronary blood flow of <or=50% to intracoronary acetylcholine (endothelium-dependent dysfunction) and/or a coronary flow reserve ratio of <or=2.5 to intracoronary adenosine (endothelium-independent dysfunction). We determined the sensitivity and specificity of various noninvasive stress tests to predict coronary vasomotor dysfunction in these patients. On invasive testing, 233 patients (63%) had coronary vasomotor dysfunction, of which 187 patients (51%) had endothelium-dependent dysfunction, 109 patients (29%) had endothelium-independent dysfunction, and 63 patients (17%) had both. On noninvasive stress testing, 157 (42%) had a positive imaging study and 56 (15%) a positive ECG stress test. The noninvasive stress tests had limited diagnostic accuracy for predicting coronary vasomotor dysfunction (41% sensitivity [95% CI, 34 to 47] and 57% specificity [95% CI, 49 to 66]), endothelium-dependent dysfunction (41% sensitivity [95% CI, 34 to 49] and 58% specificity [95% CI, 50 to 65]), or endothelium-independent dysfunction (46% sensitivity [95% CI, 37 to 56] and 61% specificity [95% CI, 54 to 67]). The exercise ECG test was more specific but less sensitive than the imaging tests. This study suggests that a negative noninvasive stress test does not rule out coronary vasomotor dysfunction in symptomatic patients with nonobstructive coronary artery disease. This underscores the need for invasive assessment or novel more sensitive noninvasive imaging for these patients.

Should the exercise ECG be used to screen for sudden cardiac death?

Unfortunately no randomized controlled trials have been performed to demonstrate that screening asymptomatic adults without known cardiovascular disease leads to improved outcomes. All that is available are observational studies to guide our efforts to screen and treat asymptomatic patients in an effort to minimize the risks of coronary heart disease (CHD) and sudden cardiac death (SCD). The findings of Laukkanen et al. 1 make a unique contribution to the literature in that they demonstrate the ability of the exercise ECG to predict SCD rather than just cardiac death. It is well established that the exercise ECG test can prognosticate CHD death. Using angiography as an endpoint, meta-analysis has suggested a mean sensitivity of 68% (range 23–100%) and a mean specificity of 77% (range 17–100%) for the exercise ECG.2 The only angiographic study designed to limit work-up bias has demonstrated more realistic test characteristics with a sensitivity of 45% and a specificity of 85%.3 A similar analysis in asymptomatic adults has … *Corresponding author. Email: vicmd{at}aol.com

Early Detection Of Asymptomatic Coronary Artery Disease In Patients With Type 2 Diabetes Mellitus

Background/AimsIn type 2 diabetic patients, coronary artery disease (CAD) is usually detected at an advanced stage due to a lack of symptoms. The aim of this study was to define which clinical parameters or non-invasive tests predict CAD in asymptomatic type 2 diabetic patients.MethodsOne hundred fourteen asymptomatic type 2 diabetic patients were divided into two groups based on the number of cardiovascular disease (CVD) risk factors (group A ≥2, group B ≤1). Treadmill exercise ECG tests (TMT) were conducted in all cases, and coronary artery angiography was performed on TMT-positive patients. Clinical parameters, diabetic status, and coronary angiographic findings were analyzed.ResultsThe prevalence of CAD was 41.0% in group A and 16.7% in group B. The number of risk factors was significantly correlated with the prevalence of CAD, but not with the severity of CAD. Multivariate analysis showed that family history of CAD (odds ratio [OR]=9.41; 95% confidence interval [CI], 1.60-55.49) and diabetes duration ≥10 years (OR=3.28; 95% CI, 1.29-8.84) were independent CAD risk factors in asymptomatic patients.ConclusionsWe recommend a routine screening for CAD in type 2 diabetic patients who have a longer (≥10 years) diabetic duration or a family history of CAD, even if they are asymptomatic for CAD.

Clinical signs and symptoms of oropharyngeal aspiration and dysphagia in children

The diagnostic value of various signs and symptoms (clinical markers) in predicting oropharyngeal aspiration (OPA) or swallowing dysfunction has not been established in children. The present retrospective study was undertaken to: 1) identify specific clinical markers associated with radiographic evidence of OPA, isolated laryngeal penetration (ILP) and post-swallow residue (PSR); 2) determine the sensitivity and specificity of clinical markers associated with OPA; and 3) determine the influence of age and neurological impairment on clinical markers of OPA. In total, 11 clinical markers of dysphagia were compared with the videofluoroscopic swallow study (VFSS) results (OPA, ILP and PSR) in 150 children on diets of thin fluid and purée consistencies. Chi-squared and logistic regression were used to analyse the association between clinical markers and VFSS-identified swallowing dysfunction. In children with OPA, wet voice (odds ratio (OR) 8.90, 95% confidence interval (CI) 2.87-27.62), wet breathing (OR 3.35, 95% CI 1.09-10.28) and cough (OR 3.30, 95% CI 1.17-9.27) were significantly associated with thin fluid OPA. Predictive values included: wet voice (sensitivity 0.67; specificity 0.92); wet breathing (sensitivity 0.33; specificity 0.83); and cough (sensitivity 0.67; specificity 0.53). No clinical markers were significantly associated with OPA, ILP or PSR on the purée consistency. Cough was significantly associated with PSR on thin fluids (OR 3.59, 95% CI 1.22-10.55). Differences were found for age. Wet voice, wet breathing and cough were good clinical markers for children with oropharyngeal aspiration on thin fluid but not on purée. Age and neurological status influenced the significance of these clinical markers.

Maximal Exercise Electrocardiography Responses and Coronary Heart Disease Mortality Among Men With Diabetes Mellitus

An abnormal ECG during maximal exercise testing has been shown to be a powerful predictor of future coronary heart disease (CHD) mortality in asymptomatic men. However, little is known about the relationship between exercise ECG responses and CHD risk in men with diabetes mellitus. We examined the association between exercise ECG responses and mortality in 2854 men with documented diabetes mellitus (mean age 49.5 years) who completed a maximal treadmill exercise test during the period from 1974 to 2001 and who were without a previous cardiovascular disease (CVD) event at baseline. Mortality due to all causes, CHD, and CVD were the main outcome measures across categories of exercise ECG responses, with stratification by cardiorespiratory fitness, quantified as treadmill test duration. During an average follow-up of 16 years, 441 deaths (210 CVD and 133 CHD) were identified. Across normal, equivocal, and abnormal exercise ECG groups, age- and examination year-adjusted CHD mortality rates per 10 000 person-years were 23.0, 48.6, and 69.0, respectively (P(trend)<0.001). After further adjustment for fasting plasma glucose level, smoking, body mass index, hypercholesterolemia, hypertension, family history of CVD or diabetes mellitus, abnormal resting ECG responses, and cardiorespiratory fitness, hazard ratios (95% confidence intervals) were 1.00 (referent), 1.68 (1.01 to 2.77), and 2.21 (1.41 to 3.46; P(trend)<0.001). Similar patterns of associations were noted between exercise ECG testing and both CVD and all-cause mortality risk. Among men with diabetes mellitus, equivocal and abnormal exercise ECG responses were associated with higher risk of all-cause, CVD, and CHD mortality.

THE CORRELATION BETWEEN ERECTILE DYSFUNCTION AND THE SEVERITY OF CORONARY ARTERY INVOLVEMENT IN PATIENTS WITH CORONARY ARTERY DISEASE

Purpose: Erectile dysfunction (ED) may be considered as a clinical manifestation of generalized vascular disease. This study aimed to assess the correlation between ED and the severity of the involved coronary artery in patients with coronary artery disease (CAD). Materials and Methods: 255 men with CAD, who underwent coronary angiography (CAG), were evaluated for erectile function using a questionnaire that included a 5-item Version the International Index of Erectile Function (IIEF-5). Cardiovascular risk factors were also reviewed. The correlation between erectile function and the number of involved coronary vessels, age and number of accompanying cardiovascular risk factors were analyzed. Results: Of the patients, 59.6% had various degrees of ED, which were subdivided into mild (21.7%), moderate (14.5%) and complete (63.8%) according to the severity. The cardiovascular risk factors were hypertension, smoking, overweight, age, lipid abnormalities and diabetes in 67.8, 67.5, 47.1, 38.4, 28.6 and 19.6%, respectively. One, two and three coronary vessels were involved in 26.3, 27.4 and 21.2%, respectively, while 25.1% showed non specific finding on CAG, despite abnormal findings in the resting ECG and treadmill exercise test. Erectile function decreased significantly according to the increasing number of involved coronary vessels (p<0.05), age (p<0.001) and accompanying cardiovascular risk factors (p<0.05). Of the cardiovascular risk factors, age, smoking and diabetes had negative effects on erectile function (p<0.05) in patients with CAD. Conclusions: Statistically significant correlations were demonstrated between ED and the number of involved coronary vessels, age and the number of accompanying cardiovascular risk factors in patients with CAD. Furthermore, in patients with symptoms of chest discomfort, although CAG showed non specific findings, the possibility of hidden ED will need to be investigated. (Korean J Urol 2007;48:94-102)

Exercise Performance vs. Growth of Haemopoietic Stem Cells Amount in CUWs’ Blood after Noninvasive Modulation

We've reported earlier about spontaneous regular fluctuations of concentration of the CD34 + -cells recorded in the blood of Chernobyl cleanup workers (CUWs) in remote period of time and about an opportunity of artificial growth of the previously mentioned parameter by transcutaneous vibrational impact on awake medullary hemopoiesis zones. The current research aims at studying interfacing of CUWs’ exercise performance indices and of the amount of haemopoietic stem cells in their peripheral blood after vibroacoustic influence. Materials: A random sampling of CUWs under long-term dispensary observation (40 male patients, aged 50 on average) have been examined under dispensary conditions. Methods: A course of vibroacoustic mobilization of autologous haemopoietic stem cells into the bloodstream from the bone marrow haemopoietic zones has been conducted with the purpose of correction of CUWs’ psychosomatic condition. The CUWs’ exercise performance has been examined via veloergometric exercise ECG testing before the modulation course and 3 to 6 months later on. CD34 + -cell subpopulation in peripheral blood was estimated by laser cross flow-cytometry method (FACScan, Beckton-Dickinson) with monoclones (DAKO, BD) before and right after the end of the modulation course. Results: For a cluster of patients examined, certain increase in the number of CD34 + -cells in the blood right after the end of the modulation course has been discovered. Dynamic tracking (3 to 6 months) of this cluster has revealed certain increase in the number of patients capable of fulfilling the exercise ECG test; maximal oxygen uptake for all the patients of this cluster has also shown certain increase in the same period of time. On the contrary, increase of the reviewed indices were uncertain for those patients, who did not demonstrate any growth of the amount of CD34 + -cells right after the modulation course. Conclusions: For a distinct cluster of examined patients, interfacing has been discovered in between growth of the amount of CD34 + -cells into their peripheral bloodstream right after the course of noninvasive vibroacoustic modulation and increase of the showings of their exercise performance in 3 to 6 months.

Ischemia-modified albumin (IMA) is not useful for detecting myocardial ischemia during symptom-limited exercise stress tests

Background/AimsWe examined the ischemia-modified albumin (IMA) level during exercise in patients with coronary artery disease (CAD).MethodsForty patients with a history of chest pain underwent both symptom-limited treadmill exercise stress testing and coronary angiography within one week. During the treadmill tests, blood samples were obtained at baseline and 5 min after exercise to measure the serum IMA level.ResultsOf the 40 patients, fourteen (35%, CAD group) had significant coronary artery stenosis, while the other 26 (65%, non-CAD group) did not. The baseline and post-exercise IMA levels in the two groups did not differ significantly (105.2±7.2 vs. 107.7±6.7 U/mL at baseline and 93.1±10.1 vs. 94.8±5.7 U/mL at post-exercise in the CAD and non-CAD groups, p=0.29 and 0.57, respectively). The changes in IMA after exercise did not differ either (-10.4±7.5 vs. -14.0±7.6 U/mL in the CAD and non-CAD groups, respectively, p=0.10). Similarly, the change in IMA between the exercise ECG test positive (TMT positive, n=9) and negative (TMT negative, n=20) groups did not differ (-14.63±5.19, vs -8.50±9.01 U/mL, p=0.15, in the TMT positive and negative groups, respectively).ConclusionsOur results suggest that IMA has limitation in detecting myocardial ischemia during symptom-limited exercise stress tests.

Heart rate variability derived from exercise ECG in the detection of coronary artery disease

The diagnostic performance of heart rate variability (HRV) analysis from exercise ECG in the detection of coronary artery disease (CAD) is unknown. Bicycle exercise ECG recordings from The Finnish Cardiovascular Study (FINCAVAS) of angiography-proofed CAD patients (n = 112) and a patient group with a low likelihood of CAD (n = 114) were analyzed. HRV parameters (SDNN, RMSSD, Poincaré SD1 and SD2) were calculated from 1 min segments before exercise, during exercise and after exercise. All the parameters were in addition calculated from heart rate (HR)-corrected RR-interval segments. The ST-segment depressions in each stage were also determined. The diagnostic performance of the parameters was evaluated with the area under the receiver operating characteristic (ROC) curve method. The uncorrected HRV parameters showed the best diagnostic performance in the recovery segments but the correlation with HR was also high (SDNN: 0.758/−0.64, RMSSD: 0.747/−0.60; area under the ROC/correlation coefficient). The HR correction decreased the correlation and the diagnostic performance in recovery segments (SDNN: 0.515/−0.12, RMSSD: 0.609/0.20). The diagnostic performance of ST-level at its best was higher than any of HRV parameters (ST-level: 0.795/0.36). According to the results, the HR correction decreased the diagnostic performance of the recovery phase. The HRV parameters calculated from 1 min segments of exercise test ECG were not as capable as traditional ST-segment analysis. In conclusion, the HRV analysis from exercise or recovery phase seems to be inadequate in the detection of CAD.

Gender differences in the clinical management of patients with angina pectoris: a cross-sectional survey in primary care

BackgroundPrevious research suggests that women admitted to hospital with acute myocardial infarction (MI) are managed less intensively than men. Chronic stable angina is the commonest clinical manifestation of coronary heart disease in the community, but little information is available concerning its contemporary clinical management. The aim of this study is to assess the extent of gender differences in the clinical management of angina pectoris in primary care.MethodsA cross-sectional survey undertaken in 8 sentinel centres serving 63,724 individuals in the city of Liverpool (15% of the city population). Aspects of clinical care assessed included: risk factor recording (smoking, cholesterol, blood pressure, body mass index); secondary prevention (aspirin, beta-blocker, statin); cardiac investigation (exercise ECG, perfusion scanning, angiography); and revascularisation (percutaneous coronary intervention, coronary artery bypass grafting). Male-to-female adjusted odds ratios (AOR) were calculated (adjusted for age, angina duration, age at diagnosis and previous MI) using logistic regression.Results1,162 patients (610 men; 552 women) with angina were identified. Women were older than men (71 vs 67 years), with a shorter duration of angina (6 vs 7 years), and a lower prevalence of previous MI (25% vs 43%). Men were significantly more likely than women to undergo detailed risk factor assessment (AOR = 1.35, 95%CI 1.06 to 1.73); receive 'triple' secondary prevention with aspirin, beta-blockers and statins (AOR = 1.47, 95%CI 1.07 to 2.02); access exercise ECG testing (AOR = 1.31, 95%CI 1.02 to 1.68); angiography (AOR = 1.61, 95%CI 1.23 to 2.12); and undergo coronary revascularisation (AOR = 1.93, 95%CI 1.39 to 2.68).ConclusionSystematic gender differences exist in the comprehensive clinical management of patients with angina in primary care.