High-dose baclofen induced complete and prolonged suppression of symptoms and consequences of alcohol dependence, and relieved anxiety. This model, integrating cure and well-being, should be tested in randomized trials, under medical surveillance. It offers a new concept: medication-induced, dose-dependent, complete and prolonged suppression of substance-dependence symptoms with alleviation of comorbid anxiety.
Normal values for heart rate-adjusted indexes of ST segment depression during treadmill exercise electrocardiography (the ST segment/heart rate slope and the AST segment/heart rate index) were derived from evaluation of 150 subjects with a low likelihood of coronary artery disease, including 100 normal subjects and 50 subjects with nonanginal chest pain. Partitions chosen by the method of percentile estimation to include 95% of normal subjects remained highly specific in subjects with nonanginal pain syndromes. Sensitivities of the derived partitions for detection of myocardial ischemia were tested in an additional 150 patients with a high likelihood of coronary disease, including 100 patients with angiographically demonstrated coronary obstruction and 50 patients with stable angina. In contrast to the 68% (102 of 150 subjects) sensitivity of standard exercise electrocardiographic criteria for the detection of disease in this population, the sensitivity of an ST segment/heart rate slope partition of 2.4 liV/ beats/min was 95% (142 of 150 subjects, p < 0.001), and the sensitivity of a AST segment/heart rate index partition of 1.6 ,V/beats/min was 91% (137 of 150 subjects, p <0.001). Analysis of receiver-operating curves confirmed the superior performance of the heart rate-adjusted indexes throughout a wide range of test specificities. These findings suggest that heart rate adjustment of ST segment depression can markedly improve the clinical usefulness of the treadmill exercise electrocardiogram. (Circulation 1989;79:245-255 Therefore, the purpose of this study was to establish normal limits during treadmill exercise for the ST/HR slope and for an extreme simplification of the original method, the AST/HR index.20'2' These findings were then used to test the ability of heart rate adjustment of ST segment depression to improve the electrocardiographic detection of coronary artery disease. Methods Study PopulationThree hundred consecutively studied subjects and patients who met criteria outlined below were by guest on May 9, 2018 http://circ.ahajournals.org/ Downloaded from
Although the time course of ST segment depression after exercise has been related to the presence and severity of coronary artery disease, recovery-phase patterns of ST segment depression with reference to changing heart rate have not been quantified. We have found distinct recovery loop patterns of ST segment depression that distinguish subjects without coronary disease from patients with coronary artery disease when ST segment depression is examined in the heart rate domain. Continuous plots of ST segment depression and heart rate were constructed throughout treadmill exercise and recovery in 100 clinically normal subjects, in 124 patients with coronary artery disease proven by catheterization, and in 17 patients with no significant coronary disease at catheterization. Among clinically normal subjects, 95% (95 of 100) had normal (clockwise) rate-recovery loops, and 5% (five of 100) had abnormal (counterclockwise) rate-recovery loops. In these normal subjects, the resulting 95% specificity of a normal rate-recovery loop was similar to the 93% (93 of 100) specificity of standard end-exercise ST segment depression criteria. Among patients with coronary disease proven by angiography, 93% (115 of 124) had abnormal (counterclockwise) rate-recovery loops, and 7% (nine of 124) had normal rate-recovery loops. In contrast was the significantly lower 74% (92 of 124) sensitivity of standard ST segment criteria (p<0.001 vs. the rate-recovery loop).Specificity of a normal rate-recovery loop (71%, 12 of 17) and standard ST segment depression criteria (71%, 12 of 17) were similar in the patients with normal coronary arteries at angiography. We conclude that the pattern of ST segment depression as a function of heart rate during exercise and recovery can markedly enhance the accuracy of the exercise electrocardiogram for the identification of coronary artery disease. (Circulation 1989;80:533-
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