Biomedical subjects
Publications and source records attributed to N L Coplan.
Exercise-induced ventricular tachycardia is a well-described arrhythmia most commonly associated with atherosclerotic coronary artery disease. The case reported here presents its association with a coronary arteriovenous fistula, which has not been previously reported in the literature.
We evaluated the impact of diastolic function and gender on exercise capacity in sedentary, untreated hypertensive subjects (34 men, 23 women) using echocardiography and a bicycle ergometry with measurement of oxygen consumption (VO2). In men, peak (A) mitral inflow velocity and left ventricular (LV) mass were inversely related to peak VO2 (r = -0.64) and maximal workload (r = -0.57) and were the sole independent determinants of exercise capacity. In women, there was no relationship between any echocardiographic measure and exercise capacity. Thus, LV mass and Doppler-determined diastolic function predict maximal VO2 in hypertensive men but not in women. This finding may be related to gender differences in the contribution of diastolic filling to exercise capacity or may reflect limitations of resting Doppler echocardiography to predict exercise diastolic filling in hypertensive women.
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This study evaluated 10 male cyclists before and after phlebotomy to determine the effect of donation of 1 U of blood on exercise performance. Each subject underwent maximal exercise testing with oxygen consumption measurement at baseline, 2 hours after phlebotomy, 2 days after phlebotomy, and 7 days after phlebotomy. Maximal performance was decreased for at least 1 week. Submaximal performance was unaffected by blood donation.
The time and frequency domain components of heart rate variability have been used to assess prognosis in patients with different types of heart disease. However, the effect of habitual exercise, which influences baseline parasympathetic tone, on heart rate variability has not been fully evaluated. To determine the effect of chronic exercise on heart rate variability, we studied 12 athletes and 18 control subjects. Time domain and frequency domain analysis was performed on 15-minute resting heart rate acquisitions. Athletes had evidence of increased vagal activity in the time domain compared with control subjects (eg, increased standard deviation of R-R intervals) but showed evidence of decreased power in variables reflecting vagal activity in the frequency domain (eg, total power and high-frequency power). Of note, there was good correlation between time and frequency domain variables, which reflected parasympathetic tone in the control group that was not seen in athletes. These data suggest that frequency domain analysis of heart rate variability may not be an accurate indicator of cardiac vagal tone in chronically trained endurance athletes and activity level may have to be considered when using heart rate variability to carry out prognostic stratification in patients with heart disease.
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To evaluate criteria frequently used to designate an exercise test as maximal, 33 men and 18 women completed progressive incremental cycle ergometry to exhaustion with direct measurement of oxygen consumption (VO2). On a separate day, subjects exercised at 115% of the maximal work rate attained in the first test following a 5-minute warm-up. If VO2 exceeded that of the progressive test by greater than or equal to 150 ml/min, subjects returned on a third day and pedalled at 125% of the first day's work ratepeak. This procedure was repeated until VO2 increased less than 150 ml/min, and defined whether the progressive test was a maximal or nonmaximal test. There were 45 tests that met the criterion for maximum during the progressive test and six nonmaximal tests. Respiratory exchange ratio and 85% age-predicted maximal heart rate were sensitive criteria for a maximal test but were not specific. Attainment of age-predicted maximal heart rate and peak lactate greater than 8 mmol/L were highly specific but insensitive measures of a maximal test. In the absence of a VO2 plateau, age-predicted maximal heart rate and lactate greater than 8 mmol/L can be used as indicators of maximal tests with a high degree of confidence. When age-predicted maximal heart rate or lactate greater than 8 mmol/L are not attained, the test may still be maximal because negative predictive value is low.
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