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Milani M, Milani JGPO, Simoes MV, Gallo Junior L. Presence and clinical significance of myocardial ischemia during aerobic exercise training in patients with ischemic burden. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiovascular rehabilitation is efficient and safe for patients with coronary artery disease (CAD). Exercises are usually prescribed below the clinic and electrocardiographic ischemic threshold. Training above this threshold remains controversial, given the potential risks compared to the additional benefits. However, clinic and electrocardiographic detection of ischemia has lower accuracy than myocardial perfusion scintigraphy (MPS). Therefore, MPS during physical training can better assess ischemia. Moreover, serial maximum MPS can document the benefits of exercise that can be correlated with ischemia during training.
Purpose
To investigate the presence and clinical significance of scintigraphic myocardial ischemia during aerobic exercise in patients with CAD and ischemic burden.
Methods
Thirty-three patients with stable CAD were evaluated at maximum effort (M1) and at rest (R1) using MPS. Twelve patients were excluded; 3 did not complete the intervention, and 9 did not exhibit ischemia. The remaining 21 patients with ischemic burden were included. The intervention consisted of a 12-week training program of moderate-intensity aerobic exercises, below the clinical and electrocardiographic ischemic threshold. During weeks 1 (T1) and 12 (T2), patients underwent MPS during the exercises. After 12 weeks, patients underwent another MPS at maximum effort (M2). All images were quantitatively analyzed, and the presence, extent, and intensity of ischemia were determined. The Wilcoxon test was used to compare 2 variables, and the Friedman test to compare 3 variables, followed by the post hoc Dunn’s test. Correlations were analyzed using Spearman’s test. The level of significance was set at 5% (p < 0.05).
Results
The prevalence of scintigraphic ischemia during exercise training was 81% at T1 and 71% at T2. The median number (and interquartile range) of ischemic segments at T1 was 3 (2–5), which was significantly different (p = 0.003) from that observed at M1 [5 (3–8)]. The median values of the myocardial uptake in the ischemic segments at R1, T1, and M1 were 59.1% (53.1–68.5), 51.5% (45.3–60.3), and 40.8% (37.3–53.3), respectively, with significant differences between T1 and R1 (p < 0.05) and between T1 and M1 (p < 0.01). After 12 weeks, the extent and intensity of ischemia at maximum effort decreased. The median number of ischemic segments significantly decreased from 5 (3–8) at M1 to 4 (2–6) at M2 (p = 0.005). This reduction in the extent of ischemia after training was significantly correlated with the number of ischemic segments at M1 (r = 0.60; p = 0.004) and at T1 (r = 0.64; p = 0.002), such that patients with more extensive ischemia experienced greater benefits from training.
Conclusions
Scintigraphic ischemia was highly prevalent during moderate-intensity aerobic training in patients with CAD and ischemic burden. There was a correlation between the ischemic stimulus during training and the documented benefits at maximum effort.
Abstract Figure. Polar maps at rest, training and maximum
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Affiliation(s)
- M Milani
- Fitcordis Exercise Medicine Clinic, Brasilia, Brazil
| | - JGPO Milani
- Fitcordis Exercise Medicine Clinic, Brasilia, Brazil
| | - MV Simoes
- Medical School of Ribeirao Preto, Ribeirao Preto, Brazil
| | - L Gallo Junior
- Medical School of Ribeirao Preto, Ribeirao Preto, Brazil
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Costa DC, Santi GLD, Crescêncio JC, Seabra LP, Carvalho EEV, Papa V, Marques F, Gallo Junior L, Schmidt A. Use of the Wasserman equation in optimization of the duration of the power ramp in a cardiopulmonary exercise test: a study of Brazilian men. ACTA ACUST UNITED AC 2015; 48:1136-44. [PMID: 26397972 PMCID: PMC4661031 DOI: 10.1590/1414-431x20154692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/21/2015] [Indexed: 11/22/2022]
Abstract
This study aimed to analyze the agreement between measurements of unloaded oxygen
uptake and peak oxygen uptake based on equations proposed by Wasserman and on real
measurements directly obtained with the ergospirometry system. We performed an
incremental cardiopulmonary exercise test (CPET), which was applied to two groups of
sedentary male subjects: one apparently healthy group (HG, n=12) and the other had
stable coronary artery disease (n=16). The mean age in the HG was 47±4 years and that
in the coronary artery disease group (CG) was 57±8 years. Both groups performed CPET
on a cycle ergometer with a ramp-type protocol at an intensity that was calculated
according to the Wasserman equation. In the HG, there was no significant difference
between measurements predicted by the formula and real measurements obtained in CPET
in the unloaded condition. However, at peak effort, a significant difference was
observed between oxygen uptake (V˙O2)peak(predicted)and V˙O2peak(real)(nonparametric Wilcoxon test). In the CG,
there was a significant difference of 116.26 mL/min between the predicted values by
the formula and the real values obtained in the unloaded condition. A significant
difference in peak effort was found, where V˙O2peak(real)was 40% lower than V˙O2peak(predicted)(nonparametric Wilcoxon test). There was
no agreement between the real and predicted measurements as analyzed by Lin’s
coefficient or the Bland and Altman model. The Wasserman formula does not appear to
be appropriate for prediction of functional capacity of volunteers. Therefore, this
formula cannot precisely predict the increase in power in incremental CPET on a cycle
ergometer.
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Affiliation(s)
- D C Costa
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - G L de Santi
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J C Crescêncio
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L P Seabra
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - E E V Carvalho
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - V Papa
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F Marques
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L Gallo Junior
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A Schmidt
- Laboratório de Fisiologia do Exercício, Divisão de Cardiologia, Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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