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Exercise stress testing and systolic time intervals.

Abstract

Changes in ET/PEP in normal subjects are characterized by initial increase associated with the increase in the heart rate, stroke volume and cardiac contractility and are subsequently followed by plateuing or slightly decrease after exceeding the 70% heart rate level of the age predicted maximal heart rate. The decrease in ET/PEP is thought to be mainly due to decrease in stroke volume. After exceeding the predicted maximal heart rate ET/PEP reveals remarkable decrease that may reflect decreased cardiac function (CF). Some patients with ischemic heart diseases revealed decrease of ET/PEP at the heart rate less than the 60% level of the age predicted maximal heart rate. This may indicate decreased cardiac contractility associated with decreased stroke volume (Fig. 10). Since transient left ventricular failure is thought to take place in anginal attack, decreased ET/PEP at the heart rate below the 60% of age predicted maximal heart rate may indicate decreased cardiac function, although invasive evaluation of the cardiac function was not performed in the present study.

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BibTeXRIS

Y Inagaki, T Saito, M Shukuya. 1979. Exercise stress testing and systolic time intervals.. https://doi.org/10.1253/jcj.43.207

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Effect of a hypoglycemic agent on ischemic preconditioning in patients with type 2 diabetes and stable angina pectoris.

OBJECTIVE: Ischemic preconditioning is an increased tolerance to myocardial ischemia during the second of two consecutive exercise tests. ATP-sensitive K(+) channel blockers, such as glinides and sulfonylurea drugs, can induce loss of ischemic preconditioning. This study aimed to investigate the effects of repaglinide, a hypoglycemic agent with an affinity for myocardial ATP-sensitive K (+)channels, on the results of consecutive exercise tests in patients with diabetes and multivessel coronary artery disease. METHODS: Forty-two patients with type 2 diabetes and chronic stable angina pectoris, and two-vessel or three-vessel disease participated in this study. The patients underwent two consecutive treadmill exercise tests (phase 1). On the day after these exercise tests, 2 mg of oral repaglinide was given to the patients. One week later, two exercise tests were repeated consecutively (phase 2). RESULTS: All patients achieved 1.0-mm ST-segment depression during the four exercise tests (T1, T2, T3, and T4). In phase 2, seven patients improved in time to onset of 1.0-mm ST-segment depression. The worsening of the time to onset of 1.0-mm ST-segment depression in phase 2 demonstrated ischemic preconditioning block in 83.3% of patients (P=0.0001). Even the postexercise electrocardiographic parameters (ST-segment depression morphology and magnitude and arrhythmias) were significantly different between the groups with and without pharmacologic ischemic preconditioning block (P=0.031). CONCLUSIONS: Repaglinide, an oral hypoglycemic agent with ATP-sensitive K(+) channel-blocker activity, eliminated the myocardial ischemic preconditioning in patients with coronary disease and diabetes.

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