COLD PRESSOR TEST IN DETECTION OF CORONARY HEART-DISEASE AND CARDIOMYOPATHY USING TECHNETIUM-99m GATED BLOOD-POOL IMAGING

Wainwright, R. J.; Cueni, T; Brennand-Roper, D. A.; Sowton, Edgar; Hilson, Ajw; Maisey, M. N.

doi:10.1016/s0140-6736(79)90341-6

Cited by 44 publications

(8 citation statements)

References 9 publications

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“…Some started 15-30 seconds after immersion of the hand in iced water with a 2-3 minute aquisition time.7 10 17 Wainwright etal delayed the start of imaging for one minute and acquired images for five minutes. 6 We have found haemodynamic changes 15-30 seconds after immersion of the hand in ice, with maximal changes occurring between one and three minutes and being maintained for five minutes (unpublished observations). Because of these observations and because we were using a general purpose collimator we felt it appropriate to start imaging after 30 seconds and to acquire images for five minutes.…”

Section: Study Protocolmentioning

confidence: 77%

“…Because of these observations and because we were using a general purpose collimator we felt it appropriate to start imaging after 30 seconds and to acquire images for five minutes. In addition, this protocol allowed comparison with the almost identical protocol of Wainwright et al 6 For the cold pressor test the right hand was immersed to the level of the styloid process in a mixture of crushed ice and water. Throughout the test the water and ice round the hand were mixed to maintain the cold stimulus.…”

Section: Study Protocolmentioning

confidence: 99%

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How useful are the cold pressor test and sustained isometric handgrip exercise with radionuclide ventriculography in the evaluation of patients with coronary artery disease?

Northcote¹,

Cooke²

1987

Heart

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SUMMARY The feasibility of using the cold pressor test and the sustained isometric handgrip test as alternatives to dynamic exercise for stressing the heart was investigated. Serial changes in heart rate, blood pressure, and left ventricular performance induced by these tests were studied by radionuclide ventriculography in patients with coronary artery disease and in normal volunteers. Both tests significantly increased heart rate and blood pressure. The reproducibility of serial evaluation of ejection fraction response to cold pressor and isometric handgrip stresses was satisfactory but the sensitivity for detecting coronary artery disease was not.Both Accepted for publication 24 November 1986 used to determine serial changes in the same patient.We have investigated the usefulness of both these interventions in the detection of coronary artery disease and their reproducibility in serial studies of left ventricular function. Patients and methodsThe protocol was approved by our local ethics committee and the Administration of Radioactive Substances Advisory Committee gave us permission to administer technetium-99m to three groups of subjects:Group 1 Sixteen symptom free male volunteers were recruited from hospital staff and associates. All were in sints rhythm; they were normotensive and lifelong non-smokers. They all had normal electrocardiograms at rest and during maximal graded exercise on a modified Bruce protocol.13 The chest x ray and the cardiothoracic ratio were normal, and no subject was taking any medication at the time of the study. None had evidence of valvar or congenital heart disease, respiratory disease, or peripheral vascular disease and all were presumed to have normal hearts (table 1).

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Section: Study Protocolmentioning

confidence: 77%

Section: Study Protocolmentioning

confidence: 99%

How useful are the cold pressor test and sustained isometric handgrip exercise with radionuclide ventriculography in the evaluation of patients with coronary artery disease?

Northcote¹,

Cooke²

1987

Heart

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“…These include differing selection criteria for both patients and normal controls. In previously reported studies normal controls were patients who had undergone coronary arteriography for investigation of chest pain, with negative results.7 13 This group of patients has been shown to have a highly variable response when the L ejection fraction during dynamic exercise is studied.15 It is debatable therefore whether they should .. . t' *2miun be considered as truly normal, particularly when --m*, their response to cold stress is measured.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular function during isometric hand grip and cold stress in normal subjects.

Jones¹,

Lahiri²,

Cashman³

et al. 1986

Heart

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SUMMARY Both isometric exercise and cold stress have been suggested as alternatives to dynamic exercise for the detection of obstructive coronary artery disease. A non-imaging nuclear probe was used to measure left ventricular ejection fraction and relative left ventricular volumes continuously during both of these stress tests in 24 normal subjects. There was a significant fall in left ventricular ejection fraction within 15 seconds of subjects starting a two minute isometric hand grip test at 50% maximal voluntary contraction, with a mean (SE) maximal fall of 10% (1 8) after 90 seconds. During two minutes immersion of the hand and wrist in iced water left ventricular ejection fraction fell significantly within 30 seconds with a mean maximal fall of 7% (1 -7) after one minute. Nine subjects underwent repeat tests under identical conditions approximately two weeks later. The standard error of the change in ejection fraction on two occasions was 5 4% at rest, 70O% at the peak of isometric exercise, and 4-8% at peak cold stress.These results indicate that the reproducibility of both of these stress tests is acceptable when they are performed under carefully controlled conditions. The resulting changes in ejection fraction are transient, however, and moreover depend upon the choice of stress protocol. The discrepancies between published reports of such studies in coronary artery disease may be mainly due to methodological differences, and neither test is likely to be of sufficient discriminative ability to distinguish between individuals with obstructive coronary artery disease and normal subjects.There are similarities between the cardiovascular responses to isometric exercise and cold stress, and both have been advocated for the detection of obstructive coronary artery disease.' 2 Isometric exercise in normal subjects increases blood pressure by 30-35%, which together with an increase in heart rate produces a pronounced increase in the ratepressure product. Cutaneous cold stimulation leads to a rise in blood pressure of 20-25% with little change in heart rate, although cold stress may also affect myocardial blood flow through an

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“…There are significant differences in technique employed between our study and that of Wainwright et al 9 We used a 2-minute scanning time during CPS after having verified that hemodynamic changes were maintained for such a period of time. The patients studied by Wainwright et al were imaged for 5 minutes.…”

Section: Discussionmentioning

confidence: 99%

“…'0 It requires only a few minutes of testing and can be easily administered to almost all patients. Wainwright et al 9 reported that CPS is a sensitive and specific method of provoking ischemic left ventricular dysfunction when used in conjunction with radionuclide angiography and has diagnostic accuracy similar to that of supine bicycle stress. In this study we describe our experience with radionuclide imaging in patients who later underwent coronary arteriography and the limitations of the response to CPS compared with supine bicycle exercise for the diagnosis of CAD.…”

mentioning

confidence: 99%

Insensitivity of the cold pressor stimulation test for the diagnosis of coronary artery disease.

Wasserman¹,

Reiss²,

Katz³

et al. 1983

Circulation

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SUMMARY Cold pressor stimulation (CPS) was compared with supine bicycle exercise during radionuclide ventriculography as a procedure for diagnosing coronary artery disease (CAD). Thirty patients were studied. In the 18 patients with angiographically proved CAD, left ventricular ejection fraction (LVEF) decreased a mean of 5.0 + 1.0 ejection fraction units (+ SEM) in response to CPS. Only two patients developed a new wall motion abnormality. In response to maximal supine exercise, the CAD group showed a mean decrease in LVEF from rest of 1.9 + 1.1%. Nine patients developed an exercise-induced wall motion abnormality.In the 12 patients with angiographically proved normal coronary arteries, LVEF decreased a mean of 5.8 + 1.3 units in response to CPS and increased a mean of 9.2 + 1.2% in response to exercise.Thus, the LVEF response to CPS was not significantly different in the CAD and normal groups (5.0 + 1.0 vs 5.8 1.3, NS). These same patients demonstrated the expected difference in LVEF response to exercise. We conclude that CPS produces similar changes in LVEF in patients with and without CAD, and therefore is not useful in diagnosing ischemic heart disease.EXERCISE radionuclide ventriculography is widely used to diagnose coronary artery disease (CAD).1 2 Some patients, however, cannot adequately exercise to provoke underlying myocardial ischemia. Therefore, other forms of stress have been evaluated as alternatives to exercise, including isometric handgrip,>7 atrial pacing8 and cold pressor stimulation (CPS).9CPS is a potent a-adrenergic stimulus that causes an acute increase in heart rate and blood pressure.'0 It requires only a few minutes of testing and can be easily administered to almost all patients. Wainwright et al.9 reported that CPS is a sensitive and specific method of provoking ischemic left ventricular dysfunction when used in conjunction with radionuclide angiography and has diagnostic accuracy similar to that of supine bicycle stress. In this study we describe our experience with radionuclide imaging in patients who later underwent coronary arteriography and the limitations of the response to CPS compared with supine bicycle exercise for the diagnosis of CAD. Methods Study PopulationThe study group consisted of 30 consecutive subjects (23 men and seven women), mean age 55 years (range 38-69 years). All patients were referred to George Washington University Hospital for evaluation of chest pain. No Coronary arteriography was performed within 24 hours of the radionuclide study. The percutaneous femoral technique was used in all patients. Studies were independently reviewed by two experienced angiographers without knowledge of the radionuclide results. Coronary stenoses were considered to be significant if luminal diameter was narrowed by 70% or more, except for the left main coronary artery, which was considered significantly narrowed if luminal diameter was reduced by 50% or more.Eighteen patients (16 men and two women), mean age 55 years, had angiographically proved CAD as defined by significant...

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COLD PRESSOR TEST IN DETECTION OF CORONARY HEART-DISEASE AND CARDIOMYOPATHY USING TECHNETIUM-99m GATED BLOOD-POOL IMAGING

Cited by 44 publications

References 9 publications

How useful are the cold pressor test and sustained isometric handgrip exercise with radionuclide ventriculography in the evaluation of patients with coronary artery disease?

How useful are the cold pressor test and sustained isometric handgrip exercise with radionuclide ventriculography in the evaluation of patients with coronary artery disease?

Left ventricular function during isometric hand grip and cold stress in normal subjects.

Insensitivity of the cold pressor stimulation test for the diagnosis of coronary artery disease.

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