Myocardial Ischemic Effects of Isometric, Dynamic and Combined Exercise in Coronary Artery Disease

Kerber, Richard E.; Miller, Roger; Najjar, Sakib M.

doi:10.1378/chest.67.4.388

Cited by 49 publications

(16 citation statements)

References 18 publications

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“…In general, ischemic responses are less frequently noted with static and static-dynamic effort than with symptom-limited dynamic exercise testing. [40][41][42][43] Our data were similar to those noted by Weiss et al'7 regarding measurements of heart rate, blood pressure, and double product before and during exercise. The rate-pressure product achieved during our exercise stress was less than that achieved with other exercise testing such as treadmill or bicycle ergometer stress tests.…”

Section: Resultssupporting

confidence: 88%

Detection of myocardial ischemia by 31P magnetic resonance spectroscopy during handgrip exercise.

et al. 1994

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BACKGROUND The metabolic changes of myocardial ischemia in patients with coronary artery disease assessed by 31P magnetic resonance spectroscopy (MRS) have been reported previously. A significant decrease in the ratio of phosphocreatine (PCr) to ATP during handgrip exercise in a group of patients with severe coronary artery disease has been demonstrated. However, there are no reports at present that directly compare cardiac 31P MRS data with exercise 201Tl myocardial scintigraphy, now established as one of the most important clinical methods to assess myocardial ischemia. The purpose of this study was to investigate whether 31P MRS with handgrip exercise testing is able to detect myocardial ischemia, demonstrated by exercise 201Tl scintigraphy. METHODS AND RESULTS Twenty-seven patients with severe stenosis of the left anterior descending coronary artery (> or = 75%) and 11 normal control subjects composed the present study. Patients were divided into two groups on the basis of exercise 201Tl scintigraphy: a reversible 201Tl defect group (RD[+]) who demonstrated redistribution at the late image and a fixed 201Tl defect group (RD[-]). While lying supine within the magnet, subjects performed handgrip exercise at 30% of maximal force once in every two cardiac cycles. 31P MR spectra were collected before and during handgrip exercise. Data were corrected for the saturation factor. ANOVA revealed significant differences among the three groups with respect to the mean +/- SD PCr/ATP ratio at rest (control, 1.85 +/- 0.28 > RD(+), 1.60 +/- 0.19 > RD(-), 1.24 +/- 0.30; P < .05). The PCr/ATP ratio decreased significantly from 1.60 +/- 0.19 at rest to 0.96 +/- 0.28 during exercise (P < .001) in the RD(+) group (n = 15). However, in the RD(-) group (n = 12), the ratio did not change significantly during handgrip exercise (1.24 +/- 0.30 at rest versus 1.19 +/- 0.28 during exercise). Similarly, the ratio did not change in the control group (n = 11) (1.85 +/- 0.28 at rest versus 1.90 +/- 0.23 during exercise). CONCLUSIONS Contrary to normal subjects or patients with fixed thallium defects, the PCr/ATP ratio was significantly altered by exercise in patients with reversible thallium defects. These results suggest that 31P MRS with handgrip exercise testing is a sensitive method for detecting myocardial ischemia.

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Section: Resultssupporting

confidence: 88%

Detection of myocardial ischemia by 31P magnetic resonance spectroscopy during handgrip exercise.

et al. 1994

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“…Kerber et al noted fewer ischemic ST-segment responses when suitcase carrying was added to near-maximal treadmill walking than with treadmill walking alone. 4 Similarly, Haissly noted a higher intra-arterial double product with sustained handgrip combined with submaximal bicycle ergometry than with maximal leg ergometry. Yet, despite their higher double products during combined static-dynamic effort, these patients had fewer anginal responses than during maximal dynamic effort alone.3 Like Kerber and Haissly, we found evidence that the myocardial oxygen supplydemand relationship during dynamic effort was altered by the addition of a static load: The heart rate and systolic blood pressure response at ischemia was uniformly and significantly increased.…”

Section: Methodsmentioning

confidence: 95%

“…Arm fatigue stopped three staticdynamic tests in two patients of group B and six staticdynamic tests in six patients of group C. In six of these nine tests, the peak heart rate and systolic blood pressure responses to static-dynamic effort equalled or 160 E a, 4) . Cardiovascular parameters at the onset of treadmill-induced ischemic ST-segment depression and at peak effort are shown in table 3.…”

Section: Methodsmentioning

confidence: 95%

Comparison of cardiovascular responses to static-dynamic effort and dynamic effort alone in patients with chronic ischemic heart disease.

DeBusk¹,

Pitts²,

Haskell³

et al. 1979

Circulation

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Thirty men, mean age 55 years, known to have treadmill-induced ischemic ST-segment depression, performed static and dynamic effort, i.e., forearm lifting and treadmill exercise, separately and combined. Static effort was sustained at 20%, 25% or 30% of maximal forearm lifting capacity. Two symptom-limited treadmill tests, one with and one without added static effort, were performed on each of two visits. Compared with dynamic effort alone, combined static-dynamic effort decreased treadmill work load and increased heart rate, systolic blood pressure and rate-pressure product at the onset of ischemic ST-segment depression or angina pectoris: 7.1 +/- 0.4 vs 8.0 +/- 0.5 (SEM) multiples of resting oxygen consumption (mets), estimated; 141 +/- 3 vs 134 +/- 3 beats/min; 170 +/- 4 vs. 162 +/- 4 mm Hg and 239 +/- 8 vs 218 +/- 9 (p less than 0.001). The prevalence of angina pectoris was significantly less with combined static-dynamic effort than with dynamic effort alone. Static effort causes a resetting of the threshold at which ischemic abnormalities appear during dynamic effort.

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“…Patients with ischemic heart disease are usually advised to avoid dynamic activities in which there is a significant static component, but we' and others2' 3 have noted a lower incidence of exercise-induced ischemic ST-segment depression or angina pectoris when patients performed combined static-dynamic effort than when they performed dynamic effort alone.…”

mentioning

confidence: 90%

Comparison of cardiovascular response to combined static-dynamic effort, postprandial dynamic effort and dynamic effort alone in patients with chronic ischemic heart disease.

Hung¹,

McKillip²,

Savin³

et al. 1982

Circulation

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SUMMARY The cardiovascular responses to combined static-dynamic effort, postprandial dynamic effort and dynamic effort alone were evaluated by upright bicycle ergometry during equilibrium-gated blood pool scintigraphy in 24 men, mean age 59 ± 8 years, with chronic ischemic heart disease. Combined static-dynamic effort and the postprandial state elicited a peak cardiovascular response similar to that of dynamic effort alone: work load 643 ± 156 and 638 ± 161 vs 650 i 153 kg-m/min, respectively; heart rate 147 ± 14 and 145 ± 14 vs 143 ± 17 beats/min; systolic pressure 195 i 26 and 200 ± 25 vs 197 ± 25 mm Hg; and rate-pressure product 286 ± 48 and 292 ± 55 vs 282 ± 52. Heart rate, intraarterial systolic and diastolic pressures, ratepressure product and ejection fraction were similar for the three test conditions at the onset of ischemia and at peak effort. The prevalence and extent of exercise-induced ischemic left ventricular dysfunction, ST-segment depression, angina pectoris and ventricular ectopic activity were also similar during the three test conditions. Direct and indirect measurements of systolic and diastolic blood pressure were highly correlated. The onset of ischemic ST-segment depression and angina pectoris correlated as strongly with heart rate alone as with the rate-pressure product during all three test conditions. The cardiovascular response to combined static-dynamic effort and to postprandial dynamic effort becomes more similar to that of dynamic effort alone as dynamic effort reaches a symptom limit. If significant ischemic and arrhythmic abnormalities are absent during symptom-limited dynamic exercise testing, they are unlikely to appear during combined static-dynamic or postprandial dynamic effort. This simplifies the task of formulating guidelines for physical effort in patients with chronic ischemic heart disease, especially in providing "clearance" to perform avocational and vocational tasks involving combined static-dynamic and postprandial dynamic effort.EXERCISE TESTING for the detection of ischemic ST-segment depression or angina pectoris is usually performed in the fasting state, with care to avoid the static effort involved in gripping of handrails or of handlebars. Although such testing accurately reflects the cardiovascular response to isolated dynamic effort, it does not simulate the superimposition of static on dynamic effort or of dynamic effort in the postprandial state -circumstances to which patients with ischemic heart disease are exposed during their customary activities.Patients with ischemic heart disease are usually advised to avoid dynamic activities in which there is a significant static component, but we' and others2' 3 have noted a lower incidence of exercise-induced ischemic ST-segment depression or angina pectoris when patients performed combined static-dynamic effort than when they performed dynamic effort alone. Haissly et al.2 measured a higher diastolic blood pressure during combined static-dynamic effort than during dynamic effort alone and attributed the lower...

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Myocardial Ischemic Effects of Isometric, Dynamic and Combined Exercise in Coronary Artery Disease

Cited by 49 publications

References 18 publications

Detection of myocardial ischemia by 31P magnetic resonance spectroscopy during handgrip exercise.

Detection of myocardial ischemia by 31P magnetic resonance spectroscopy during handgrip exercise.

Comparison of cardiovascular responses to static-dynamic effort and dynamic effort alone in patients with chronic ischemic heart disease.

Comparison of cardiovascular response to combined static-dynamic effort, postprandial dynamic effort and dynamic effort alone in patients with chronic ischemic heart disease.

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