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. 1981 Jun;36(6):428–434. doi: 10.1136/thx.36.6.428

Use of exercise tests in assessment of the functional result of aortocoronary bypass surgery

I Y Luksic 1,2, J A Raffo 1,2, D A S G Mary 1,2, D A Watson 1,2, P B Deverall 1,2, R J Linden 1,2
PMCID: PMC471528  PMID: 6976014

Abstract

The value of an objective exercise test for the assessment of the functional results of aortocoronary bypass was investigated in 19 patients who were studied before and six months after the operation. For positive tests the end point was defined as a net ST segment depression of 0·1 mv 80 ms after the J point of the ECG. For negative tests the end point was 85% of the age-predicted maximal heart rate response. One patient who was not able to attain either of these points after the operation was excluded. In the remaining 18 patients three indices were used in the analysis. First, the heart rate (HR) and the product of heart rate and systolic blood pressure (RPP) were measured at the defined level of ST segment depression during positive exercise tests to yield HR/ST and RPP/ST threshold respectively. Second, the HR and RPP were measured at the end point of the negative tests. Third, the duration of exercise till the end point of the tests was measured. In each patient the duration of the postoperative test was longer than that of the preoperative test. While all the patients had a positive exercise test before the operation, the test was negative in 11 after it. In 10 of these 11 patients the HR and RPP attained at the end point of the postoperative test had increased; the HR and RPP remained unchanged in one patient. Positive tests were still present in seven of the 18 patients. In five of these the HR/ST threshold and RPP/ST threshold were greater after than before operation, and they remained unchanged in two. An improvement in myocardial blood supply after aortocoronary bypass was suggested indirectly by the ability to attain, during exercise, a higher HR and RPP at the end point of the test. The test proved especially valuable in patients who retained a positive exercise test after the operation.

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Selected References

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  1. Amsterdam E. A., Hughes J. L., DeMaria A. N., Zelis R., Mason D. T. Indirect assessment of myocardial oxygen consumption in the evaluation of mechanisms and therapy of angina pectoris. Am J Cardiol. 1974 May 20;33(6):737–743. doi: 10.1016/0002-9149(74)90214-8. [DOI] [PubMed] [Google Scholar]
  2. Aronow W. S., Stemmer E. A. Two-year follow-up of angina pectoris: medical or surgical therapy. Ann Intern Med. 1975 Feb;82(2):208–212. doi: 10.7326/0003-4819-82-2-208. [DOI] [PubMed] [Google Scholar]
  3. Bailey I. K., Griffith L. S., Rouleau J., Strauss W., Pitt B. Thallium-201 myocardial perfusion imaging at rest and during exercise. Comparative sensitivity to electrocardiography in coronary artery disease. Circulation. 1977 Jan;55(1):79–87. doi: 10.1161/01.cir.55.1.79. [DOI] [PubMed] [Google Scholar]
  4. Barry W. H., Pfeifer J. F., Lipton M. J., Tilkian A. R., Hultgren H. N. Effects of coronary artery bypass grafting on resting and exercise hemodynamics in patients with stable angina pectoris: a prospective, randomized study. Am J Cardiol. 1976 May;37(6):823–830. doi: 10.1016/0002-9149(76)90105-3. [DOI] [PubMed] [Google Scholar]
  5. Bartel A. G., Behar V. S., Peter R. H., Orgain E. S., Kong Y. Exercise stress testing in evaluation of aortocoronary bypass surgery. Report of 123 patients. Circulation. 1973 Jul;48(1):141–148. doi: 10.1161/01.cir.48.1.141. [DOI] [PubMed] [Google Scholar]
  6. Benchimol A., dos Santos A., Desser K. B. Relief of angina pectoris in patients with occluded coronary bypass grafts. Am J Med. 1976 Mar;60(3):339–343. doi: 10.1016/0002-9343(76)90749-x. [DOI] [PubMed] [Google Scholar]
  7. Block T. A., Murray J. A., English M. T. Improvement in exercise performance after unsuccessful myocardial revascularization. Am J Cardiol. 1977 Nov;40(5):673–680. doi: 10.1016/0002-9149(77)90181-3. [DOI] [PubMed] [Google Scholar]
  8. Chatterjee K., Swan H. J., Parmley W. W., Sustaita H., Marcus H. S., Matloff J. Influence of direct myocardial revascularization on left ventricular asynergy and function in patients with coronary heart disease. With and without previous myocardial infarction. Circulation. 1973 Feb;47(2):276–286. doi: 10.1161/01.cir.47.2.276. [DOI] [PubMed] [Google Scholar]
  9. Clausen J. P. Circulatory adjustments to dynamic exercise and effect of physical training in normal subjects and in patients with coronary artery disease. Prog Cardiovasc Dis. 1976 May-Jun;18(6):459–495. doi: 10.1016/0033-0620(76)90012-8. [DOI] [PubMed] [Google Scholar]
  10. DIMOND E. G., KITTLE C. F., CROCKETT J. E. Comparison of internal mammary artery ligation and sham operation for angina pectoris. Am J Cardiol. 1960 Apr;5:483–486. doi: 10.1016/0002-9149(60)90105-3. [DOI] [PubMed] [Google Scholar]
  11. Ellestad M. H., Cooke B. M., Jr, Greenberg P. S. Stress testing: clinical application and predictive capacity. Prog Cardiovasc Dis. 1979 May-Jun;21(6):431–460. doi: 10.1016/0033-0620(79)90025-2. [DOI] [PubMed] [Google Scholar]
  12. Fortuin N. J., Weiss J. L. Exercise stress testing. Circulation. 1977 Nov;56(5):699–712. doi: 10.1161/01.cir.56.5.699. [DOI] [PubMed] [Google Scholar]
  13. Frick M. H. An appraisal of symptom relief after coronary bypass grafting. Postgrad Med J. 1976 Dec;52(614):765–769. doi: 10.1136/pgmj.52.614.765. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Frick M. H., Harjola P. T., Valle M. Effect of aorto-coronary grafts and native vessel patency on the occurrence of angina pectoris after coronary bypass surgery. Br Heart J. 1975 Apr;37(4):414–419. doi: 10.1136/hrt.37.4.414. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Griffith L. S., Achuff S. C., Conti C. R., Humphries J. O., Brawley R. K., Gott V. L., Ross R. S. Changes in intrinsic coronary circulation and segmental ventricular motion after saphenous-vein coronary bypass graft surgery. N Engl J Med. 1973 Mar 22;288(12):589–595. doi: 10.1056/NEJM197303222881201. [DOI] [PubMed] [Google Scholar]
  16. Hammermeister K. E., Kennedy J. W., Hamilton G. W., Stewart D. K., Gould K. L., Lipscomb K., Murray J. A. Aortocoronary saphenous-vein bypass. Failure of successful grafting to improve resting left ventricular function in chronic angina. N Engl J Med. 1974 Jan 24;290(4):186–192. doi: 10.1056/NEJM197401242900403. [DOI] [PubMed] [Google Scholar]
  17. Kloster F. E., Kremkau E. L., Rahimtoola S. H., Ritzmann L. W., Griswold H. E., Neill W. A., Rösch J., Starr A. Prospective randomized study of coronary bypass surgery for chronic stable angina. Cardiovasc Clin. 1977;8(2):145–156. [PubMed] [Google Scholar]
  18. Knoebel S. B., McHenry P. L., Phillips J. F., Lowe D. K. The effect of aortocoronary bypass grafts on myocardial blood flow reserve and treadmill exercise tolerance. Circulation. 1974 Oct;50(4):685–693. doi: 10.1161/01.cir.50.4.685. [DOI] [PubMed] [Google Scholar]
  19. Kolibash A. J., Call T. D., Bush C. A., Tetalman M. R., Lewis R. P. Myocardial perfusion as an indicator of graft patency after coronary artery bypass surgery. Circulation. 1980 May;61(5):882–887. doi: 10.1161/01.cir.61.5.882. [DOI] [PubMed] [Google Scholar]
  20. Kolibash A. J., Goodenow J. S., Bush C. A., Tetalman M. R., Lewis R. P. Improvement of myocardial perfusion and left ventricular function after coronary artery bypass grafting in patients with unstable angina. Circulation. 1979 Jan;59(1):66–74. doi: 10.1161/01.cir.59.1.66. [DOI] [PubMed] [Google Scholar]
  21. Lapin E. S., Murray J. A., Bruce R. A., Winterscheid L. Changes in maximal exercise performance in the evaluation of saphenous vein bypass surgery. Circulation. 1973 Jun;47(6):1164–1173. doi: 10.1161/01.cir.47.6.1164. [DOI] [PubMed] [Google Scholar]
  22. Mathur V. S., Guinn G. A., Anastassiades L. C., Chahine R. A., Korompai F. L., Montero A. C., Luchi R. J. Surgical treatment for stable angina pectoris. Prospective randomized study. N Engl J Med. 1975 Apr 3;292(14):709–713. doi: 10.1056/NEJM197504032921401. [DOI] [PubMed] [Google Scholar]
  23. McGowan R. L., Martin N. D., Zaret B. L., Hall R. R., Bryson A. L., Strauss H. W., Flamm M. D. Diagnostic accuracy of noninvasive myocardial imaging for coronary artery disease: an electrocardiographic and angiographic correlation. Am J Cardiol. 1977 Jul;40(1):6–10. doi: 10.1016/0002-9149(77)90092-3. [DOI] [PubMed] [Google Scholar]
  24. McIntosh H. D., Garcia J. A. The first decade of aortocoronary bypass grafting, 1967-1977. A review. Circulation. 1978 Mar;57(3):405–431. doi: 10.1161/01.cir.57.3.405. [DOI] [PubMed] [Google Scholar]
  25. Merrill A. J., Jr, Thomas C., Schechter E., Cline R., Armstrong R., Stanford W. Coronary bypass surgery. Value of maximal exercise testing in assessment of results. Circulation. 1975 Aug;52(2 Suppl):173–177. doi: 10.1161/01.cir.52.2.173. [DOI] [PubMed] [Google Scholar]
  26. Mnayer M., Chahine R. A., Raizner A. E. Mechanisms of angina relief in patients after coronary artery bypass surgery. Br Heart J. 1977 Jun;39(6):605–609. doi: 10.1136/hrt.39.6.605. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Nitter-Hauge S. Exercise ECG in evaluation of aortocoronary bypass surgery; report on 66 patients. Eur J Cardiol. 1979 Mar;9(3):191–198. [PubMed] [Google Scholar]
  28. Raffo J. A., Luksic I. Y., Kappagoda C. T., Mary D. A., Stoker J. B., Whitaker W., Linden R. J. Diagnostic value of routine exercise testing in hospital patients with angina pectoris. Br Med J. 1979 Aug 4;2(6185):295–297. doi: 10.1136/bmj.2.6185.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Raffo J. A., Luksic I. Y., Kappagoda C. T., Mary D. A., Whitaker W., Linden R. J. Effects of physical training on myocardial ischaemia in patients with coronary artery disease. Br Heart J. 1980 Mar;43(3):262–269. doi: 10.1136/hrt.43.3.262. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Robinson P. S., Williams B. T., Webb-Peploe M. M., Crowther A., Coltart D. J. Thallium-201 myocardial imaging in assessment of results of aortocoronary bypass surgery. Br Heart J. 1979 Oct;42(4):455–462. doi: 10.1136/hrt.42.4.455. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Selden R., Neill W. A., Ritzmann L. W., Okies J. E., Anderson R. P. Medical versus surgical therapy for acute coronary insufficiency. A randomized study. N Engl J Med. 1975 Dec 25;293(26):1329–1333. doi: 10.1056/NEJM197512252932601. [DOI] [PubMed] [Google Scholar]
  32. Shepherd R. L., Itscoitz S. B., Glancy D. L., Stinson E. B., Reis R. L., Olinger G. N., Clark C. E., Epstein S. E. Deterioration of myocardial function following aorto-coronary bypass operation. Circulation. 1974 Mar;49(3):467–475. doi: 10.1161/01.cir.49.3.467. [DOI] [PubMed] [Google Scholar]
  33. Strauss H. W., Pitt B. Evaluation of cardiac function and structure with radioactive tracer techniques. Circulation. 1978 Apr;57(4):645–654. doi: 10.1161/01.cir.57.4.645. [DOI] [PubMed] [Google Scholar]
  34. Wolf N. M., Kreulen T. H., Bove A. A., McDonough M. T., Kessler K. M., Strong M., LeMole G., Spann J. F. Left ventricular function following coronary bypass surgery. Circulation. 1978 Jul;58(1):63–70. doi: 10.1161/01.cir.58.1.63. [DOI] [PubMed] [Google Scholar]
  35. Zeft H. J., Manley J. C., Huston J. H., Tector A. J., Auer J. E., Johnson W. D. Left main coronary artery stenosis; results of coronary bypass surgery. Circulation. 1974 Jan;49(1):68–76. doi: 10.1161/01.cir.49.1.68. [DOI] [PubMed] [Google Scholar]

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