Comparison of chest pain, electrocardiographic changes and thallium-201 scintigraphy during varying exercise intensities in men with stable angina pectoris
This study was performed to evaluate the presence of angina pectoris, electrocardiographic changes and reversible thallium-201 defects resulting from 2 different levels of exercise in 19 patients with known coronary artery disease and evidence of exercise-induced ischemia. The exercise protocols con...
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| Veröffentlicht in: | The American journal of cardiology 1991-09, Vol.68 (6), p.569-574 |
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| creator | Heller, Gary V. Ahmed, Imtiaz Tilkemeier, Peter L. Barbour, Marilyn M. Garber, Carol Ewing |
| description | This study was performed to evaluate the presence of angina pectoris, electrocardiographic changes and reversible thallium-201 defects resulting from 2 different levels of exercise in 19 patients with known coronary artery disease and evidence of exercise-induced ischemia.
The exercise protocols consisted of a symptom-limited incremental exercise test (Bruce protocol) followed within 3 to 14 days by a submaximal, steady-state exercise test performed at 70% of the maximal heart rate achieved during the Bruce protocol. The presence and time of onset of angina and electrocardiographic changes (≥0.1 mV ST-segment depression) as well as oxygen uptake, exercise duration and pressure-rate product were recorded. Thallium-201 (2.5 to 3.0 mCi) was injected during the last minute of exercise during both protocols, and the images were analyzed using both computer-assisted quantitation and visual interpretations.
Incremental exercise resulted in anginal symptoms in 84% of patients, and electrocardiographic changes and reversible thallium-201 defects in all patients. In contrast, submaximal exercise produced anginal symptoms in only 26% (p < 0.01) and electrocardiographic changes in only 47% (p < 0.05), but resulted in thallium-201 defects in 89% of patients (p = not significant). The locations of the thallium-201 defects, when present, were not different between the 2 exercise protocols. These findings confirm the sequence of the ischemic cascade using 2 levels of exercise and demonstrate that the cascade theory is applicable during varying ischemic intensities in the same patient. |
| doi_str_mv | 10.1016/0002-9149(91)90345-L |
| format | Article |
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The exercise protocols consisted of a symptom-limited incremental exercise test (Bruce protocol) followed within 3 to 14 days by a submaximal, steady-state exercise test performed at 70% of the maximal heart rate achieved during the Bruce protocol. The presence and time of onset of angina and electrocardiographic changes (≥0.1 mV ST-segment depression) as well as oxygen uptake, exercise duration and pressure-rate product were recorded. Thallium-201 (2.5 to 3.0 mCi) was injected during the last minute of exercise during both protocols, and the images were analyzed using both computer-assisted quantitation and visual interpretations.
Incremental exercise resulted in anginal symptoms in 84% of patients, and electrocardiographic changes and reversible thallium-201 defects in all patients. In contrast, submaximal exercise produced anginal symptoms in only 26% (p < 0.01) and electrocardiographic changes in only 47% (p < 0.05), but resulted in thallium-201 defects in 89% of patients (p = not significant). The locations of the thallium-201 defects, when present, were not different between the 2 exercise protocols. These findings confirm the sequence of the ischemic cascade using 2 levels of exercise and demonstrate that the cascade theory is applicable during varying ischemic intensities in the same patient.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/0002-9149(91)90345-L</identifier><identifier>PMID: 1877474</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>550601 - Medicine- Unsealed Radionuclides in Diagnostics ; ANEMIAS ; Angina Pectoris - diagnostic imaging ; Angina Pectoris - physiopathology ; BETA DECAY RADIOISOTOPES ; Biological and medical sciences ; BLOOD PRESSURE ; Blood Pressure - physiology ; BODY ; Cardiology. Vascular system ; CARDIOVASCULAR DISEASES ; CARDIOVASCULAR SYSTEM ; COMPARATIVE EVALUATIONS ; Coronary Disease - diagnostic imaging ; Coronary Disease - physiopathology ; Coronary heart disease ; DAYS LIVING RADIOISOTOPES ; DIAGNOSIS ; DIAGRAMS ; DISEASES ; ELECTROCARDIOGRAMS ; Electrocardiography ; ELECTRON CAPTURE RADIOISOTOPES ; EVALUATION ; EXERCISE ; Exercise Test - methods ; HEART ; Heart - diagnostic imaging ; Heart - physiopathology ; Heart Rate - physiology ; HEAVY NUCLEI ; HEMIC DISEASES ; Humans ; IMAGE PROCESSING ; ISCHEMIA ; ISOMERIC TRANSITION ISOTOPES ; ISOTOPES ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - physiopathology ; NUCLEI ; ODD-EVEN NUCLEI ; ORGANS ; Oxygen Consumption - physiology ; PAIN ; PATIENTS ; Physical Exertion - physiology ; PROCESSING ; RADIOISOTOPES ; RADIOLOGY AND NUCLEAR MEDICINE ; Radionuclide Imaging ; SECONDS LIVING RADIOISOTOPES ; SYMPTOMS ; THALLIUM 201 ; THALLIUM ISOTOPES ; Thallium Radioisotopes ; VASCULAR DISEASES</subject><ispartof>The American journal of cardiology, 1991-09, Vol.68 (6), p.569-574</ispartof><rights>1991</rights><rights>1992 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c328t-f702882d2c93444de65c07ab80776ede7d68b3a030e78803d2a1e9a974dbb0f3</citedby><cites>FETCH-LOGICAL-c328t-f702882d2c93444de65c07ab80776ede7d68b3a030e78803d2a1e9a974dbb0f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/0002-9149(91)90345-L$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=5000270$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/1877474$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/5264892$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Heller, Gary V.</creatorcontrib><creatorcontrib>Ahmed, Imtiaz</creatorcontrib><creatorcontrib>Tilkemeier, Peter L.</creatorcontrib><creatorcontrib>Barbour, Marilyn M.</creatorcontrib><creatorcontrib>Garber, Carol Ewing</creatorcontrib><title>Comparison of chest pain, electrocardiographic changes and thallium-201 scintigraphy during varying exercise intensities in men with stable angina pectoris</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>This study was performed to evaluate the presence of angina pectoris, electrocardiographic changes and reversible thallium-201 defects resulting from 2 different levels of exercise in 19 patients with known coronary artery disease and evidence of exercise-induced ischemia.
The exercise protocols consisted of a symptom-limited incremental exercise test (Bruce protocol) followed within 3 to 14 days by a submaximal, steady-state exercise test performed at 70% of the maximal heart rate achieved during the Bruce protocol. The presence and time of onset of angina and electrocardiographic changes (≥0.1 mV ST-segment depression) as well as oxygen uptake, exercise duration and pressure-rate product were recorded. Thallium-201 (2.5 to 3.0 mCi) was injected during the last minute of exercise during both protocols, and the images were analyzed using both computer-assisted quantitation and visual interpretations.
Incremental exercise resulted in anginal symptoms in 84% of patients, and electrocardiographic changes and reversible thallium-201 defects in all patients. In contrast, submaximal exercise produced anginal symptoms in only 26% (p < 0.01) and electrocardiographic changes in only 47% (p < 0.05), but resulted in thallium-201 defects in 89% of patients (p = not significant). The locations of the thallium-201 defects, when present, were not different between the 2 exercise protocols. These findings confirm the sequence of the ischemic cascade using 2 levels of exercise and demonstrate that the cascade theory is applicable during varying ischemic intensities in the same patient.</description><subject>550601 - Medicine- Unsealed Radionuclides in Diagnostics</subject><subject>ANEMIAS</subject><subject>Angina Pectoris - diagnostic imaging</subject><subject>Angina Pectoris - physiopathology</subject><subject>BETA DECAY RADIOISOTOPES</subject><subject>Biological and medical sciences</subject><subject>BLOOD PRESSURE</subject><subject>Blood Pressure - physiology</subject><subject>BODY</subject><subject>Cardiology. Vascular system</subject><subject>CARDIOVASCULAR DISEASES</subject><subject>CARDIOVASCULAR SYSTEM</subject><subject>COMPARATIVE EVALUATIONS</subject><subject>Coronary Disease - diagnostic imaging</subject><subject>Coronary Disease - physiopathology</subject><subject>Coronary heart disease</subject><subject>DAYS LIVING RADIOISOTOPES</subject><subject>DIAGNOSIS</subject><subject>DIAGRAMS</subject><subject>DISEASES</subject><subject>ELECTROCARDIOGRAMS</subject><subject>Electrocardiography</subject><subject>ELECTRON CAPTURE RADIOISOTOPES</subject><subject>EVALUATION</subject><subject>EXERCISE</subject><subject>Exercise Test - methods</subject><subject>HEART</subject><subject>Heart - diagnostic imaging</subject><subject>Heart - physiopathology</subject><subject>Heart Rate - physiology</subject><subject>HEAVY NUCLEI</subject><subject>HEMIC DISEASES</subject><subject>Humans</subject><subject>IMAGE PROCESSING</subject><subject>ISCHEMIA</subject><subject>ISOMERIC TRANSITION ISOTOPES</subject><subject>ISOTOPES</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - physiopathology</subject><subject>NUCLEI</subject><subject>ODD-EVEN NUCLEI</subject><subject>ORGANS</subject><subject>Oxygen Consumption - physiology</subject><subject>PAIN</subject><subject>PATIENTS</subject><subject>Physical Exertion - physiology</subject><subject>PROCESSING</subject><subject>RADIOISOTOPES</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Radionuclide Imaging</subject><subject>SECONDS LIVING RADIOISOTOPES</subject><subject>SYMPTOMS</subject><subject>THALLIUM 201</subject><subject>THALLIUM ISOTOPES</subject><subject>Thallium Radioisotopes</subject><subject>VASCULAR DISEASES</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1991</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kd2K1TAUhYso43H0DRSCiChYzV-b5kaQg39wwJu5D2mye06kTWqSzjjP4suaTg_jnTfZhP1lZe-1quo5we8JJu0HjDGtJeHyjSRvJWa8qQ8Pqh3phKyJJOxhtbtHHldPUvpZroQ07UV1USDBBd9Vf_ZhmnV0KXgUBmROkDKatfPvEIxgcgxGR-vCMer55EwBtD9CQtpblE96HN0y1RQTlIzz2d1ht8gu0fkjutbxdq3wG6JxCVBBwCeXXVFwHk3g0Y3LJ5Sy7kcookfnNZrLv6GM9LR6NOgxwbNzvayuvny-2n-rDz--ft9_OtSG0S7Xg8C066ilRjLOuYW2MVjovsNCtGBB2LbrmcYMg-g6zCzVBKSWgtu-xwO7rF5usiFlp8oeGczJBO_LGKqhLe8kLdDrDZpj-LUUk9TkkoFx1B7CkpSguGEdkwXkG2hiSCnCoObopmKEIlituak1FLWGUg51l5s6lGcvzvpLP4H992gLqvRfnfs6GT0OUfvi6D3WrKICF-zjhkHx69pBXPcBb8C6uK5jg_v_HH8BMMq2wA</recordid><startdate>19910901</startdate><enddate>19910901</enddate><creator>Heller, Gary V.</creator><creator>Ahmed, Imtiaz</creator><creator>Tilkemeier, Peter L.</creator><creator>Barbour, Marilyn M.</creator><creator>Garber, Carol Ewing</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>OTOTI</scope></search><sort><creationdate>19910901</creationdate><title>Comparison of chest pain, electrocardiographic changes and thallium-201 scintigraphy during varying exercise intensities in men with stable angina pectoris</title><author>Heller, Gary V. ; Ahmed, Imtiaz ; Tilkemeier, Peter L. ; Barbour, Marilyn M. ; Garber, Carol Ewing</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c328t-f702882d2c93444de65c07ab80776ede7d68b3a030e78803d2a1e9a974dbb0f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1991</creationdate><topic>550601 - Medicine- Unsealed Radionuclides in Diagnostics</topic><topic>ANEMIAS</topic><topic>Angina Pectoris - diagnostic imaging</topic><topic>Angina Pectoris - physiopathology</topic><topic>BETA DECAY RADIOISOTOPES</topic><topic>Biological and medical sciences</topic><topic>BLOOD PRESSURE</topic><topic>Blood Pressure - physiology</topic><topic>BODY</topic><topic>Cardiology. Vascular system</topic><topic>CARDIOVASCULAR DISEASES</topic><topic>CARDIOVASCULAR SYSTEM</topic><topic>COMPARATIVE EVALUATIONS</topic><topic>Coronary Disease - diagnostic imaging</topic><topic>Coronary Disease - physiopathology</topic><topic>Coronary heart disease</topic><topic>DAYS LIVING RADIOISOTOPES</topic><topic>DIAGNOSIS</topic><topic>DIAGRAMS</topic><topic>DISEASES</topic><topic>ELECTROCARDIOGRAMS</topic><topic>Electrocardiography</topic><topic>ELECTRON CAPTURE RADIOISOTOPES</topic><topic>EVALUATION</topic><topic>EXERCISE</topic><topic>Exercise Test - methods</topic><topic>HEART</topic><topic>Heart - diagnostic imaging</topic><topic>Heart - physiopathology</topic><topic>Heart Rate - physiology</topic><topic>HEAVY NUCLEI</topic><topic>HEMIC DISEASES</topic><topic>Humans</topic><topic>IMAGE PROCESSING</topic><topic>ISCHEMIA</topic><topic>ISOMERIC TRANSITION ISOTOPES</topic><topic>ISOTOPES</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - physiopathology</topic><topic>NUCLEI</topic><topic>ODD-EVEN NUCLEI</topic><topic>ORGANS</topic><topic>Oxygen Consumption - physiology</topic><topic>PAIN</topic><topic>PATIENTS</topic><topic>Physical Exertion - physiology</topic><topic>PROCESSING</topic><topic>RADIOISOTOPES</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Radionuclide Imaging</topic><topic>SECONDS LIVING RADIOISOTOPES</topic><topic>SYMPTOMS</topic><topic>THALLIUM 201</topic><topic>THALLIUM ISOTOPES</topic><topic>Thallium Radioisotopes</topic><topic>VASCULAR DISEASES</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Heller, Gary V.</creatorcontrib><creatorcontrib>Ahmed, Imtiaz</creatorcontrib><creatorcontrib>Tilkemeier, Peter L.</creatorcontrib><creatorcontrib>Barbour, Marilyn M.</creatorcontrib><creatorcontrib>Garber, Carol Ewing</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>OSTI.GOV</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Heller, Gary V.</au><au>Ahmed, Imtiaz</au><au>Tilkemeier, Peter L.</au><au>Barbour, Marilyn M.</au><au>Garber, Carol Ewing</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of chest pain, electrocardiographic changes and thallium-201 scintigraphy during varying exercise intensities in men with stable angina pectoris</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>1991-09-01</date><risdate>1991</risdate><volume>68</volume><issue>6</issue><spage>569</spage><epage>574</epage><pages>569-574</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>This study was performed to evaluate the presence of angina pectoris, electrocardiographic changes and reversible thallium-201 defects resulting from 2 different levels of exercise in 19 patients with known coronary artery disease and evidence of exercise-induced ischemia.
The exercise protocols consisted of a symptom-limited incremental exercise test (Bruce protocol) followed within 3 to 14 days by a submaximal, steady-state exercise test performed at 70% of the maximal heart rate achieved during the Bruce protocol. The presence and time of onset of angina and electrocardiographic changes (≥0.1 mV ST-segment depression) as well as oxygen uptake, exercise duration and pressure-rate product were recorded. Thallium-201 (2.5 to 3.0 mCi) was injected during the last minute of exercise during both protocols, and the images were analyzed using both computer-assisted quantitation and visual interpretations.
Incremental exercise resulted in anginal symptoms in 84% of patients, and electrocardiographic changes and reversible thallium-201 defects in all patients. In contrast, submaximal exercise produced anginal symptoms in only 26% (p < 0.01) and electrocardiographic changes in only 47% (p < 0.05), but resulted in thallium-201 defects in 89% of patients (p = not significant). The locations of the thallium-201 defects, when present, were not different between the 2 exercise protocols. These findings confirm the sequence of the ischemic cascade using 2 levels of exercise and demonstrate that the cascade theory is applicable during varying ischemic intensities in the same patient.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>1877474</pmid><doi>10.1016/0002-9149(91)90345-L</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9149 |
| ispartof | The American journal of cardiology, 1991-09, Vol.68 (6), p.569-574 |
| issn | 0002-9149 1879-1913 |
| language | eng |
| recordid | cdi_osti_scitechconnect_5264892 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | 550601 - Medicine- Unsealed Radionuclides in Diagnostics ANEMIAS Angina Pectoris - diagnostic imaging Angina Pectoris - physiopathology BETA DECAY RADIOISOTOPES Biological and medical sciences BLOOD PRESSURE Blood Pressure - physiology BODY Cardiology. Vascular system CARDIOVASCULAR DISEASES CARDIOVASCULAR SYSTEM COMPARATIVE EVALUATIONS Coronary Disease - diagnostic imaging Coronary Disease - physiopathology Coronary heart disease DAYS LIVING RADIOISOTOPES DIAGNOSIS DIAGRAMS DISEASES ELECTROCARDIOGRAMS Electrocardiography ELECTRON CAPTURE RADIOISOTOPES EVALUATION EXERCISE Exercise Test - methods HEART Heart - diagnostic imaging Heart - physiopathology Heart Rate - physiology HEAVY NUCLEI HEMIC DISEASES Humans IMAGE PROCESSING ISCHEMIA ISOMERIC TRANSITION ISOTOPES ISOTOPES Male Medical sciences Middle Aged Myocardial Infarction - physiopathology NUCLEI ODD-EVEN NUCLEI ORGANS Oxygen Consumption - physiology PAIN PATIENTS Physical Exertion - physiology PROCESSING RADIOISOTOPES RADIOLOGY AND NUCLEAR MEDICINE Radionuclide Imaging SECONDS LIVING RADIOISOTOPES SYMPTOMS THALLIUM 201 THALLIUM ISOTOPES Thallium Radioisotopes VASCULAR DISEASES |
| title | Comparison of chest pain, electrocardiographic changes and thallium-201 scintigraphy during varying exercise intensities in men with stable angina pectoris |
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