Circulation, Vol 74, 72-80, Copyright © 1986 by American Heart Association
S Campbell, J Barry, MB Rocco, EG Nabel, K Mead-Walters, GS Rebecca and AP Selwyn
To better understand the relationship between the transient myocardial
ischemia seen during an exercise test and ischemic activity out of
hospital, 39 patients with well-documented coronary artery disease
underwent standard treadmill exercise testing (Bruce protocol) and 24 to 48
hr of continuous ambulatory electrocardiographic monitoring during normal
daily activities. A total of 245 episodes of transient ischemia were
recorded in 21 of 32 patients with positive exercise electrocardiograms
(group I), whereas seven patients with negative test results (group II) had
no episodes of transient ischemia, during monitoring out of hospital (p
less than .01). Certain measures in the exercise test were related to the
severity of ischemia out of hospital: there were more episodes and a
greater total duration of transient ischemia per 24 hr of ambulatory
monitoring in patients who developed ischemic electrocardiographic changes
before 6 min of exercise (p less than or equal to .021) or at a heart rate
of less than 150 beats/min (p = .005) and in those in whom these ST segment
changes persisted for more than 5 min after exercise (p less than or equal
to .016). In contrast, there was no relationship between transient ischemia
out of hospital and the commonly quoted exercise variables: chest pain,
total exercise duration, and the maximum levels of heart rate, systolic
blood pressure, and double product. Thus, patients with coronary artery
disease and negative exercise electrocardiograms are most unlikely to
experience active ischemia during normal daily life.(ABSTRACT TRUNCATED AT
250 WORDS)
ARTICLES
Features of the exercise test that reflect the activity of ischemic heart disease out of hospital
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