Comparison of the Asymptomatic Cardiac Ischemia Pilot and modified Asymptomatic Cardiac Ischemia Pilot versus Bruce and Cornell exercise protocols

Tamesis, Beaver R.; Stelken, Art; Byers, Sheila; Shaw, Leslee J.; Younis, Liwa T.; Miller, D. Douglas; Chaitman, Bernard R.

doi:10.1016/0002-9149(93)90891-f

Cited by 54 publications

(15 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…marker for exercise capacity. We used an individualized ramp treadmill protocol, which, in addition to its demonstrated superiority in the determination of the relationship between work rate and oxygen uptake, 16 requires a similar relative workload for each subject at each time point. Because the relative workload has been shown to be strongly associated with the physiological HR response to exercise, 9,10 this protocol minimizes possible differences in HR that arise solely from different relative exercise workloads.…”

Section: Figurementioning

confidence: 99%

Prognostic Value of Heart Rate Increase at Onset of Exercise Testing

et al. 2007

View full text Add to dashboard Cite

Background-The initial response of heart rate to dynamic exercise has been proposed as having prognostic value in limited studies that have used modalities other than the treadmill. Our aim was to evaluate the prognostic value of early heart rate parameters in patients referred for routine clinical treadmill testing. Methods and Results-The heart rate rise at the onset of exercise was measured in 1959 patients referred for clinical treadmill testing at the Palo Alto (Calif) Veterans Affairs Medical Center from 1997 to 2004. Multivariable Cox survival analysis was performed for 197 all-cause and 74 cardiovascular deaths that accrued during a mean follow-up of 5.4Ϯ2.1 years. Decreased heart rate changes at all initial relative exercise workloads were associated with significantly increased all-cause mortality. The heart rate rise at one-third total exercise capacity, however, was the only early heart rate variable that significantly predicted both all-cause and cardiovascular risk after adjustment for confounders. Failing to reach 1 SD in the heart rate rise at one-third total exercise capacity was associated with a 28% increased all-cause mortality rate (hazard ratio, 0.72; 95% CI, 0.61 to 0.85; PϽ0.001) and a 35% cardiovascular mortality rate (hazard ratio, 0.65; 95% CI, 0.49 to 0.86; Pϭ0.003). Of all heart rate measurements considered (initial and recovery), the heart rate increase at peak exercise was the most powerful predictor of cardiovascular prognosis after adjustment for potential confounders. The Duke treadmill score, however, was superior to all heart rate measurements in the prediction of cardiovascular mortality. Conclusions-In the present study population, a rapid initial heart rate rise was associated with improved survival, but the heart rate increase at peak exercise and other conventional measurements such as exercise capacity and the Duke treadmill score were more powerful predictors of prognosis.

show abstract

Section: Figurementioning

confidence: 99%

Prognostic Value of Heart Rate Increase at Onset of Exercise Testing

et al. 2007

View full text Add to dashboard Cite

show abstract

“…Exercise treadmill testing was performed with the Asymptomatic Cardiac Ischemia Pilot (ACIP) protocol 9 and a Marquette CASE 3000 Treadmill system. Twelve-lead ECGs were recorded at the end of each minute of exercise and every 2 minutes of the recovery period until the ECG returned to baseline.…”

Section: End Pointsmentioning

confidence: 99%

Effect of Intensive Lipid Lowering, With or Without Antioxidant Vitamins, Compared With Moderate Lipid Lowering on Myocardial Ischemia in Patients With Stable Coronary Artery Disease

et al. 2005

View full text Add to dashboard Cite

Background-Lipid lowering with statins prevents adverse cardiac events. Both lipid-lowering and antioxidant therapies may favorably affect vasomotor function and thereby improve ischemia. Methods and Results-In a randomized, double-blind, placebo-controlled trial, 300 patients with stable coronary disease, a positive exercise treadmill test, 48-hour ambulatory ECG with Ն1 episode of ischemia, and fasting total cholesterol of 180 to 250 mg/dL were assigned to 1-year treatment with intensive atorvastatin to reduce LDL to Ͻ80 mg/dL (nϭ96), intensive atorvastatin to reduce LDL to Ͻ80 mg/dL plus antioxidant vitamins C (1000 mg/d) and E (800 mg/d) (nϭ101), or diet and low-dose lovastatin, if needed, to reduce LDL to Ͻ130 mg/dL (nϭ103; control group). Ischemia end points, including ambulatory ECG monitoring and exercise treadmill testing, and endothelial assessment using brachial artery flow-mediated dilation were obtained at baseline and at 6 and 12 months. Baseline characteristics were similar in all groups. LDL decreased from Ϸ153 mg/dL at baseline in the 2 atorvastatin groups to Ϸ83 mg/dL at 12 months (each PϽ0.0001) and from 147 to 120 mg/dL in the control group (PϽ0.0001). During ambulatory ECG monitoring, mean number of ischemic episodes per 48 hours decreased 31% to 61% in each group (each PϽ0.001; Pϭ0.15 across groups), without a change in daily heart rate activity. Mean duration of ischemia for 48 hours decreased 26% to 62% in each group (each PϽ0.001; Pϭ0.06 across groups). Mean exercise duration to 1-mm ST-segment depression significantly increased in each group, but total exercise duration and mean sum of maximum ST depression were unchanged. Angina frequency decreased in each group. There was no incremental effect of supplemental vitamins C and E on any ischemia outcome. Flow-mediated dilation studies indicated no meaningful changes. Conclusions-Intensive lipid lowering with atorvastatin to an LDL level of 80 mg/dL, with or without antioxidant vitamins, does not provide any further benefits in ambulatory ischemia, exercise time to onset of ischemia, and angina frequency than moderate lipid lowering with diet and low-dose lovastatin to an LDL level of Ͻ120 mg/dL. (Circulation. 2005;111:1747-1755.)

show abstract

“…The remaining 60% were tested using a linear increase of 20 W/ min. We utilized an individualized ramp treadmill protocol, which exhibits a strong correlation between workload and oxygen uptake at a given point and results in a very linear increase in HR [9,14]. This is important since the relative workload has been shown to be strongly associated with the heart rate response to exercise [15,16].…”

Section: Discussionmentioning

confidence: 99%