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B Chaitman

Publications and source records attributed to B Chaitman.

22 records · Page 2Linked to original sources
PubMed1984

Significance of exercise-induced ventricular arrhythmia in stable coronary artery disease: a coronary artery surgery study project.

This retrospective study examines the prognostic significance of exercise-induced ventricular arrhythmia in patients with stable coronary artery disease (CAD) who were included in the multicenter patient registry of the Coronary Artery Surgery Study. The population is composed of 1,486 patients selected from 1975 to 1979 and followed an average of 4.3 years. All underwent a standard Bruce exercise test and had CAD by cardiac catheterization at entry. Patients were classified into group I or II depending on whether they had minimal or significant CAD. (Significant CAD was defined as 70% or greater diameter reduction in any major coronary artery or 50% or greater narrowing in the left main artery.) They were further subclassified into groups A or B depending on whether or not they had exercise-induced ventricular arrhythmia. Groups IA (16 patients) and IB (229 patients) had similar clinical and angiographic characteristics except for the average ejection fraction (EF), which was 50% for group IA and 64% for group IB (p less than 0.05). Group IIA (130 patients) had a higher prevalence of previous myocardial infarction, a lower mean EF and a higher proportion of patients with at least 2 coronary arteries significantly narrowed than group IIB (1,111 patients). The 5-year event-free survival was not influenced by the presence of exercise-induced ventricular arrhythmia; it was 76 and 88% in groups IA and IB, respectively (difference not significant), and 71 and 76% in groups IIA and IIB, respectively (difference not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1982

[Use of the ECG under physical load for assessing the status of ischemic heart disease patients].

To determine to what extent the diagnostic accuracy of stress testing is influenced by the prevalence of coronary artery disease, we correlated the description of chest pain, the ST-segment response to exercise, and the results of coronary arteriography in 1465 men and 580 women from the registry for the Coronary Artery Surgery Study (CASS). A positive ST-segment response increased the pre-test risk by only 7 to 20%, whereas a negative ST-segment response decreased the risk by only 2 to 28%. Although the percentage of false positive results differed between men and women (12 +/- 1% vs 53 +/-- 3%, p less than 0.001), this difference was not seen in a subgroup matched for prevalence of coronary artery disease. Thus, the ability of stress testing to predict coronary artery disease is limited in a heterogenous population in which the prevalence of disease can be estimated through classification of chest pain and the sex of the patient. Additional multivariant linear discriminant function analysis on treadmill and angiographic data from 500 men with definite angina, 584 men with probable angina and 267 men with nonspecific chest pain identified independent predictors of presence and extent of coronary disease. The discriminant function developed clinical, and clinical and exercise risk indices for each patient subset. Probability curves demonstrated that exercise testing provided more diagnostic information than clinical data alone in patients with definite and probable angina. However, exercise testing in men with nonspecific chest pain was of limited value since disease prevalence was already low. We conclude that (a) analysis of the ST-segment response to exercise provides limited information regarding the diagnosis of coronary artery disease when used alone, and (b) use of other exercise variables in addition to clinical data improves the diagnostic ability of the exercise test in men with definite or probable angina.

Angina Pectoris↗
PubMedDate not supplied

The Psychophysiological Investigations of Myocardial Ischemia (PIMI) study: objective, methods, and variability of measures.

OBJECTIVE: This study evaluated physiological, neuroendocrine, and psychological status and functioning of patients with coronary artery disease in order to clarify their role in the expression of symptoms during myocardial ischemia (MI), and to establish repeatability of responses to mental stress. Design and methods of the study are presented. METHODS: One hundred ninety-six coronary artery disease patients were examined during physical and mental stress tests in four hospitals. Eligibility criteria included narrowing of at least 50% in the diameter of at least one major coronary artery or verified history of myocardial infarction, and evidence of ischemia on an exercise treadmill test. Psychological, biochemical, and autonomic function data were obtained before, during, and after exposure to mental and exercise stressors during 2 or 3 half-days of testing. Ventricular function was assessed by radionuclide ventriculography, and daily ischemia by ambulatory electrocardiography. Sixty patients returned for a short-term mental stress repeatability study. Twenty-nine individuals presumed to be free of coronary disease were also examined to establish reference values for cardiac responses to mental stress. RESULTS: Study participants were 41 to 80 years of age; 83 (42%) had a history of MI, 6 (3%) of congestive heart failure, and 163 (83%) of chest pain; 170 (87%) were men; and 90 (46%) had ischemia accompanied by angina during exercise treadmill testing. Ischemia during ambulatory monitoring was found in 35 of 90 (39%) patients with and 48 of 106 (45%) patients without angina during exercise-provoked ischemia. Intraobserver variability of ejection fraction changes during bicycle exercise and two mental stress tests (Speech and Stroop) was good (kappa = 1.0, .90, and .76, respectively; percent agreement = 100, 97.5, and 93.8%, respectively). Variability of assessed wall motion abnormalities during bicycle exercise was better (kappa, agreement = 85%) than during Speech or Stroop kappa and .57, percent agreement = 70% and 82.5%, respectively). CONCLUSIONS: Study design, quality control data, and baseline characteristics of patients enrolled for a clinical study of symptomatic and asymptomatic myocardial ischemia are described. Lower repeatability of reading wall motion abnormalities during mental stress than during exercise may be due to smaller effects on wall motion and lack of an indicator for peak mental stress.

Adult↗