A hemodynamic study of acute coronary insufficiency precipitated by exercise

Parker, John O.; Giorgi, Salvatore Di; West, Roxroy O.

doi:10.1016/0002-9149(66)90237-2

Cited by 186 publications

(33 citation statements)

References 18 publications

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“…In 2 patients, it was just within the lower limit of the normal range; i. e. when exercise had to be discontinued because of angina, the patients were in left heart failure. This finding confirms the results of other authors (7,14,20,21,23). Probably acute left heart failure is the most important factor to limit exercise tolerance of patients with angina pectoris.…”

Section: Pump Functionsupporting

confidence: 92%

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The ischemic segment and left ventricular function during exercise angina

Rentrop

Karsch

Nitsche

1978

Clinical Cardiology

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Summary: Improvement of the quality of transpulmonary left ventriculograms by exercise was demonstrated in 5 patients in a pre-study. In the main study transpulmonary left ventriculography was performed in 10 patients with coronary artery disease (CAD) at rest and during exercise, producing maximum angina pectoris (AP). Left ventricular pressure was recorded simultaneously. The extent of CAD, demonstrated in all patients by coronary angiography, was quantitated by a score. In the exercise ventriculograms, local wall motion was quantitated by 14 hemiaxes. During exercise AP, all patients developed wall motion abnormalities not present at rest. There was a significant linear correlation between coronary score and number of abmormally shortening hemiaxes « 30% shortening) during exercise-AP (y = 0.16 x + 4.34; r = 0.933). The number of anormal hemiaxes correlated significantly (p < 0.05) with left ventricular enddiastolic pressure (LVEDP), dp/dt min, endsystolic volume index, enddiastolic volume index, ejection fraction, stroke work index, minute work, compliance SV / L1 PD/ESV, and cardiac index. During exercise AP the extent of ischemic wall motion abnormalities is determined by localization and severity of coronary artery lesions. The extent of ischemic impairment of wall motion determines the severity of impairment of left ventricular pump function, filling pressure, and maximum speed of relaxation. Transpulmonary left ventriculography during exercise AP is a safe and relatively simple method to quantitate the extent of ischemic wall motion abnormalities. It could be useful in the selection of patients for coronary artery surgery and in the assessment of the results of this operation.lbc sludies were performed in the catheterization laboratories of the Georg-August-University Gocttingen and the Rehabilitationszentrum Bad Krozingcn, West Germany.

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Section: Pump Functionsupporting

confidence: 92%

“…This pressure rise is, as first suggested by Parker et al (23) and later shown by Dwyer (11), a consequence of acute left heart failure with a shift of the pressure-volume curve to the right. Parker et al discussed a decrease of left ventricular compliance as a second factor.…”

Section: Diastolic Eventssupporting

confidence: 69%

The ischemic segment and left ventricular function during exercise angina

Rentrop

Karsch

Nitsche

1978

Clinical Cardiology

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“…Influence of sex, geographical origin, exercise method and position on Ppa Sex and the geographical origin of the data did not significantly influence resting and exercise P pa values (online data supplement, tables G-I) [13,14,16,18,19,29,35,39,43,47].…”

Section: Pulmonary Arterial Pressure During Exercisementioning

confidence: 99%

Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review

Kovàcs

Berghold²,

Scheidl³

et al. 2009

Eur Respir J

902

639

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According to current guidelines, pulmonary arterial hypertension (PAH) is diagnosed when mean pulmonary arterial pressure (Ppa) exceeds 25 mmHg at rest or 30 mmHg during exercise. Issues that remain unclear are the classification of Ppa values ,25mmHg and whether Ppa .30 mmHg during exercise is always pathological.We performed a comprehensive literature review and analysed all accessible data obtained by right heart catheter studies from healthy individuals to determine normal Ppa at rest and during exercise. Data on 1,187 individuals from 47 studies in 13 countries were included. Data were stratified for sex, age, geographical origin, body position and exercise level.Ppa at rest was 14.0¡3.3 mmHg and this value was independent of sex and ethnicity. Resting Ppa was slightly influenced by posture (supine 14.0¡3.3 mmHg, upright 13.6¡3.1 mmHg) and age (,30 yrs: 12.8¡ 3.1mmHg; 30-50 yrs: 12.9¡3.0 mmHg; o50 yrs: 14.7¡4.0 mmHg). Ppa during exercise was dependent on exercise level and age. During mild exercise, Ppa was 19.4¡4.8 mmHg in subjects aged ,50 yrs compared with 29.4¡8.4 mmHg in subjects o50 yrs (p,0.001).In conclusion, while Ppa at rest is virtually independent of age and rarely exceeds 20 mmHg, exercise Ppa is age-related and frequently exceeds 30 mmHg, especially in elderly individuals, which makes it difficult to define normal Ppa values during exercise.

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“…This speculation was included in the first guidelines on PH [35]. As an alternative concept, a slight [40] and more prominent [41] increase in Ppaw at increasing pulmonary flow during exercise was described. In the PPH guidelines, based on invasive data [40], the upper limit of normal was suggested to be 20 mmHg.…”

Section: Ppa Versus Comentioning

confidence: 99%

Pulmonary vascular resistances during exercise in normal subjects: a systematic review

Kovàcs

Olschewski²,

Berghold³

et al. 2011

Eur Respir J

210

161

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The physiological range of pulmonary vascular resistance (PVR) and total pulmonary resistance (TPR), and the impact of exercise, age and posture have been a matter of debate for many years.We performed a systematic literature review including all right heart catheterisation data where individual PVR and TPR of healthy subjects both at rest and exercise were available. Data were stratified according to age, exercise level and posture.Supine resting PVR in subjects aged ,24 yrs, 24-50 yrs, 51-69 yrs and o70 yrs was 61¡23, 69¡28, 86¡15 and 90¡39 dyn?s?cm -5 , respectively. Corresponding TPR was 165¡50, 164¡46, 226¡64 and 223¡45 dyn?s?cm -5, respectively. During moderate exercise in subjects aged f50 yrs, an 85% increase in cardiac output was associated with a 25% decrease in TPR (p,0.0001) and a 12% decrease in PVR (p,0.01). At 51-69 yrs of age there was no significant decrease in TPR and PVR. In individuals aged o70 yrs TPR even increased by 17% (p50.01), while PVR did not change significantly. At higher exercise levels, TPR decreased in all age groups. In the upright position, based on a limited number of data, resting TPR and PVR were higher than in the supine position and decreased more prominently during exercise, suggesting the release of resting pulmonary vasoconstriction.These data may form a basis to define normal PVR at rest and exercise.

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A hemodynamic study of acute coronary insufficiency precipitated by exercise

Cited by 186 publications

References 18 publications

The ischemic segment and left ventricular function during exercise angina

The ischemic segment and left ventricular function during exercise angina

Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review

Pulmonary vascular resistances during exercise in normal subjects: a systematic review

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