The prognostic value of a limited treadmill exercises test performed one day before hospital discharge after acute myocardial infarction was studied in 210 consecutive patients who had no over heart failure and had been free of chest pain for at least four days. No complications occurred. During a one-year follow-up period 28 of 43 patients (65 per cent) who had chest pain during the test reported angina, as compared with 60 of 167 (36 per cent) who had no chest pain during test (P less than 0.001). The one-year mortality rates were 2.1 per cent (three of 146) in patients without changes in the S-T segment during exercise and 27 per cent (17 of 64) in those with depression of the S-T segment (P less than 0.001). Sudden death occurred in one of 146 (0.7 per cent) patients who showed no change in the S-T segment and in 10 of 64 (16 per cent) with depression of the segment (P less than 0.001). Thus, a limited treadmill exercise test performed before hospital discharge after acute myocardial infarction is safe and can predict mortality in the subsequent year.

Prognostic Value of Exercise Testing Soon after Myocardial Infarction

https://www.amjmed.com/article/0002-9343(84)90437-6/pdf

Factors affecting sensitivity and specificity of exercise electrocardiography. Multivariable analysis.

A B S T R A C T In rats, muscle glycogen depletion has been associated with increased insulin action. Whether this also occurs in man has not been reported. After 4 d rest, 13 males (E Group) had a percutaneous muscle biopsy of the vastus lateralis muscle followed by a euglycemic clamp at plasma insulin =100 AU/ml and =1,900 MU/ml, with simultaneous indirect calorimetry. This was repeated 1 wk later, but after glycogendepleting exercise the night before the euglycemic clamp. Seven subjects underwent the same protocol but were also re-fed 100 g carbohydrate (CHO) after the exercise (EF group). In both groups, the mean muscle glycogen content was '40% lower (P < 0.01) after exercise compared with the muscle glycogen content measured after rest. In the E group, the mean muscle glycogen synthase activity (percent independent of glucose-6-phosphate) increased threefold (P < 0.001) after exercise, but increased only twofold in the EF group (P < 0.02 between groups). In both groups, the mean basal and insulinstimulatedCHO oxidation rates were lower in the postexercise, glycogen-depleted condition compared with the rested, glycogen-replete condition. The mean insulin-stimulated CHO storage rate increased significantly in the E group after exercise but not in the EF group. In the E group, the total insulin-stimulated CHO disposal rate (M) was 17 (P < 0.04) and 10% (P < 0.03) higher after exercise during the low and high dose insulin infusion, respectively. No significant changes in M were observed in the EF group. For all subjects, after rest and exercise, the M correlated with the CHO storage rates during the low (r = 0.80, P < 0.001) and high dose (r = 0.77, P < 0.001) insulin infusions. After exercise, the muscle glycogen synthase activity correlated with the CHO storage rate (r = 0.73, P < 0.002; r = 0.75, P < 0.002) during the low and high dose insulin infusions, respectively, and also with M (r = 0.64, P < 0.008; r = 0.57; P < 0.02).

/pdf/effect-of-muscle-glycogen-depletion-on-in-vivo-insulin-4jqyicpedj.pdf

Effect of muscle glycogen depletion on in vivo insulin action in man.

http://degreesofclarity.com/emsbasics/library/kern%20-%20MYOCARDIAL%20%20PERFUSION%20%20PRESSURE-%20%20A%20PREDICTOR%20%20OF%2024HOUR%20%20%20SURVIVAL%20%20DURING%20%20PROLONGED%20%20CARDIAC%20%20ARREST%20%20IN%20DOGS%20.pdf

Myocardial perfusion pressure: a predictor of 24-hour survival during prolonged cardiac arrest in dogs

https://www.amjmed.com/article/0002-9343(79)90476-5/pdf

Global and regional left ventricular response to bicycle exercise in coronary artery disease: Assessment by quantitative radionuclide angiocardiography

ALTHOUGH EXERCISE STRESS TESTING FOR CARDIAC PATIENTS has been in use for nearly 50 years, widespread acceptance of the technique as an important diagnostic tool in cardiology has been accomplished only recently. This has occurred with the recognition that patients with cardiac disease, even in advanced degree, can perform exercise safely under controlled conditions, and that objective information regarding cardiac functional capacity and the presence or absence of myocardial ischemia can be determined. In addition, epidemiologic follow-up studies and correlative studies comparing exercise electrocardiographic findings with coronary arteriograms have provided documentation of the sensitivity and specificity of the test in patients with coronary artery disease. In spite of considerable scientific input into this field in the last ten years, controversy regarding the usefulness and role of exercise stress testing in a variety of clinical settings persists.' This review will consider those aspects of exercise testing most relevant to the practicing physician. Several comprehensive monographs dealing with various aspects of this field have been published recently.2-8 The reader is referred to these sources for technical details or further discussion of some of the material covered here.

J L Weiss

Papers

Exercise stress testing.