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N Kelermenos

Publications and source records attributed to N Kelermenos.

3 recordsLinked to original sources
PubMed1991

Post-exercise response of the systolic blood pressure in the diagnosis of coronary artery disease: comparison of two exercise methods.

We studied 81 angiographically documented coronary artery disease patients and 28 with normal coronary arteries, having paired exercise tests (the Bruce treadmill protocol and the jogging in place test) in order to investigate the value of the ratio of recovery systolic blood pressure to peak exercise systolic blood pressure (postexercise pressure ratio) compared to the classic ST depression. The postexercise pressure ratio was significantly higher in patients with coronary artery disease than in patients with normal coronary arteries for each of the 2 exercise tests (P less than 0.001--P less than 0.00001). On the contrary, we obtained significantly lower sensitivities for the pathologic (greater than mean +/- 2 SD of patients with normal coronary arteries) values of the post-exercise pressure ratio than for the positive electrocardiographic outcome 30% vs 58% (P less than 0.00002) and 37% vs 64% (P less than 0.0001) as well as lower accuracies 48% vs 63% (P less than 0.03) and 52% vs 71% (P less than 0.005), respectively. Thus, we proved that the classic ST depression has much more diagnostic value than the post-exercise pressure ratio and this result is independent of the exercise methodology. Consequently this ratio is not recommended to replace the electrocardiographic exercise criteria.

Angiography↗
PubMed1991

Regional and global myocardial circulatory and metabolic effects of isoflurane and halothane in patients with steal-prone coronary anatomy.

The use of isoflurane in patients with coronary artery disease remains controversial because of the possibility of "coronary steal". In this study, the effects of isoflurane and halothane on global and regional myocardial blood flow and metabolism were compared, and the relationship between steal-induced myocardial ischemia and the administered volatile anesthetic was investigated in 40 patients with steal-prone coronary anatomy undergoing elective coronary artery bypass operations. The patients were randomly assigned to receive either isoflurane or halothane (0.5 MAC inspired concentration) immediately after induction with fentanyl (50 micrograms/kg). Hemodynamic measurements and blood samples were obtained at preinduction, postintubation, preincision, poststernotomy, at 60 min after beginning isoflurane or halothane, and precannulation (a total of 238 study events). Throughout the study, heart rate was kept constant by atrial pacing at approximately postintubation values while arterial pressure was maintained within 10% of postintubation values with fluid administration or phenylephrine infusion. Overall, systemic hemodynamic changes observed during the study were similar in the two groups. Myocardial ischemic episodes were defined as a new electrocardiographic ST-segment shift of greater than or equal to 0.1 mV, new echocardiographic regional wall motion abnormalities (RWMA) and/or myocardial lactate production (MLP). A total of 18 new ischemic episodes were detected in 15 patients (7 episodes during isoflurane in 7 patients and 11 during halothane in 8 patients). Ten (56%) episodes were related to acute hemodynamic abnormalities, whereas 8 (44%) were random and unrelated to changes. Seven episodes were detected by echocardiography (38%), 6 by MLP (33%) and 1 by ECG (6%) only, whereas concomitant echocardiographic abnormalities and MLP were observed during 2 episodes (11%), echocardiographic and ECG during 1 (6%), and ECG and MLP during 1 other (6%). Ratios of regional to global coronary venous flow, coronary vascular resistance, myocardial oxygen content, and lactate extraction, along with hemodynamic data obtained during these episodes, do not support coronary steal for the development of myocardial ischemia. We conclude that in patients with steal-prone coronary anatomy anesthetized with fentanyl, neither isoflurane nor halothane administered at concentrations used in the current study is likely to cause myocardial ischemia by the coronary steal mechanism.

Adult↗