TY - JOUR
T1 - Noninvasive assessment of changes in myocardial perfusion and ventricular performance following exercise training
AU - Tubau, Julio
AU - Witztum, Kathryn
AU - Froelicher, Victor
AU - Jensen, David
AU - Atwood, Edwin
AU - McKirnan, M. Dan
AU - Reynolds, Jane
AU - Ashburn, William
N1 - Funding Information:
From the Department Department of Radiology, University of California. Supported by Specialized Center of Research on Ischemic Heart Disease, National Institutes of Health Research Grant HL-17682 from the National Heart, Lung and Blood Institute. Received for publication Jan. 20, 1982; accepted Julio F. Tubau, M.D., VA Medical Center, Cardiology 4150 Clement St., San Francisco, CA 94121.
PY - 1982/8
Y1 - 1982/8
N2 - Seventeen coronary patients (CAD) underwent thallium (TI-201) treadmill and radionuclide (RNV) ejection fraction supine bicycle testing before and after 5.6 ± 1.6 (X ± SD) months of an exercise program. Thallium data were assessed both using analog images and a computerized circumferential profile technique. Patients exercised on the treadmill to a higher workload after the exercise program, but achieved a similar pressure-rate product. When interpreting the analog thallium images, only 50% agreement was obtained for the assessment of changes in myocardial perfusion (pre/post-training). The computer technique, however, had low inter-intraobserver variability (6%) and better agreement (90.5%). Using the circumferential profile method, five patients improved (a total of 11 regions) and one patient worsened (with two regions). Before the exercise program, the ejection fraction (EF) response to supine bike exercise was normal (an increase greater than 11%) in four, flat in seven, and severely abnormal (a decrease of more than 4%) in six patients. After the exercise program, even though achieving similar or higher pressure-rate products, six patients improved their EF response, nine did not change, and two worsened. Of the five patients who improved their thallium images, one improved his EF response, two remained normal, and two did not change. One patient worsened both his thallium study and the EF response after the exercise program. Changes in thallium exercise images and the EF response to supine exercise occurred in our patients after an exercise program, but were not always concordant. Indeed, of five patients with exercise-induced ischemic ST changes before and after training, the EF response improved in three whereas myocardial perfusion was unchanged. Reasons for this lack of agreement are discussed, and have been considered in the planning of a randomized trial of the effects of an exercise program on myocardial perfusion and function.
AB - Seventeen coronary patients (CAD) underwent thallium (TI-201) treadmill and radionuclide (RNV) ejection fraction supine bicycle testing before and after 5.6 ± 1.6 (X ± SD) months of an exercise program. Thallium data were assessed both using analog images and a computerized circumferential profile technique. Patients exercised on the treadmill to a higher workload after the exercise program, but achieved a similar pressure-rate product. When interpreting the analog thallium images, only 50% agreement was obtained for the assessment of changes in myocardial perfusion (pre/post-training). The computer technique, however, had low inter-intraobserver variability (6%) and better agreement (90.5%). Using the circumferential profile method, five patients improved (a total of 11 regions) and one patient worsened (with two regions). Before the exercise program, the ejection fraction (EF) response to supine bike exercise was normal (an increase greater than 11%) in four, flat in seven, and severely abnormal (a decrease of more than 4%) in six patients. After the exercise program, even though achieving similar or higher pressure-rate products, six patients improved their EF response, nine did not change, and two worsened. Of the five patients who improved their thallium images, one improved his EF response, two remained normal, and two did not change. One patient worsened both his thallium study and the EF response after the exercise program. Changes in thallium exercise images and the EF response to supine exercise occurred in our patients after an exercise program, but were not always concordant. Indeed, of five patients with exercise-induced ischemic ST changes before and after training, the EF response improved in three whereas myocardial perfusion was unchanged. Reasons for this lack of agreement are discussed, and have been considered in the planning of a randomized trial of the effects of an exercise program on myocardial perfusion and function.
UR - http://www.scopus.com/inward/record.url?scp=0020446136&partnerID=8YFLogxK
U2 - 10.1016/0002-8703(82)90199-5
DO - 10.1016/0002-8703(82)90199-5
M3 - Article
C2 - 7102507
AN - SCOPUS:0020446136
SN - 0002-8703
VL - 104
SP - 238
EP - 248
JO - American Heart Journal
JF - American Heart Journal
IS - 2 PART 1
ER -