Low-level exercise testing after myocardial infarction: usefulness in enhancing clinical risk stratification.

Krone, Ronald J.; Gillespie, John A.; Weld, Francis M.; Miller, John P.; Moss, Arthur J.

doi:10.1161/01.cir.71.1.80

Cited by 165 publications

(10 citation statements)

References 32 publications

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“…Conventional exercise test parameters (ST depression and angina) were not found to be significant predictors of outcome [28], This is in agreement with the findings of pre vious investigators [17,34,35]: however, in this study, even with the consideration of clinical and hemodynamic parameters (such as exercise duration and blood pressure re sponse, as suggested by Krone et al [34]. the exercise test did not predict outcome.…”

Section: Exercise Testingsupporting

confidence: 91%

Noninvasive Predictors of Cardiac Events after Myocardial Infarction

Kuchar¹,

Thorburn²,

Freund³

et al. 1989

Cardiology

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Signal-averaged electrocardiography, resting radionuclide ventriculography and Holier monitoring were performed prior to hospital discharge, to assess their value in predicting recurrent cardiac events in 210 survivors of acute myocardial infarction. In addition, 153 of these patients also underwent exercise radionuclide ventriculographic assessment. During median follow-up of 14 months (6–24 months), there were 16 cardiac deaths, 15 patients had recurrent infarction and 7 patients represented with symptomatic ventricular tachycardia. Cox regression analysis identified independent predictors of ‘ischemic events’ (death or re-infarction) as a previous history of infarction (p = 0.01), Killip class III-IV (p = 0.03) and an abnormal exercise radionuclide study (p = 0.04); and predictors of’arrhythmic events’ (sustained ventricular tachycardia or sudden death) as an abnormal signal-averaged electrocardiograph (p = 0.01) and left ventricular ejection fraction less than 40% (p = 0.03). Patients with an abnormal signal-averaged electrocardiograph and reduced left ventricular ejection fraction had a 34% incidence of arrhythmic events during the first 6 months compared with a 4% incidence among patients without late potentials. In those patients who underwent exercise testing and signal averaging, 85% of total cardiac events and all cardiac deaths were predicted by an abnormality of either noninvasive test. In addition, exercise testing and signal-averaged ECG were independent predictors of outcome. Hence, using a combination of noninvasive tests, patients can be stratified according to the risk of recurrent life-threatening cardiac events after myocardial infarction; such patients may be suitable for intensive investigation and considered for trials involving active intervention.

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Section: Exercise Testingsupporting

confidence: 91%

Noninvasive Predictors of Cardiac Events after Myocardial Infarction

Kuchar¹,

Thorburn²,

Freund³

et al. 1989

Cardiology

View full text Add to dashboard Cite

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“…[5][6][7][8][9][10][11][12] Generally, aerobic exercise training lasting up to 30 min using a cycle ergometer or treadmill is carried out prior to hospital discharge, following the resumption of basic activities such as sitting, standing, self-care and level walking within the ward in the early days after AMI. [13][14][15][16][17] This predischarge exercise training can provide information on cardiovascular response that is useful for setting home activities guidelines, outpatient programs and socializing such as return to work after hospital discharge.…”

mentioning

confidence: 99%

Adaptation to Low-Intensity Exercise on a Cycle Ergometer by Patients With Acute Myocardial Infarction Undergoing Phase I Cardiac Rehabilitation

Matsunaga¹,

Masuda²,

Ogura³

et al. 2004

Circ J

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BackgroundThe adaptation of patients with acute myocardial infarction (AMI) to a phase I rehabilitation program has not been widely assessed. Methods and Results Forty-two male patients (62±8 years) with AMI were classified as exercise tolerant (group A, n=25) or excessive response (systolic blood pressure (SBP) increase >30 mmHg during exercise; group B, n=17). Hemodynamic parameters during exercise using a cycle-ergometer were monitored for the first 3 days. The power of low-and high-frequency components (LF: 0.05-0.2 Hz; HF: 0.2-1 Hz) was analyzed by heart rate variability. Anxiety status was assessed using the Spielberger's State-Trait Anxiety Inventory. Patients in group B were significantly older, had lower cardiac function and a longer hospitalization than group A (p<0.05, respectively). The excessive elevation of SBP on Day 1 decreased and became <30 mmHg on Day 3 in group B. The decreases in HF during exercise on Days 1 and 3 were significantly smaller in group B than in group A (p<0.05 and p<0.05, respectively). The LF/HF ratio on Day 1 was significantly higher in group B than in group A (p<0.05). In group B, the anxiety score before exercise was significantly higher than that at the time of discharge (p<0.05), whereas there was no change in group A. Conclusion Factors influencing a significant elevation of blood pressure during phase I rehabilitation are age, physical deconditioning, imbalance of autonomic nervous activity and anxiety. (Circ J 2004; 68: 938 -945)

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“…Direct measurement of LV function by means of EF is a poor predictor of exercise capacity [2], but it has been shown that indexes of impaired LV function during exercise predicts increased mortality [12][13][14], and in patients with congestive heart failure both EF and exercise capacity emerged as in dependent predictors of survival [15]. We have previously reported a beneficial effect of captopril on physical endurance in patients with LV dysfunction following MI [8], as have Pfeffer et al [7] and Lamas et al [16], The topic of the present paper is to relate indexes of systolic and diastolic function of the LV, as evaluated by echocardiography, to changes in Percentage change In exercise time…”

Section: Discussionmentioning

confidence: 99%

Exercise Capacity in Patients with Left Ventricular Dysfunction following Acute Myocardial Infarction: Relation to Systolic and Diastolic Function and Intervention with Captopril

Søgaard

Gøtzsche²,

Ravkilde³

et al. 1994

Cardiology

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Patients with acute or chronic heart disease may have limited exercise capacity if they have reduced left ventricular function. Indexes of reduced left ventriuclar function during exercise are a predictor of subsequent survival although left ventricular ejection fraction is a poor predictor of physical endurance. We evaluated the effect of captopril on physical endurance in 48 males with left ventricular dysfunction following myocardial infarction. On the 7th day following myocardial infarction patients were randomized to either captopril 50 mg daily or corresponding placebo. Patients were followed up by means of serial echocardiography and exercise stress testing for a period of 180 days. Exercise capacity was significantly improved in the captopril group. Changes in exercise capacity were significantly correlated to changes in left ventricular (LV) volumes and compliance. The beneficial effect of captopril on exercise capacity was probably mediated via improvement in LV performance and compliance.

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Low-level exercise testing after myocardial infarction: usefulness in enhancing clinical risk stratification.

Cited by 165 publications

References 32 publications

Noninvasive Predictors of Cardiac Events after Myocardial Infarction

Noninvasive Predictors of Cardiac Events after Myocardial Infarction

Adaptation to Low-Intensity Exercise on a Cycle Ergometer by Patients With Acute Myocardial Infarction Undergoing Phase I Cardiac Rehabilitation

Exercise Capacity in Patients with Left Ventricular Dysfunction following Acute Myocardial Infarction: Relation to Systolic and Diastolic Function and Intervention with Captopril

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