Download SYSTOLIC BLOOD PRESSURE IN REPEATED EXERCISE TESTS

SYSTOLIC BLOOD PRESSURE IN REPEATED EXERCISE TESTS AFTER MYOCARDIAL
INFARCTION
Kamile L Blozneliene, Laima Talijuniene Kaunas Medical University Institute of Cardiology
Key words: acute myocardial infarction, systolic blood pressure, exercise tests, prognosis after acute myocardial
infarction.
Summary. Exercise testing still remains the cornestone of non-invasive eveluation of functional statement in patients after acute myocardial infarction (AMI). The purpose of the present study was: to analyse the relationship
between hypertension at the early exercise testing (ET) and development of fatal coronary events in patients
with AMI; to assess the changes in systolic blood preasure (SBP) parameters obtained by repeated exercise
testings ant to define their informativeness in terms or poor outcome after myocardial infarction (MI).
Design and methods 468 consecutive patients have undergone ET within 3 weeks of AMI. The Kaunas Acute
Myocardial Infarction Register data were used for survival analysis. During 48-120 months follow up period
there were 98 cardiac lethal outcome and 370 survivors. Among non-survivors within 48-120 months after AMI
there were only 8 patients (8.2%) who had hypertensive (=>220/115 mmHg) response to exercise. In 253 patients exercise tolerance was assessed by ET 3,12 months and 2, 3 and 5 years after AMI. Within the first 2
years after MI there were 20 cases of cardiac deaths, 23 cases of recurrent MI, 56 cases of left ventricular failure
(HF) NYHA class II-IV.
Results. The cardiovascular responce to ET within 3 weeks after AMI was following: the mean peak workload
44.0+-0.7 W, the mean peak heart rate 110.0+-0.5 bpm/min, the mean peak SBP 157.4+-0.9 mmHg.
Cardiovascular response to ET 3 months after MI: mean peak work load 48.62+-0.90 W; mean peak heart rate
128.48+-1.3 bpm/ min;mean peak SBP 177.78+-1.33 mmHg; mean systolic blood pressure increment (SBPI)
41.72+-1.25%. Eleven patients died suddenly within 6 months after AMI, however this group had no patients
with hypertensive response to exercise at the early exercise test (3 weeks after AMI). There was no correlation
between SBPI 3 months after MI and rate of cardiac deaths, cases of recurrent MI within the first 2 years after
MI. Nevertheless in the survivor persons suffering from HF at 2 years after MI, SBPI was found decreased at 3
months after MI already compared with patients without HF: 35.6-1-4.8% and 38.0-1-1.6% respectively.
Difference between SBPI at 1 year after MI and SBPI at 3 months after MI were -1.3+-5.8% and 2.63+4.8%
respectively (p<0.005). In patients suffering from HF at 5 years after MI, ET repeated 3 years after MI showed
statistically significant smaller increase of SBPI parameter values compared with SBPI in the patients without
HF 5 years after MI: 30.8-1-5.2% and 37.8+-2.1% respectively (p<0.01).
Conclusion: SBP increment parameters in repeated exercise tests may help detect persons prone to develop heart
failure after AMI. Exercise hypertension within 3 weeks after myocardial infarction had no influence on
long-term survivor after AMI. Seminars in Cardiology. 2001;7(2):57-59
Sistolinis kraujospudis kartojant fizinio kruvio meginj sergantiesiems miokardo infarktu.
Raktazodziai: uminis miokardo infarktas, sistolinis kraujospudis, fizinio kruvio meginys, prognoze po uminio
miokardo infarkto.
Reziume. Darbo tikslas: tirti priklausomybeę tarp hipertenzines reakcijos j fizinj kruvj atliekant ankstyvajj
fizinio kruvio meginj (FKM) ir sveikstanciuji} po miokardo infarkto (MI) koronariniij mirciij; jvertinti sistolinio
kraujospudzio prieaugio, kartojant fizinio kruvio meginius po MI, prognostinj informatyvumą. 468-iems
sveikstantiesiems po uminio MI trečią susirgimo savaitę atliktas fizinio kruvio meginys (FKM). Jij
isgyvenamumas nustatytas remiantis Kauno miesto Uminio Miokardo Infarkto Registro duomenimis. Stebejimo
trukme 48-120 men. Isgyveno 370 asmenij. 98 asmenys mire koronarine mirtimi. Mirusiujij per 48-120 men. po
MI grupeje tik 8 (8.2 proc.) pacientams ankstyvojo FKM metu buvo nustatyta hipertenzine reakcija j fizinj kruvj
(=>220/115 mmHg). Vienuolika asmenij mire staiga per pirmajj pusmetj po MI, taciau sioje grupeje ne vienam
pacientui ankstyvasis FKM nesukele hipertenzines reakcijos j kruvj. 253 pacientams FKM buvo atliktas po 3,12
menesiij ir po 2, 3, 5 metij po MI. Mazas sistolinio kraujospudzio prieaugis kartotinai atliekant FKM statistiskai
patikimai (p<0.01) siejosi su kairiojo skilvelio nepakankumumu, praejus 5 metams po MI.
Isvada. Tyrinejimi} rezultatai rodo, kad sveikstanciujij po miokardo infarkto hipertenzine reakcija j fizinj kruvj
neturi rysio su atokiuoju isgyvenamumu; mazas sistolinio kraujospudzio prieaugis kartotinai atliekant FKM
statistiskai patikimai siejasi su kairiojo skilvelio nepakankumumu, praejus 5 metams po MI. Kardiologyos
seminarai. 2001;7(2):57-59
Introduction. Exercise testing still remains the cor-nestone of non-invasive evaluation of functional statement in
cardiac patients and is almoust uniformly performed after acute myocardial infarction [1]. Inadequate blood
pressure response to exercise testing (ET) at the early exercise test in acute myocardial infarction (AMI) patients
is thout to be associated with the occurrence of fatal coronary events [2-5].The purpose of the present study was:
to analyse the relationship between hypertension at the early ET and development of fatal coronary events in
patients with AMI; to assess the changes in systolic blood preasure (SBP) parameters obtained by repeated
exercise testings and to define their in-formativeness in terms of poor outcome after myocardial infarction (MI).
Patients and methods. Patients convalescing from AMI were eligible for this study within the first three weeks
after AMI. At the time of testing, none of patients had contraindications for ET, such as unstable angina, severe
heart failure, seriuos venricular arrhythmias, heart block or significant hypertension (> 160/100 mmHg); thoug,
in some cases seriuos complications had occured during the acute phase of myocardial infarction.
A symptom-limited exercise test was performed on the cycle ergometer (Elema-Schonander EM 370/796) with
a starting load of 25 W and with 25 W increments every 5 minutes. Exercise ECGs were registered on the
electrocardiograph (Elkar 7623) with an on-line ECG (leads I, II, aVF, V2,4,6) or on the Mingograph 740
(Si-emens-Elema). From the Mingograph, on-line paper prints out of six chest leads were produced at 10 mm/s
paper speed continuously and a 12 lead ACG at 50 mm/ s paper speed was registered every minute.Significant
ischaemia was defined as ST-segment depression of at least 1mm, horizontal or downsloping, 80 ms from the
J-point. Cuff blood pressure was measured at 1-minute intervals during the exercise and during recovery period
of 10 minutes. We stopped the exercise when the patient reaches 75% of maximal heart rate or the patient is unable to continue because of chest pain, general and/or leg muscle fatigue (or) dyspnoea. For safety we also
stopped the exercise if there was a fall in systolic blood pressure or hypertensive response to exercise (=>220/
115 mmHg) or the following parameters were registered: ST-segment depression = >2 mm, ST- segment
elevation = > 1 mm (in leads without diagnostic Q-waves) or a severe ventricular arrhythmias.
468 consecutive patients have undergone ET within 3 weeks of AMI. The Kaunas Acute Myocardial Infarction
Register data were used for survival analysis. During 48-120 months follow up period there were 98 cardiac
lethal outcome (Fig.l) and 370 survivors. Among non-survivors within 48-120 months after AMI there were
only 8 patients (8.2%) who had hypertensive (=>220/ 115 mmHg) response to exercise (Fig2). In 253 patients
exercise tolerance was assessed by ET 3,12 months and 2, 3 and 5 years after AMI. Within the first 2 years after
MI there were 20 cases of cardiac deaths, 23 cases of recurrent MI, 56 cases of left ventricular failure (HF)
NYHA class II-IV.
Results and discussion. Results. The cardiovascular responce to ET within 3 weeks after AMI was following:
the mean peak workload 44.0+-0.7 W, the mean peak heart rate 110.0+-0.5 bpm/min, the mean peak SBP
157.4+-0.9 mmHg. Cardiovascular response to ET 3 months after MI: mean peak work load 48.62+-0.90 W;
mean peak heart rate 128.48+-1.3 bpm/min;mean peak SBP 177.78+-1.33 mmHg; mean systolic blood pressure
increment (SBPI) 41.72+4.25%. Eleven patients died suddenly within 6 months after AMI, however this group
had no patients with hypertensive response to exercise at the early exercise test (3 weeks after AMI). There was
no correlation between SBPI 3 months after MI and rate of cardiac deaths, cases of recurrent MI within the first
2 years after MI. Nevertheless in the survivor persons suffering from HF at 2 years after MI, SBPI was found
decreased at 3 months after MI already compared with patients without HF: 35.6+-4.8% and 38.0+-1.6% respectively. Difference between SBPI at 1 year after MI and SBPI at 3 months after MI were -1.3+-5.8% and
2.63+-1.8% respectively (p<0.005). In patients suffering from HF at 5 years after MI, ET repeated 3 years after
MI showed statistically significant smaller increase of SBPI parameter values compared with SBPI in the
patients without HF 5 years after MI: 30.8+-5.2% and
37.8+-2.1% respectively (p<0.01).
Physical activity as an indispensable condition for the proper functioning of the human organism is important
for understanding cardiovascular diseases and especially for prescribing appropiate therapies [6-7]. The exercise
electrocardiography still remains the first importance of risk stratification after AMI.Exercise capacy and heart
rate and blood pressure reaction relate to myocardial ischaemia, left ventricular function and the peripheral
haemodynamic response to exercise. Therefore, in order to predict the patient's outcome more effectively one
should use combinations of these parameters [6-8]. As it is shown by our study the exercise hypertension within
3 weeks the systolic blood pressure increment in repeated exercise tests after AMI had no influence to long-term
survival. Nevertheless the systolic blood pressure increment parameters in repeated tests may help detect
persons prone to develop heart failure after myocardial infarction.
References
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