Usefulness of systolic time intervals in coronary artery disease

Lewis, Richard P.; Boudoulas, Harisios; Welch, Thomas G.; Forester, Wilbur F.

doi:10.1016/0002-9149(76)90376-3

Cited by 93 publications

(54 citation statements)

References 57 publications

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“…The usefulness of the STI during the re covery period of an exercise test as a diagnos tic tool to evaluate the left ventricular func tion in patients with CAD was assessed in several previous studies [2][3][4]12], However, this approach does not allow one to discrim inate CAD patients from normal subjects due to its poor sensitivity and specificity. On the other hand, the possibility that exercise may improve the sensitivity of the method in de tecting hemodynamic disorders in patients with CAD has been questioned because of the technical difficulties in obtaining STI by conventional methods during dynamic stress testing.…”

Section: Discussionmentioning

confidence: 99%

“…in the late postexercise recovery peri od, was found to be significantly longer in CAD patients as compared with normals. This is probably related to the inability of the ischemic myocardium to respond to adrener gic stimulation [2].…”

Section: Discussionmentioning

confidence: 99%

“…To increase the sensitivity of this method in discriminating patients with coronary ar tery disease (CAD) from normal subjects, STI were utilized in assessing exercise-in duced changes in cardiac performance; how ever, the usefulness of this method has been limited by the difficulty in recording high quality tracings during dynamic exercise; therefore, many investigators choose to rec ord the carotid pulse during short interrup tions or at the end of the exercise [2][3][4]. To improve the quality of STI recordings during exercise, Spodick and Lance [5] introduced the ear densitography, a new method allow ing continuous ST1 monitoring during unin terrupted dynamic stress test.…”

Section: Introductionmentioning

confidence: 99%

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Systolic Time-Interval Evaluation by Thermistor Plethysmography during Uninterrupted Dynamic Stress Test in Normals and in Patients with Coronary Artery Disease

Ferrò¹,

Giunta²,

Maione³

et al. 1983

Cardiology

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18 patients with coronary artery disease (CAD) and 21 normal subjects underwent a triangular bicycle exercise test. Systolic time intervals (STI) were calculated at rest and every 2 min during exercise. Under resting conditions, STI were similar in the two groups. During exercise, the ejection time index (ETI), i.e. left ventricular ejection time (LVET) corrected for HR, rose significantly more in CAD patients, as compared to normals. Pre-ejection period (PEP) was also differently affected by exercise in CAD patients, who showed a more shortened PEP (p < 0.001) in the early stage of dynamic stress. PEP/LVET ratio, which in the control group decreased continuously, in CAD patients fell during exercise at lower work loads (p < 0.001), whilst rose during strenuous exercise. Finally, significant differences (p < 0.001) were found in the percent change (%Δ) PEP/LVET ratio between the two groups during the early phase of exercise, in which no superimposition of single values was present. Therefore, this last parameter seems the most reliable to differentiate clearly CAD patients from normal subjects, but its use must be limited at early exercise.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Systolic Time-Interval Evaluation by Thermistor Plethysmography during Uninterrupted Dynamic Stress Test in Normals and in Patients with Coronary Artery Disease

Ferrò¹,

Giunta²,

Maione³

et al. 1983

Cardiology

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“…Stable angina pectoris was diagnosed when recurrent attacks of substernal distress of brief duration (less than 10 minutes), brought on by exertion or excitement and relieved by rest or nitroglycerin, were present in a relatively consistent pattern for at least 4 months. The frequency of angina pectoris was determined by having patients record their chest pains in an angina diary during the first month of the study.…”

Section: Methods Patient Populationmentioning

confidence: 99%

The prognostic value of systolic time intervals in angina pectoris patients.

Gillilan¹,

Parnes²,

Khan³

et al. 1979

Circulation

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26. Pitt B, Gregg DE: Coronary hemodynamic effects of increasing ventricular rate in the unanesthetized dog. SUMMARY Eighty-five subjects with stable angina pectoris and proven obstructive coronary disease were followed prospectively (mean follow-up 4.2 ± 2.0 years) to assess the value of various predictors of longevity.After patients with congestive heart failure, hypertension, left bundle branch block, valvular heart disease or recent propranolol therapy were excluded, subjects were followed until a major cardiac event (new acute myocardial infarction, cardiac surgery or death) occurred. During follow-up, 22 patients died, 49 survived without events, nine underwent coronary bypass surgery, and five had nonfatal myocardial infarctions. The measurements made at the onset of the study, including cardiothoracic ratio (C/T) on chest x-ray, resting electrocardiographic abnormalities, maximum exercise tolerance testing (METT) data, systolic time interval (STI) measurements (before exercise and 34 minutes after METT), and results of cardiac catheterization (55 patients), were analyzed at its conclusion to determine the best predictor of subsequent mortality. Of these measurements, left ventricular ejection fraction, endurance time on METT and C/T were shown to be useful prognostic indicators of subsequent mortality. However, the pre-ejection phase-to-left ventricular ejection time (PEP/LVET) ratio (0.40 ± 0.05 in survivors vs 0.50 + 0.09 in nonsurvivors) in the resting pre-exercise state wa1s significantly more predictive of mortality than the other measurements. On life-table analysis, the difference in survival between subjects with a resting PEP/LVET < 0.50 and those with a resting PEP/LVET 2 0.50 was highly significant. The measurement of the STIs after maximal exercise testing failed to improve upon the prognostic ability of the simple determination of PEP/LVET in the resting, supine state. STIs provided highly specific noninvasive prognostic information in this group of patients with stable angina pectoris.DEPRESSED LEFT VENTRICULAR function, particularly as reflected in a reduced angiographic ejection fraction (EF) determined at cardiac catheterization, has been shown to affect adversely the prognosis of both medically and surgically treated patients with coronary heart disease.' 2 Measurement of systolic time intervals (STIs) is a noninvasive technique that has shown a close correlation with the angiographic assessment of left ventricular performance in most forms of heart disease, although the correlation of the ratio of pre-ejection phase to left

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“…[6][7][8][9][10][11] A pattern of prolongation of the PEP and shortening of the LVET characterizes acute myocardial infarction, angina pectoris, and heart failure. [11][12][13] The ratio of PEP to LVET (PEP/LVET) has also been regarded as an inverse measure of left ventricular systolic performance. PEP reduction reflects a positive inotropic effect of the cardiac sympathetic nerves on the myocardium.…”

Section: Cardiac Evaluationmentioning

confidence: 99%