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. 1984 Apr;51(4):386–394. doi: 10.1136/hrt.51.4.386

Assessment of aortocoronary bypass grafting using exercise ST segment/heart rate relation.

M M Kardash, R M Boyle, D A Watson, J B Stoker, D A Mary, R J Linden
PMCID: PMC481519  PMID: 6608367

Abstract

The maximal rate of progression of ST segment depression relative to increases in heart rate (maximal ST/HR slope) has recently been shown to be an accurate index of the presence and the severity of coronary heart disease in patients with angina. The value of this new exercise test was assessed in patients undergoing aortocoronary bypass. The maximal ST/HR slope and the results of coronary angiography were obtained in each of 46 patients before aortocoronary bypass surgery and in 26 of the 46 patients six months after the operation. At each stage of the investigation the maximal ST/HR slope detected without false results the absence and the number of significantly diseased vessels as shown by angiocardiography. As in previous findings the ranges of the maximal ST/HR slope showed no overlap between the four groups of patients: those with no significant disease and those with single, double, or triple vessel disease. In each of the 46 patients in whom the maximal ST/HR slope was determined before operation and three months afterwards the slope was lower after operation than before, indicating improvement. Follow up examinations showed that the maximal ST/HR slopes accurately detected the number of patent grafts used to bypass significantly diseased coronary arteries. Furthermore, the development of a significant narrowing or occlusion in any vein graft caused an increase in the maximal ST/HR slope which was equivalent to the value of single vessel disease. It is suggested that the maximal ST/HR slope may be used reliably in individual patients to indicate restoration of adequate blood supply to the myocardium after successfully aortorcoronary bypass surgery and the to detect in the period of six months after the operation the degree of severity of coronary heart disease whether it is caused by occlusion of the graft of significant disease of the coronary arteries.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baron D. W., Poole-Wilson P. A., Rickards A. F. Maximal 12-lead exercise testing for prediction of severity of coronary artery disease. Eur J Cardiol. 1980;11(4):259–267. [PubMed] [Google Scholar]
  2. Bourassa M. G., Campeau L., Lespérance J. Effects of bypass surgery on the coronary circulation: incidence and effects of vein graft occlusion. Cardiovasc Clin. 1977;8(2):107–118. [PubMed] [Google Scholar]
  3. Bourassa M. G., Campeau L., Lespérance J., Grondin C. M. Changes in grafts and coronary arteries after saphenous vein aortocoronary bypass surgery: results at repeat angiography. Circulation. 1982 Jun;65(7 Pt 2):90–97. doi: 10.1161/01.cir.65.7.90. [DOI] [PubMed] [Google Scholar]
  4. Chaitman B. R., Waters D. D., Bourassa M. G., Tubau J. F., Wagniart P., Ferguson R. J. The importance of clinical subsets in interpreting maximal treadmill exercise test results: the role of multiple-lead ECG systems. Circulation. 1979 Mar;59(3):560–570. doi: 10.1161/01.cir.59.3.560. [DOI] [PubMed] [Google Scholar]
  5. 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]
  6. Elamin M. S., Boyle R., Kardash M. M., Smith D. R., Stoker J. B., Whitaker W., Mary D. A., Linden R. J. Accurate detection of coronary heart disease by new exercise test. Br Heart J. 1982 Oct;48(4):311–320. doi: 10.1136/hrt.48.4.311. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Elamin M. S., Mary D. A., Smith D. R., Linden R. J. Prediction of severity of coronary artery disease using slope of submaximal ST segment/heart rate relationship. Cardiovasc Res. 1980 Dec;14(12):681–691. doi: 10.1093/cvr/14.12.681. [DOI] [PubMed] [Google Scholar]
  8. Epstein S. E. Implications of probability analysis on the strategy used for noninvasive detection of coronary artery disease. Role of single or combined use of exercise electrocardiographic testing, radionuclide cineangiography and myocardial perfusion imaging. Am J Cardiol. 1980 Sep;46(3):491–499. doi: 10.1016/0002-9149(80)90020-x. [DOI] [PubMed] [Google Scholar]
  9. 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]
  10. Fox K., England D., Jonathan A., Selwyn A. Precordial surface mapping of the exercise ECG. Br J Hosp Med. 1982 Mar;27(3):291-2, 295, 297-9. [PubMed] [Google Scholar]
  11. Kardash M., Boyle R., Elamin M. S., Stoker J. B., Mary D. A., Linden R. J. Detection of severity of coronary artery disease by the ST segment/heart rate relationship in patients on beta-blocker therapy. Cardiovasc Res. 1982 Sep;16(9):508–515. doi: 10.1093/cvr/16.9.508. [DOI] [PubMed] [Google Scholar]
  12. Kent K. M., Borer J. S., Green M. V., Bacharach S. L., McIntosh C. L., Conkle D. M., Epstein S. E. Effects of coronary-artery bypass on global and regional left ventricular function during exercise. N Engl J Med. 1978 Jun 29;298(26):1434–1439. doi: 10.1056/NEJM197806292982602. [DOI] [PubMed] [Google Scholar]
  13. 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]
  14. 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]
  15. Linden R. J., Mary D. A. Limitations and reliability of exercise electrocardiography tests in coronary heart disease. Cardiovasc Res. 1982 Dec;16(12):675–710. doi: 10.1093/cvr/16.12.675. [DOI] [PubMed] [Google Scholar]
  16. Luksic I. Y., Raffo J. A., Mary D. A., Watson D. A., Deverall P. B., Linden R. J. Use of exercise tests in assessment of the functional result of aortocoronary bypass surgery. Thorax. 1981 Jun;36(6):428–434. doi: 10.1136/thx.36.6.428. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Massie B. M., Botvinick E. H., Brundage B. H., Greenberg B., Shames D., Gelberg H. Relationship of regional myocardial perfusion to segmental wall motion: a physiologic basis for understanding the presence and reversibility of asynergy. Circulation. 1978 Dec;58(6):1154–1163. doi: 10.1161/01.cir.58.6.1154. [DOI] [PubMed] [Google Scholar]
  18. Pfisterer M., Emmenegger H., Schmitt H. E., Müller-Brand J., Hasse J., Grädel E., Laver M. B., Burckhardt D., Burkart F. Accuracy of serial myocardial perfusion scintigraphy with thallium-201 for prediction of graft patency early and late after coronary artery bypass surgery. A controlled prospective study. Circulation. 1982 Nov;66(5):1017–1024. doi: 10.1161/01.cir.66.5.1017. [DOI] [PubMed] [Google Scholar]
  19. 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]
  20. Rahimtoola S. H. Coronary bypass surgery for chronic angina--1981. A perspective. Circulation. 1982 Feb;65(2):225–241. doi: 10.1161/01.cir.65.2.225. [DOI] [PubMed] [Google Scholar]
  21. Sabbah H. N., Stein P. D. Hemodynamics of multiple versus single 50 percent coronary arterial stenoses. Am J Cardiol. 1982 Aug;50(2):276–280. doi: 10.1016/0002-9149(82)90177-1. [DOI] [PubMed] [Google Scholar]
  22. Serruys P. W., Rousseau M. F., Cosyns J., Ponlot R., Brasseur L. A., Detry J. M. Haemodynamics during maximal exercise after coronary bypass surgery. Br Heart J. 1978 Nov;40(11):1205–1215. doi: 10.1136/hrt.40.11.1205. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. 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]
  24. Simoons M. L., Block P. Toward the optimal lead system and optimal criteria for exercise electrocardiography. Am J Cardiol. 1981 Jun;47(6):1366–1374. doi: 10.1016/0002-9149(81)90270-8. [DOI] [PubMed] [Google Scholar]
  25. Simoons M. L., Hugenholtz P. G., Ascoop C. A., Distelbrink C. A., de Land P. A., Vinke R. V. Quantitation of exercise electrocardiography. Circulation. 1981 Mar;63(3):471–475. doi: 10.1161/01.cir.63.3.471. [DOI] [PubMed] [Google Scholar]
  26. 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]
  27. Talbot S., Kilpatrick D., Oakley D. Coronary artery bypass surgery. Assessment of graft patency by exercise testing. Eur Heart J. 1982 Aug;3(4):348–352. doi: 10.1093/oxfordjournals.eurheartj.a061317. [DOI] [PubMed] [Google Scholar]
  28. 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]

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