Download Diastolic Time during Static and Dynamic Exercise in Myocardial

Diastolic
Exercise
Time during Static and Dynamic
in Myocardial Infarction*
Tadiishi
Hasegawa,
M. D. ; Tetsuro
Sugiura,
M. D.
F. C. C. F;
Masahide
Matsutani,
M.D.;
Tsutomu
Sumimoto,
M.D.;
Toshiji
iwasaka,
M. D. , F. C. C. F; and Mitsuo
Inada,
M.D.
,
To evaluate
the
early
of static
phase
(treadmill)
by ear
exercise,
None
graphic
patients
the
the
had
during
pressure-HR
time.
Diastolic
blood
static
exercise,
exercise.
D
lengthening
of left
pressure
it remained
time,
cardial
to HR
in various
a small
increase
in
particularly
DT,
dynamic
in daily
an
patients
with
ercise
is
increase
exercise.
to static
The
and
disease
have
dynamic
a linear
of myo-
a large
and
decrease
exercise.
Static
infarction.
less
blood
differences
dynamic
been
increase
pressure
focused
on
in
HR
but
dynamic
in hemodynamic
responses
exercise
in coronary
artery
evaluated;
however,
the
the
difference
early
in
phase
of
not
many
the
hemo-
static
and
exercise.
exercise
in patients
with
recent
myocardial
infarction.
ANI)
Flit lents
age ±
three
to)
study
had
*From
had postinfaretional
gestive
weeks
four
the
had
their
Second
before
the
first
Q-wave
Department
study.
All patients
myocardial
of
Medical
University,
Osaka,
Japan.
Manuscript
received
January
2; revision
Reprint
requests:
Dr Hasegawa,
CCU,
1 Fumizono-cho,
Moriguchi
City, Osaka,
1 1 patients
myocardial
Internal
Japan
infarctioln
in this
and
Medicine,
accepted
Kansai
(mean
included
infarction,
March
Medical
.570
respec-
a consequent
observed
in
angina,
heart
and
demand.
(Chest
rate;
valvular
dynamic
no patient
the
disease,
atrial
load
and
fibrillation,
or clinical
discomitinued
receiving
was
weight
98:667-71)
electromechanical
hypertension,
were
imbalance
1990;
QS1
heart
defects,
All medications
failure.
before
for initiating
and
heart
conduction
half-lives,
five
HR
3-adrenergic
the
treadmill
con-
for at least
blockers
exercise.
Recordings
Data
for
systolic
densitograph
densitograms
were
Packard
780-10)
Denshi
MIC
(Fukuda
time
pulse
intervals
derivative
6600).
Denshi
none
Kansai
14.
University,
were
and
obtained
with
modified
and
recorded
the
RF-85)
at a paper
employed
for
the
ear
(Hewlett-
(Fukuda
a polygraph
made
speed
Ear
earpiece
throlt,gh
were
from
electrocardiogram.
a photoelectric
filtered
Recordings
on
a thermal
recorder
of 100 mm/s.
Ttfeasurements
The
and
methods
left
The
ventricular
DT
was
ments
time
calculated
period
of HR
as
plus
to) a computer
average
(If five
time
mintms
ejection
intervals
calculated
the
(If
(QS2
Measure-
l)y a digitizer
aided
were
for cacti
QS2
timne).
were
and
perioal,
elsewhere.”
from
the
recordimigs.
Exercise
(right
exercise
test
was
state . The P;tti’mits
hand)
V., and
in the
obtained
at resting
the response
recordings
were
sustained
weight
load.
apparatus
(Nippon
Cohn
at standing
instructed
control
made
lift
capacity)
for
six mimiutes.
and
monitored,
control
and
of systolic
Blood
aVF,
electrocardiogramims
niinmmte
ohmring
exercise.
during
exercise,
control
and
at three
mninutes
of
presstmre
was
recorded
with
an
from
mimiutes
Valsalva
CHEST
the
omme hamiol
1.ea(ls
intervals
STBP-680)
the
on
full
ss’ith
in time
weighumig
time
at standing
Downloaded From: http://publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21618/ on 05/14/2017
tl,e )Ltiemts
held a sack
position
amid at three
to) avoid
dolmie with
co)m,tinuo)Imsls
(If maximnal
stamiding
V, colntin000msly
To evaluate
were
length
FM-8)
beats
preejection
as described
ventricular
(Fujitsu
consecimtive
HR.
were
cardiac
left
amid systolic
coupled
were
meastmring
ejection
10 kg (30 to) 35 percemit
of
was
supply
time;
The
static
postabsorptive
MEi’uous
sttmdied population
was comprised
SD, 51 ± 8 years)
with a documented
exercises,
of QS2 with
has a potential
oxygen
DT = diastolic
systole
Static
MATERIALS
The
exercise
preejection
This study
was designed
to evaluate
the difference
in the response
of DT in the early phase
of static
amid
dynamic
dynamic
(p<O.O5)
and
DT
and
ex-
than
of dynamic
or digitalis
Static
in
and
and
(DTe729#{176}#{176}’M”M, and
prolongation
DT
intraventricular
relation
exercise,’4
produce
induce
response
dymiamic
had
be performed
numerous
times
discharge
from the hospital
of
in
have
studies
will
myocardial
to
dynamic
a nonlinear
in low-level
acute
HR
including
HR
must
after
known
greater
has
conditions,
exercise
activities
during
with
of
of exercise,
relation
exercise.
In addition
to a higher
pressure-HR
product,
the
disproportionate
shortening
of diastole
in the early
phase
of myocardial
ejection
determinant
supply,
in
associated
significantly
and
important
oxygen
was
unchanged
systole
of
higher
ventricular
rose
Electromechanical
iastolic
which
minutes
inverse
A significant
shortening
in
types
at three
DT = e7#{176}#{176}#{176}’42
HR for static
electrocardioboth
relation
tively).
infarc-
significantly
inverse
HR had a nonlinear
was studied
an increase
with
was
exercise,
in the
dynamic
myocardial
Despite
product
of dynamic
and
an ischemic
product
at three minutes
with
a significant
but
with
exercise.
pressure-HR
of DT
load)
of DT and HR
in 11 patients
of the
and
response
weight
the relation
response
exercise,
in the
(sustained
densitography
tion.
HR
difference
the left
arm
of exercise.
manetmver
and
was taken
All patients
amid probailly
I 98 I 3 I SEPTEMBER,
1990
were
667
free
from
it,
simice
initiation
(If the
Dynamic
F;x’rcfs’
respiration
weight
load
was
o)l)serveol
shortly
after
the
and
timiie,
derived
exercise.
were
The
treadmill
exercise
exercise
test.
Demislii
M L-S(XX))
The
test
test
performed
was
amid treadmiiill
folr tWO) 3-mimiute
1 .7 mph. Leads aVF, \‘,
amid full electrocardiograms
tlit’ minmte
durimig
exercise.
it, the
intervals
at stamidimig
was
comitrol
recorded
aml
taken
at control
ventricular
crystal
the
camera
left
three
mimiimtes
apparatus
(Nippon
(Baird-Atomic
the
simigle
area
fromn
vo)lumne
o)ftliis
ergolmneter
in
charge
low-level
Statistieal
been
exercise
The
of revolution
modified
until
within
three
test
(static
where
bicycle
or
than
amid dynamic
left
vemitricular
and
dynamic
analyzed
was
accepted
were
RESU
LTS
by analysis
at the
95 percent
expressed
as
the
the
sustained
exercise
protocol
weight
(the
exercise)
without
angina
electrocardiographic
ofhorizolntal
lolad
treadmill
responses
or downward-sloping
60 ms after
QRS
ST-
complex
in three
beats).
There
were
pressure,
and
both
dynamic
types
to
each
by
data
were
amigio-
differences
prodtmct
exercise
(Table
the
with
rose
in HR, blood
between
at control
1).
increased
exercise,
greater
exercise
&essure
product
(If
(control
bicycle
Blood
pressure-HR
presstmre-HR
and
re-
and
no significant
and
volumne
obtaining
(If the
of HR
significantly
fraction
radiont,clide
days
A is
increased
the
1 mm
pressure
on the
was
then
results
ergometer
depression
blood
reliability
and
dynamic
ischemic
consecutive
static
ventricle.
stroke
After
the
(static
The
finished
and the
pectoris
and
diameter
left
ejection
75’o
The
1(X)). Left
longest
exercised
(at 9 minutes).
(lilt
X A2/L,
workload
mintmtes
carried
exercise
area-lemigth
repo)rted.112
were
were
significamice
patients
and
the
X
The
study
were
models
SD.
Responses
from
the
fraction.
patients
were
b
eqimatiomi:
amid
each
lines
(p<O.O5).
exercise
as: (end-diastolic
measured
relation
in
models
regression
mnultiprojection.
(If the
linear
exercise
dynamic
significantly
three
minumtes
values
were
not
Although
HR
significantly
values
exercise.
with static
of exercise);
statistically
in
were
Diastolic
exercise
however,
different
the
from
other.
DT
(msec)
500
o.--o
static
.-.
dynamic
exercise
exercise
pre(lis-
exercise).
Analysis
The
(-test
with
Table
for
paired
samples
(hR.
control
Data
HR. beats
per
perixl,
to) comnpare
ami exercise
left ventricular
ejectiomi
400
Blood
Pressure,
and
Pressure-HR
and Three Minutes
of Exercise
Static
Dynamic
Exercise
Exercise
p Value
300
mm
Comitrol
3 miii
used
was
preejection
1-Heart
Rate,
at Control
Product
79±10
ofexercise
88±
p value
Blood
was
counts
apex
the
position.
three
sttmdies were
cycle
L is the
following
have
the
sittimig
and
ejectiomi
X
ever’
at peak
graphic
and
anterior
as 0.85
to) the
the
mnethokl
the
Statistical
All
pressure
oletermuined
ellipse
from
by
control,
incrememits
ol)taimied
value
derived
QS-h1R
regression
level
regressioln
whereas
on
muade
volumes
calculated
proljectiomi
valve
-olumne
the data at sitting
the
planinietr;
volumne
pr()ducil)ility
ii, the
was
was
with
aortic
va.s
end-diastolic
25-W
Blood
STBP-680)
colunts)/(end-diastolic
plamie
by
the
±
Nonlinear
relatiomi,
relation
two)
olfcovarlance.
of systolic
a oxlmputerizeol
cardiac
vollimnie
amiterio)r
end-diastolic
=
and
were
emxl-systollic
fractiolmi
et al,’’
olbtaimied
The
(less
with
represemitative
Doxige
measured
Strolke
responses
recolrdimigs
Svstem-77)
ejection
end-diastollic
(If
exercise).
mean
exercise.
method
mnimnms eml(1-svstollic
mnethox.I
and
the
Cohn
(If
time-HR
colnfidemice
speed
control
of exercise.
amid
first-pass
vemitricimlar
ventricular
the
mimiutes
derived
ejectiomi
segment
l)ackground-colrrected
from
at resting
(If exercise,
emid-diastollic
l)y
columits
(Fmmktmda
interruptio)mI
Angiograploy
determined
The
system
without
static
pressi,re).
DT-hIR
for the
the
o.’o)mltim)lmoumslv mflonitore(l,
To) evalmmate
amid three
Radkn,uclids’
Left
an
were
‘i’,
o)l)taimied
I)liase
and
with
the
(If 5#{176}
ami(I 100 at a colnstamit
were
early
after
a stress
0)11
(NIAT-2(XX.))
at slopes
stages
(If
timne
dolmie 30 muimiutes
was
lIlolold
for
81±12
12
<0.001
pressure.
mm
98±
NS
12
<0.001
<0.005
.
.
hg
Systolic
200
Control
115±
19
119±
17
NS
3 mimi olfexercise
133±31
136±31
NS
pvalue
<0.(XI5
<0.05
...
Control
74±10
77±7
3minofexercise
82±13
75±16
<0.001
NS
Diastolic
pvalue
Presstmre-IIR
NS
.
.
50
prooluct
Control
3 mnin ofexercise
p valise
NS
8.991
± 1,476
11,62,3±3,075
<0.0()5
9,517±
13,386±3,396
<0.001
1,325
100
150 HR
( beats/mm)
NS
<0.05
.
.
Fmo:uiom.: 1.
amid dynamic
Diastolic
exercise.
time-hR
Regression
relatiomis
curves
at three
mnint,tes
are stmperimpolsed
of static
on data
EIim1ts.
668
Diastolic
Downloaded From: http://publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21618/ on 05/14/2017
Time
dunng
Exercise
in MI (Hasegawa
et a!)
DT-HR
and
The
QS2-HR
DT was
443
(msec)
82
±
ms
and
dynamnic
exercise,
respectively),
ms
332
ms
(static
at control
(Fig
and
± 26
respectively)
significant
differences
between
static
DT-HR
exercise,
sponding
and
HR
and
HR
had
for
which
during
at
of exercise.
DT=e7iaom5exum
static
exercise
of
\
corre-
The
250
DT
\\\\
\
\
-0.99;
exercise;
p<O.00l)
dynamic
the
equmations
(r=
of
-0.97;
(r=
the
the
.-.
exercise
no
minutes
relation,
static
control
To) obtain
against
cl--a
300
were
at
three
plotted
minutes
19
±
exercise,
QS2
at
type
and
328
2). There
and
inverse
three
(static
was
exercise.
each
were:
p<O.OOl)
1 and
DT
were
a nonlinear
QS2
dynamic
relations
QS2
± 85 ms
and
dynamic
QS2-HR
DT
426
and
in
and
and
LVET
Relations
\
0
and
\
O\
mm-
at three
\
0
\
utes
dynamic
(If
linear
exercise.
inverse
relation,
QS2=474-1.8OxHR
minutes
(r=
of static
-0.90;
with
pared
at three
minutes
static
exercise.
Preejection
There
ular
were
ejection
QS2
a
significant
and
\
x
2.05
\Q
HR
\
(p<O.OS)
(p<O.OS)
was
exercise,
colm-
differences
in left
preejection
period
QS2
150 HR
(beats/mm)
and
ventricat control
Fmcuni
3. Left
vemitricimlar
ejection
time-hR
relation
at three
minutes
(If static
and
dynamic
exercise.
Regressioln
limies are
superimnpolsed
on data points.
LVET,
Left ventricular
ejection
time.
between
The
350
100
50
(msec)
\
0
of dynamic
of QS2
Time-HR
fl()
0\
three
Relations
time
200
were:
at
-
of DT
of dynamic
Ejection
Period-HR
had
HR
p<O.OOl)
=
5.23
minutes
and
three
shortening
Ventricular
Left
-0.84;
and
folr which
prolongation
a consequent
observed
(r=
at
A significant
with
QS2
equations
exercise;
p<O.OOl)
exercise.
The
the
0--c
static
.-.
dynamic
exercise
exercise
tion time-HR
time=355-1.61XHR
minutes
\
420
=
minutes
\
relation
ofstatic
time
\\\
and dynamic
exercise
equations
for the left
static
regression
exercise;
1 .77
-
and
HR
(r
left
.
ejectioln
p<O.()Ol)
A significant
from
minutes
significantly
ejectiolmi
at three
ventricular
0.84;
-
time
at three
was
=
ejection
observed
which
left vemitricular
-0.70;
p<O.O5)
exercise
ventricular
was
x
ofdynamic
ofleft
were:
(r=
(Fig 3; Table
2).
vemitricular
ejec-
control
than
imig
(p<O.OS)
dymiamic
(If
longer
at three
lengthen
exercise,
that
of
static
\-
300
00
exercise.
\
preejection
type
minutes
(If
than
that
p<O.00l).
\
250
Table
did
period
in either
\\
to) left
In contrast
not show
of exercise.
dynamic
of
static
2-Preejection
was
(76
Data
200-
Preejection
1
_____7/__
50
.
--- 100
period,
HR
( beats/mm)
systolIc-hR
Regressiomi
relations
lines
at three
minutes
are supenmpolsed
Left
with
sigmiificantly
±
8
vs
Static
Dynamic
Exercise
Exercise
110±
103±18
76±8
NS
<0.001
218±20
223±26
214 ± 28
246 ± 24
ventricular
time,
nis;
Ejection
of Exercise
3minofexercise
Left
shorter
103 ± 18
Ventricular
Minutes
HR
at three
p Value
ms
12
110±9
NS
<0.O()1
. .
ejection
ms
Control
Fm:umsm: 2. Electromechamiical
(If static
and dynamic
exercise.
(In data points.
and
Three
tinie,
period
Control
pvalue
150
a correlation
exercise
and
ejection
Preejection
exercise
Period
Time at Control
ventricular
3 miii
ofexercise
p value
NS
CHEST
Downloaded From: http://publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21618/ on 05/14/2017
NS
<(1.05
<0.001
I 98 I 3 I SEPTEMBER,
.
1990
.
669
Radionuclide
Angiograpli
Ejectiolmi
ular
was
fractiomi
end-diastolic
59 ± 10
significantly
to) 51
ml
HR
at a 1)eak
fractioln,
left
stroke
47
vollunie
was
volume
at control,
105
±
ventricular
which
Ier
beats
and
minute
emid-diastolic
79 ± 9
(ejection
volume,
three
amid
stolic
volume
from
(at
Thus,
exercise
evaluated,
ischemia
less
than
maximiial
stress
simice
than
in dvmiamiiic
and
systolic
inimiutes
(If
exercise
were
dynaniic
exercise,
The
the
were
ear
and
at
pulse
minutes
static
exercise.
derivative,
of the
pulse
of
transmission
time,
is a reliable
ptmlse miieastmremiiemit
for determining
all (If the
systolic
time
intervals
and
DT
during
exercise.257
The duratioln
ofdiastole
is determined
by
HR
(cardiac
in HR
cycle)
two)
mnain
left
were
sigmiificant
of
Despite
au
ejectiolmi
time
at
wv
given
1 amid 2). The
timiic
ollserved
time
ejection
o)fthe
are
HR
initial
iii
HR.
comitracting
early
phase
to)
with
volume,
with
an
inverse
miiuscles
exercise
were
static
dynamic
exercise
customary
an
expected
relation.’7’
on the
iiiumscle
vemious
at
the
for
initiating
and
demand.
beginning
a disproporgiven
with
HR
con-
(rightward
and
the
dispro-
shift
pressure-HR
of dynamic
that
pres-
oxygen
in
(downward
higher
in
reduc-
a higher
curve)
DT
HR
compared
hand,
myocardial
(If
DT32’
of the
product
exercise
have
of myocardial
in
a potential
oxygen
supply
H, Rittgers
SE,
in diastollic
1979;
et al.
T,
time
failure.
during
low-level
inyocardial
V
amid its
R,
derivative:
1973;
VQ.
Chest
T,
the
Inada
late
1989;
and
Diastolic
114:1192-98
time
by
physiologic
stress
ear
appli-
testing:
phomiocardiograni.
M.
hospital
96:601-05
Ejection
clinical
48:239-46
Noninvasive
(If the
folr elimination
in
DII.
Spodick
CV
J 1987;
, Iwasaka
N
time
59: 1089-92
Leier
exercise
Y,
diastolic
1987;
Heart
imifarction.
Chirife
Circimlation
DH,
Lance
Am
agents.
, Takayama
M
DV,
T, Takahashi
Sugiura
ofacute
Matsutani
Ofl ventricular
11, Umiverferth
heart
AM.
pharmacologic
Am J Cardiol
disease.
in congestive
N,
(If exercise
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left
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164 ± 39 ml,
14
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ml
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Am
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PM,
angiography.
13
II,
angiocardiography
Disease
Update
University
of Arizona
Health
Sciences
Center
will present
this program
Ventana
Canyon
Resort,
Tucson.
For more information,
contact
the University
of Medicine,
Continuing
Medical
Educatiomi,
Tucson
85724 (6()2:626-7832).
CHEST
Downloaded From: http://publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21618/ on 05/14/2017
October
6 at
of Arizona
I 98 I 3 I SEPTEMBER,
1990
671