Document Detail

Ischemic threshold during two exercise testing protocols and during ambulatory electrocardiographic monitoring.
MedLine Citation:
PMID:  8354797     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aim of this study was to examine the dependence of the ischemic threshold during exercise testing on the exercise protocol employed and to determine the relation between the ischemic thresholds observed during exercise and during daily activity. BACKGROUND: The ischemic threshold (heart rate at 1-mm ST segment depression) during daily activity has been reported to be lower than that observed during exercise testing. Recent reports have hypothesized that this difference is probably dependent on the exercise protocol employed. METHODS: Twenty-two patients with known coronary artery disease, not receiving antianginal medications, were evaluated by repeated exercise testing according to the Bruce and the modified Davidson protocols and by 48-h ambulatory electrocardiographic monitoring. RESULTS: Although the heart rate at 1-mm ST segment depression was somewhat lower with the Davidson than with the Bruce protocol (112 +/- 14 vs. 115 +/- 14 beats/min), the rate-pressure product at 1-mm ST segment depression was similar during the two protocols (16,900 +/- 4,000 vs. 17,700 +/- 3,600). The mean heart rate (100 + 12 beats/min) at 1-mm ST segment depression during ambulatory ischemic episodes (n = 137) was significantly lower than that observed during both exercise protocols (p < 0.001 for both comparisons). CONCLUSIONS: Exercise-induced ischemia occurs at a relatively fixed threshold that is mainly dependent on myocardial oxygen demand and is independent of the exercise protocol employed. Ischemia on ambulatory monitoring, however, occurs at a much more variable threshold that is commonly lower than that observed during exercise and is therefore dependent on other factors in addition to increased demand.
J Benhorin; G Pinsker; M Moriel; A Gavish; D Tzivoni; S Stern
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  22     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1993 Sep 
Date Detail:
Created Date:  1993-09-23     Completed Date:  1993-09-23     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  671-7     Citation Subset:  AIM; IM    
Heiden Department of Cardiology, Bikur Cholim Hospital, Jerusalem, Israel.
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MeSH Terms
Analysis of Variance
Coronary Disease / epidemiology,  physiopathology
Electrocardiography, Ambulatory / instrumentation,  methods*,  statistics & numerical data
Exercise Test / instrumentation,  methods*,  statistics & numerical data
Exercise Tolerance / physiology*
Heart Rate
Middle Aged
Myocardial Ischemia / epidemiology,  physiopathology*
Reproducibility of Results
Time Factors
Comment In:
J Am Coll Cardiol. 1994 Jul;24(1):271-2   [PMID:  8054043 ]

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