Nonspecific ST-T Changes Research Articles

Clinical analysis of acute pulmonary thromboembolism in 68 elderly patients

To explore the clinical characteristics of acute pulmonary thromboembolism (PTE) in elderly patients, in order to improve the diagnosis and treatment of the disease. The clinical data were reviewed for patients aged over 60 years old hospitalized with acute PTE in Peking Union Medical College Hospital from January 2006 to January 2009. The average age of the 68 patients was (72 +/- 6) years old. Deep vein thromboembolism was found in 33 cases. Hypertension (55.9%), cancer (32.4%), surgery (29.4%), immobility (29.4%), diabetes (23.5%) and obesity (20.6%) were the most common risk factors, with 70.6% (48/68) of these patients having more than 2 risk factors. The common symptoms were dyspnea (77.9%), cough (26.5%), chest pain (13.2%), palpitation (13.2%), faint (13.2%) and asymmetric edema of the lower extremities (30.9%). All of the arterial blood gas in 61 cases showed hypoxemia. The positive rate of blood D-dimer elevation was 84% (47/56). The main signs in chest X-ray were infiltrates (37.5%) and pleural effusions (18.8%). Non-specific ST-T changes (59.3%) and sinus tachycardia (23.7%) were the most common abnormalities in electrocardiogram. Forty seven cases (69.1%) were diagnosed through CT pulmonary angiography (CTPA), and 20 cases (29.4%) were through ventilation-perfusion lung scintigraphy. Sixty one cases received anticoagulant therapy and 5 received thrombolytic therapy. Vena cava filters were implanted in 5 patients. Fifty six cases improved after treatment, and the case fatality ratio was 18% (12/68). The most common risk factors for PTE in elderly patients were chronic diseases, cancer, surgery and immobility. The symptoms and auxiliary examination of these patients were not specific, and CTPA was the most useful diagnosing tool. Anticoagulation was the basic treatment for PTE in elderly patients and it was safe and effective, while the overuse of thrombolytic therapy and vena cava filter should be avoided.

Index of Suspicion

Index of Suspicion

Case 2-2010: Massive Myocardial Calcification in an Elderly Woman

81-year-old woman with known history of severe aortic stenosis, severe tricuspid regurgitation and mitral regurgitation was referred with dyspnoea, peripheral oedema and palpitations because of acute decompensation of chronic heart failure. In medical history, the patient denied any other prior or chronic disease apart from osteoarthritis. On physical examination, the patient had a blood pressure of 117/70 mmHg, an irregular pulse, heart rate of 120 beats per minute, and a respiratory rate of 18 breaths per minute. Her temperature was 36.3 °C. A loud systolic ejection murmur grade 4/6 was audible over the aortic valve; jugular veins were distended, lower limbs edema spread to knees. ECG showed atrial fibrillation with heart rate 120/ min and non-specific ST-T changes. Laboratory investigations revealed blood urea nitrogen concentration of 11.5 mmol/l, creatinine 78 μmol/l and uric acid 490 μmol/l; plasma calcium and phosphate level were within the normal limits and markers of myocardial necrosis were negative. Chest X-ray demonstrated dilatation of the upper zone pulmonary vessels and opacity in the area of the left ventricle (Fig. 1). Two-dimensional echocardiography revealed calcified aortic stenosis (systolic peak/mean gradient 91/51 mmHg, aortic valve area was 0.35 cm2/m2 according to planimetry and 0.45 cm2/m2 calculated by the continuity equation) (5), moderate mitral regurgitation with annular calcification (Fig. 2) and tricuspid regurgitation. The ejection fraction of the left ventricle was 31 % and there was left ventricular hypertrophy and moderate pulmonary hypertension. Hyperechogenic tissue areas were detected in the interventricular septum and in the left ventricular wall (Fig. 3). During hospitalization the patient underwent DC-cardioversion. After diuretic treatment she was hemodynamically stable and heart catheterization with coronary angiography was planned. But few days later, however, the patient suddenly died.

Apical Ballooning Syndrome: The Broken Heart Syndrome

Four case studies of apical ballooning syndrome are reported to demonstrate the typical presentation, specific cardiac imaging, and clinical outcomes. Most patients are women and present with symptoms of acute coronary syndrome precipitated by emotional distress or physical stressors. Electrocardiograms (ECGs) may vary from nonspecific ST-T changes to full-blown manifestations of ST segment elevation infarct. Cardiac markers demonstrate minimal or moderate elevations. Basal hypercontractility and apical ballooning are classical cardiac imaging and coronary arteries are usually normal. Patients are expected to have an uneventful hospital course and complete left ventricular function recovery, and most patients do not have any recurrences.

Electrocardiographic Findings of Acute Organophosphate Poisoning

In this study, we evaluated 85 patients who presented to our Emergency Department with organophosphate (OP) poisoning and discuss their associated electrocardiographic (ECG) abnormalities. Over a period of 3 years, 85 patients with OP poisoning were included in this retrospective study. ECG analysis included the rate, rhythm, ST-T abnormalities, conduction defects, and measurement of PR and QT intervals. The mean age was 32.2 ± 14.9 years. Sixty percent of the patients were female. The mean corrected QT interval (QTc interval) was 0.435 ± 0.052 s. Prolongation of the QTc interval (55.5%) was the most common ECG abnormality, followed by sinus tachycardia (31.8%). Elevation of the ST segment and low amplitude T waves were seen in 15 cases (17.6%). Patients with OP poisoning might reveal ECG abnormalities such as QTc interval prolongation or non-specific ST-T changes. QTc interval prolongation cannot be used as a unique predictive factor in determining short-term prognosis in OP poisoning. We found no clear relation between OP poisoning-related malignant ventricular dysrhythmia and QTc interval.

Long QT and ST-T change associated with organophosphate exposure by aerial spray

The relation between the electrocardiographic manifestation and the subjective symptoms accompanying organophosphate pesticide exposure caused by aerial spray was investigated. The study included 39 patients with a diagnosis of organophosphate poisoning, who visited A-clinic within 24 h of exposure to aerial spray of organophosphate pesticide in Gumma Prefecture, from July 2001 to September 2001. Ages ranged from 3 to 82 years. Thirty-five patients were female. Three were diagnosed as severe, 11 moderate, and 25 mild, judged from the score of subjective symptoms. Electrocardiographic abnormalities were bradycardia (<50) 2; prolonged PQ interval 4; prolonged QTc interval (>430 ms) 22; nonspecific ST-T change 35; supraventricular arrhythmia 13; and ventricular premature complex with R on T 1. Prolonged QTc interval developed in 2–3 severe cases, 4–11 moderate cases, and 16–25 mild cases. QT prolongation, ST-T change and arrhythmia were detected for some patients exposed to organophosphate by aerial spray.

Completion of the First Cohort of Patients with Cutaneous T-Cell Lymphoma Enrolled on a Phase II Trial of Depsipeptide.

Histone deacetylase inhibitors, such as depsipeptide or FK228 (Gloucester Pharmaceuticals), form a new class of antineoplastic agents found to have activity in T-cell lymphoma. A multi-institutional phase II trial of depsipeptide is ongoing; accrual is complete for the first cohort, comprised of patients with cutaneous T-cell lymphoma who had disease that had progressed or was refractory to prior therapy and who had fewer than three prior regimens of systemic cytotoxic chemotherapy. Depsipeptide is administered as a 4 hr infusion on days 1, 8, and 15 of a 28 d cycle with a starting dose of 14 mg/m2. The first 3 patients enrolled were treated on the earlier NCI schedule, on days 1 and 5 of a 21 day cycle. Twenty-seven patients with a median age of 57 (31–77) were enrolled in this cohort and received a median of 5 (1–56) cycles and 14 (2–111) doses. Patients had received a median of 3 (1–11) prior therapies. These included PUVA in 15 patients, interferon in 8, bexarotene in 13, denileukin diftitox in 6, oral steroids in 6, topical nitrogen mustard in 7, or cytotoxic chemotherapy in 15. Disease extent at time of enrollment included 6 patients with tumor stage, 6 with generalized erythroderma and 3 with Sézary syndrome. Three patients, all with Sézary syndrome, achieved a complete response and five patients had partial responses for an overall response rate of 30%. With patients continuing to respond, the median duration of response is 18 (6–48) months. Partial responses were observed in patients with plaque/patch stage (1), generalized erythroderma (1), and tumor stage disease (3). An additional five patients had stable disease with a median duration to date of 6 months (4–14). Two patients had unconfirmed partial responses, three patients were not evaluable for response, one patient is too early to evaluate for response and seven patients had documented progression of disease. Overall depsipeptide was well tolerated, the main toxicities observed were nausea, taste changes, fatigue, neutropenia, thrombocytopenia. Non-specific ST-T wave changes were noted by ECG, without changes in cardiac function. No evidence of cardiac damage has been detected by serial echocardiograms, MUGA scans or troponin assays. Eight patients with objective responses receiving depsipeptide were followed for 12 to 53 months without evidence of cumulative toxicity. Induction of histone acetylation of more than two-fold was observed in paired samples of PBMNCs obtained from 9 of the 18 individual patients tested. RT-PCR analysis of MDR-1 demonstrated unchanged expression in tumor biopsies taken from 8 patients at the time of tumor progression when compared to prior to treatment initiation. While it is generally recognized that patients with Sézary syndrome are more refractory to available therapies, remarkably all patients enrolled with Sézary syndrome achieved a complete response to single agent depsipeptide. In conclusion, depsipeptide is the first of a new generation of histone deacetylase inhibitors to demonstrate consistent clinical activity with durable responses achieved in patients with CTCL. Patients are being accrued to a replicate arm for the purpose of confirming the observed response rate.

Update on the phase II trial and correlative studies of depsipeptide in patients with cutaneous T-cell lymphoma and relapsed peripheral T-cell lymphoma

3028 Background: Depsipeptide, FK228 (Fujisawa Pharmaceuticals), is the first of a new generation of histone deacetylase inhibitors to demonstrate consistent clinical activity in a specific tumor type. As a result, we are currently conducting a multi-institutional phase II trial in patients with CTCL, PTCL, or other mature T cell lymphomas. Methods: This trial is accruing patients into 4 separate arms based on histology and prior therapy. Depsipeptide is administered as a 4 hr infusion on days 1, 8, and 15 of a 28 d cycle. Results: Thirty-nine patients have been enrolled. In Arm 1, comprised of patients with CTCL who had not previously received more than 2 cytotoxic chemotherapy regimens, objective responses were observed in 7 of 14 patients, including 3 patients with complete response and 4 patients with partial response, for a response rate of 50%. Duration of response ranged from 6 to continuing over 34 months. Of the 17 patients with PTCL enrolled, 4 (24%) achieved a PR lasting 9 and 12 months in 2 patients, and ongoing over 4 months in 2 patients. Overall the drug is well tolerated, with observed toxicities including nausea, vomiting, fatigue, neutropenia, thrombocytopenia, and hypocalcemia. Non-specific ST-T wave changes are noted by ECG, without changes in cardiac function. Six patients, all with objective responses, have received depsipeptide for 12 to 34 months without evidence of cumulative toxicity. Molecular endpoints have been studied in patient normal and malignant cells. Increased acetylation of histone H3 has been observed in patient samples obtained 4 hr after initiation of the depsipeptide infusion. Inductions ranging from 2 to 24-fold were observed in 19 out of 24 paired samples obtained from individual patients, with 13 patients demonstrating a greater than 4-fold induction. Changes in gene expression have also been noted. Conclusions: These results suggest that histone deacetylase inhibitors such as depsipeptide are active in patients with T cell lymphoma. All 4 arms remain open to accrual at the NCI and extramural sites. Molecular effects can be assayed in patients treated with HDIs. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Fujisawa Pharmaceutical Company

Update on the phase II trial and correlative studies of depsipeptide in patients with cutaneous T-cell lymphoma and relapsed peripheral T-cell lymphoma

3028 Background: Depsipeptide, FK228 (Fujisawa Pharmaceuticals), is the first of a new generation of histone deacetylase inhibitors to demonstrate consistent clinical activity in a specific tumor type. As a result, we are currently conducting a multi-institutional phase II trial in patients with CTCL, PTCL, or other mature T cell lymphomas. Methods: This trial is accruing patients into 4 separate arms based on histology and prior therapy. Depsipeptide is administered as a 4 hr infusion on days 1, 8, and 15 of a 28 d cycle. Results: Thirty-nine patients have been enrolled. In Arm 1, comprised of patients with CTCL who had not previously received more than 2 cytotoxic chemotherapy regimens, objective responses were observed in 7 of 14 patients, including 3 patients with complete response and 4 patients with partial response, for a response rate of 50%. Duration of response ranged from 6 to continuing over 34 months. Of the 17 patients with PTCL enrolled, 4 (24%) achieved a PR lasting 9 and 12 months in 2 patients, and ongoing over 4 months in 2 patients. Overall the drug is well tolerated, with observed toxicities including nausea, vomiting, fatigue, neutropenia, thrombocytopenia, and hypocalcemia. Non-specific ST-T wave changes are noted by ECG, without changes in cardiac function. Six patients, all with objective responses, have received depsipeptide for 12 to 34 months without evidence of cumulative toxicity. Molecular endpoints have been studied in patient normal and malignant cells. Increased acetylation of histone H3 has been observed in patient samples obtained 4 hr after initiation of the depsipeptide infusion. Inductions ranging from 2 to 24-fold were observed in 19 out of 24 paired samples obtained from individual patients, with 13 patients demonstrating a greater than 4-fold induction. Changes in gene expression have also been noted. Conclusions: These results suggest that histone deacetylase inhibitors such as depsipeptide are active in patients with T cell lymphoma. All 4 arms remain open to accrual at the NCI and extramural sites. Molecular effects can be assayed in patients treated with HDIs. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Fujisawa Pharmaceutical Company

Electrocardiographic findings in patients >100 years of age without clinical evidence of cardiac disease

Centenarians have a higher incidence of atrial fibrillation, left-axis deviation, premature beats, first-degree atrioventricular block, and nonspecific ST-T changes. Fewer men live long enough to reach 100 years of age, and they tend to have more significant conduction defects and old myocardial infarcts than women.

The Comparison of the Characteristics of "Nonspecific ST-T Change" Patients in Perioperative Periods

Background: ST that do not fulfill the criteria of specific one-ST greater or equal to 1 mm and lasting over 1 minute-, are termed as nonspecific. The term, ST-T change, has not had an important role as a guildeline of treatment. However, the incidence of nonspecific ST-T changes is estimated as not so negligible, and the relation to postoperative complications or the role as a coronary prognostic risk value has not been studied so far, so the authors thought to examine the general characteristics and course during the perioperative period of nonspecific ST-T patients to conduct better anesthesia services. Methods: From January 1st to June 30th in the year 2000, medical charts of patients who underwent an operation in one university hospital under general or regional anesthesia and whose preoperative electrocardiographic finding was ST-T changes were reviewed. In the preoperative viewing of charts, demographic data, co-existing disease, findings in electrocardiography or echcardiography, and replies of a consultation to a cardiologist were reviewed. In the anesthesia records, nature of conducted anesthesia, agents, operation time and drugs acting on the cardiovascular system were reviewed. Results: Incidence of nonspecific ST-T patients is 8.24%. Mean age is 54 + 16 yrs and the ratio of M: F is about 1: 2. The number of patients who had other medical diseases was 42, about 27%. The number of patients who underwent a preoperative echocardiography was 64, about 42%. Mean ejection fraction was 65 + 7%. The number of patients who consulted a cardiologist preoperatively was 44, about 22% and the majority of them were OK''d as no problem. Administration of drugs acting on the cardiovascular system was done in 49 cases, about 33%. General anesthesia was conducted in 131 cases, regional anesthesia in 23 cases. Conclusions: In all cases, operations were performed without specific events or major complications. However more attention and risk evaluation is desirable in nonspecific ST-T change patients to conduct safer and more ideal anesthesia. (Korean J Anesthesiol 2001; 40: 700-706)

Acute ECG Changes and Chest Pain Induced by Neck Motion in Patients with Cervical Hernia

We report two cases of acute cervical angina and ECG changes induced by anteflexion of the head. Cervical angina is defined as chest pain that resembles true cardiac angina but originates from cervical discopathy with nerve root compression. In these patients, Prinzmetal's angina, valvular heart disease, congenital heart disease, left ventricular aneurysm, and cardiomyopathy were excluded. After all, the patient's chest pain was reproduced by anteflexion of head, at this time, their ECGs showed nonspecific ST-T changes in the inferior and anterior leads different from the basal ECG. ECG changes returned to normal when the patient's neck moved to the neutral position. To our knowledge, these are the first cases of cervical angina associated with acute ECG changes by neck motion.

Low incidence of cardiac abnormalities in treated trichinosis: a prospective study of 62 patients from a single-source outbreak

PURPOSE: The reported incidence of cardiac involvement in trichinosis is highly variable, ranging from 21% to 75%. This study sought to determine the incidence and type of cardiac lesions in trichinosis using serial echocardiographic examinations. SUBJECTS AND METHODS: Sixty-two consecutive patients admitted to the Banja Luka Medical Center during an outbreak of trichinosis (November to December 1996) were included in the study. Diagnosis was made by typical clinical presentation, positive epidemiologic history, serologic testing, and the detection of Trichinella larvae in contaminated meat. All patients underwent serial electrocardiograms and two-dimensional and Doppler echocardiographic examinations within 20 days after the onset of symptoms. Repeated echocardiographic examinations were performed weekly during the hospital stay in all patients with electrocardiographic abnormalities or an abnormal initial echocardiogram. RESULTS: Cardiac involvement (electrocardiographic and/or echocardiographic changes) was detected in 8 (13%) of the 62 patients. Nonspecific transient electrocardiographic ST-T changes were found in 6 patients (10%); 1 patient had frequent premature ventricular complexes. Echocardiographic examinations revealed pericardial effusions in 6 patients (10%), 5 of whom had minimal effusions without impairment of global and regional left ventricular systolic function. One patient had hypokinesis of the interventricular septum with a small pericardial effusion, both of which resolved within 2 weeks. Only 2 of the patients with electrocardiographic abnormalities lacked echocardiographic evidence of cardiac involvement. At 6-month follow-up, none of the patients had electrocardiographic or echocardiographic abnormalities. CONCLUSIONS: The incidence of cardiac involvement in trichinosis appears to be lower than previously reported. Pericardial effusion is the most common manifestation of cardiac involvement, and nonspecific transient electrocardiographic changes, traditionally ascribed to myocarditis, more frequently reflect pericarditis.

Usefulness of exercise echocardiography in predicting cardiac events in an outpatient population

The prognostic value of exercise echocardiography in an outpatient population is not well defined. A total of 1,020 consecutive patients referred for exercise echocardiography in an ambulatory care setting were studied by reviewing their medical records and exercise echocardiographic data. Of these, 71 (7%) were excluded due to technically inadequate tests, leaving 949 patients who were included in the analysis. A positive exercise echocardiogram (EE) was defined as an appearance of a new wall motion abnormality or worsening of a baseline abnormality. Cardiac events, defined as myocardial infarction, coronary angioplasty, coronary bypass surgery, and death, were documented during a 12-month follow-up period. Cardiac events occurred in 17% of patients (26 of 152) with a positive exercise echocardiogram (EE) and in 2.5% (20 of 797) with a negative EE (p <0.001). The incidence of myocardial infarction (2.6% vs 0.4%, p <0.02), coronary angioplasty (7% vs 1%, p <0.001), and coronary bypass surgery (9% vs 1%, p <0.001) were higher in patients with a positive versus a negative EE. There was 1 death in the positive study group and none in the negative group. Significant independent variables (p <0.05) that predicted cardiac events included a positive exercise electrocardiogram, history of coronary angioplasty, nonspecific ST-T changes on the baseline electrocardiogram, double product <25,000, men, chest pain on exercise test, and a positive exercise electrocardiogram. On a stepwise logistic regression model, exercise echocardiography emerged as an independent predictor of future cardiac events in an outpatient population. This predictive value was enhanced in the presence of a positive exercise electrocardiogram compared with a negative exercise electrocardiogram (24.2% vs 7.9%, p <0.03). Our study suggests that exercise echocardiograhy is an independent predictor of future cardiac events in an outpatient population.

A Case of Myocarditis Associated With IDDM

We report a case of diabetic ketoacidosis (DKA) complicated by acute myocarditis, which was confirmed by cardiac biopsy. A 26-year-old man was hospitalized with severe DKA. On admission, nonspecific ST-T change was noted on the electrocardiogram (ECG). The patient's levels of creatine phosphokinase (CPK) and glutamic oxaloacetic transaminase were slightly elevated, but he did not complain of chest discomfort or symptoms of heart disease. On the first day after admission, ST-T elevation was noted on ECG during treatment of DKA. By cardiac angiography and cardiac biopsy, coronary heart disease was ruled out and postmyocarditic change was histologically confirmed. An episode of upper respiratory viral infection before the onset of acute diabetes suggested that the patient suffered from viral-induced myocarditis and consequent development of IDDM. This possibility was confirmed by the clinical course of ECG change, with elevated CPK and lactate dehydrogenase and a slightly elevated antibody titer for echovirus.

Electrocardiographic Abnormalities in Patients With Heat Stroke

Serial electrocardiograms were taken in 46 Hajj Pilgrims suffering from heat stroke immediately after cooling 12 and 24 h later. The collected data were analyzed and revealed that a statistically significant number of patients with heat stroke had sinus tachycardia (43 percent, p < 0.05), conduction defect (22 percent, p < 0.046), prolonged Q-T interval (61 percent, p < 0.007), diffuse nonspecific ST-T changes (26 percent, p < 0.036), and ST-T changes (localized to the ECG leads confirming to a territory of coronary artery) consistent with myocardial ischemia (21 percent, p < 0.02). Although adverse effects of heat stroke on the heart are multifactorial, the above data indicate that heat stroke predisposes to certain risk of myocardial ischemia and conduction disturbances. This may reflect the true cardiovascular status of these heat stroke victims.

Variable patterns of ST-T abnormalities in patients with left ventricular hypertrophy and normal coronary arteries.

Classically, the ST-T configuration in the electrocardiogram of patients with left ventricular hypertrophy is said to have a typical pattern of ST depression together with asymmetrical T wave inversion (the so-called left ventricular strain pattern). However, many patients with left ventricular hypertrophy may also have ischaemic heart disease. To revise the electrocardiographic criteria for left ventricular hypertrophy the ST-T configuration in patients with left ventricular hypertrophy documented by echocardiography and with normal coronary arteries was assessed. 24 patients were selected for this study. All had left ventricular hypertrophy documented by echocardiography, normal coronary arteries by cardiac catheterisation, and ST and/or T wave abnormalities in the lateral leads of their electrocardiogram. There were eight patients with aortic valve disease and 16 with hypertension who had coronary angiography as part of an investigation into the risk factors of sudden cardiac death caused by hypertensive left ventricular hypertrophy. No patient was receiving digitalis preparations or had electrolyte disturbances, and none had a previous myocardial infarction or ventricular conduction defect. Typical electrocardiographic evidence of left ventricular strain was found in approximately two thirds (63%) of patients and 95% of this subgroup had asymmetrical T wave inversion. Flat ST segment depression, with or without T wave inversion or isolated T wave inversion (symmetrical or asymmetrical) in the anterolateral leads, was seen in the remaining 37% of patients. These findings indicate that left ventricular hypertrophy without coronary artery disease can cause variable types of ST-T abnormalities in the anterolateral leads including the typical left ventricular strain pattern and non-specific ST-T changes. Non-specific abnormalities could not be distinguished from those of coronary artery disease and may adversely affect the accuracy of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy because they do not accord with the criteria for left ventricular strain.

運動負荷心電図の非特異的なST-T変化と推定最大酸素摂取量との関連について

This study was designed to clarify the relationship between aerobic power level, nonspecific ST-T changes in exercise ECG and coronary heart disease (CHD) risk factors in Japanese females.Oxygen intake per kilogram of body weight (VO2max/wt), nonspecific ST-T change in exercise ECG (horizontal and sagging depression ≥1mm) and CHD risk factors were examined in 317 middleaged healthy females.The findings were as follows:1) The mean value of VO2max/wt in the nonspecific ST-T changes in exercise ECG group (ST group) was significantly lower than that found in the normal ECG group (N group) (p<0.05). However, the higher the mean values of the risk factors (SBP, TC, LDL-c, TC/HDL-c) in the ST group after adjusting for the effects of age and percent body fat (% fat) (all p<0.01). There were no significant differences between the ST group and the N group in the mean values of DBP, HDL-c, and TG.2) Significant correlations were observed between VO2max/wt and CHD risk factors (each p<0.0001 except for TG<0.001).From these results, it was concluded that VO2max/wt may be closely related to CHD risk factors and nonspecific ST-T changes in exercise ECG. Also these results suggest that it may be necessary to maintain the VO2max/wt to a high level for coronary heart disease prevention.

Isolated significant left main coronary artery stenosis: Angiographic, hemodynamic, and clinical findings in 16 patients

Among 21,545 adult patients who underwent consecutive coronary anglography, 16 (0.07%) were found during their coronary arteriography to have a significant isolated stenotic lesion (luminal diameter narrowing of 50% or more) located at the left main coronary artery. The remaining major epicardial coronary arteries and their branches were free of disease. A strong predilection for the isolated lesion to occur at the ostium of the left main artery was found (12 patients). The most common presenting symptom was angina of less than 4 weeks' duration, although one third of the group was asymptomatic. Resting electrocardiograms were normal in 12 patients, while three patients had T wave inversion and another had nonspecific ST-T changes. Eleven patients exhibited severe stenosis, with eight having 70% to 89% stenosis and three having 90% to 95% stenosis. Five patients had 50% to 69% stenosis. No significant differences were found between patients with angina and patients without angina with respect to age, left ventricular end-diastolic pressure, left ventricular ejection fraction, and mean percent stenosis of the obstructive lesion. Despite the severity and the crucial location of the obstructive lesion, most patients with an isolated, significant left main stenosis appear to have a preserved left ventricular ejection fraction, normal wall motion, and no significant alteration of the left ventricular end-diastolic pressure.

Exercise Response in Young Women with Borderline Hypertension

We compared the response to dynamic exercise in 157 females (mean age 19 +/- 3 years) with borderline hypertension (BH) to findings in 105 normotensive controls. Near-maximal physical working capacity was 90 +/- 17 W in females with BH and 71 +/- 23 W for the controls (p less than 0.001). Mean heart rate, systolic and diastolic blood pressure, and pulse pressure levels both at rest and at exercise were significantly higher in BH patients (p less than 0.001 for all). Mean change between rest and exercise for all the above parameters was not significantly different among BH patients compared with controls. Nonspecific ST-T changes at rest (p less than 0.001) and exercise (p less than 0.005) were more common and mean corrected QT interval was significantly longer (p less than 0.001) in BH patients. The parallel exercise response that we found in BH and normotensives would not appear to substantiate the view that ergometry is particularly useful as a modality for diagnosing hypertension in young females.