Biphasic relaxation-frequency relations in patients with effort angina pectoris: A new marker of myocardial demand ischemia

Hisashi Umeda, Mitsunori Iwase, Hideo Izawa, Takao Nishizawa, Makoto Nonokawa, Satoshi Isobe, Akiko Noda, Kohzo Nagata, Hitoshi Ishihara, Mitsuhiro Yokota

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Abstract

Background: Relaxation-frequency relations (RFR) during demand ischemia have not been fully examined in patients with effort angina pectoris (AP). We sought to clarify the effects of pacing and exercise on RFR in patients with AP. Methods: We recorded left ventricular (LV) pressures during rapid atrial pacing and symptom-limited supine bicycle exercise. RFR were analyzed in 24 patients with AP and 10 controls. Results: LV pressure half-time (T 1/2 ) in controls was gradually shortened with an increase in heart rate (HR) during pacing (-19% ± 6% at peak HR). The changes in T 1/2 during pacing were biphasic with initial shortening (-12% ± 5% at the critical HR) followed by prolongation (-3% ± 7% at peak HR) in all patients with AP. The critical HR, at which T 1/2 was minimum, preceded the HR at 0.1-mV ST-segment depression, and finally chest pain occurred. The critical HR was correlated negatively with the severity of ischemia as assessed by thallium-201 scintigraphy. T 1/2 was remarkably shortened during exercise in controls (-41% ± 10% at peak exercise). In patients with AP, 2 distinct patterns of RFR were observed during exercise. T 1/2 was shortened progressively (-37% ± 8% at peak exercise) in 15 patients, whereas RFR remained biphasic (-21% ± 10% at the critical HR and -11% ± 11% at peak exercise) in the other 9 patients. Coronary angiography and exercise scintigraphy suggested more severe ischemia in patients with biphasic RFR during exercise. Conclusions: Impaired RFR might be the most sensitive parameter of pacing-induced ischemia. The critical HR was closely related with severity of ischemia. Adverse effects of ischemia on LV relaxation may be alleviated by exercise.

Original languageEnglish
Pages (from-to)75-83
Number of pages9
JournalAmerican Heart Journal
Volume146
Issue number1
DOIs
Publication statusPublished - 01-07-2003
Externally publishedYes

Fingerprint

Angina Pectoris
Myocardial Ischemia
Exercise
Heart Rate
Ischemia
Ventricular Pressure
Radionuclide Imaging
Thallium
Coronary Angiography
Chest Pain

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Umeda, Hisashi ; Iwase, Mitsunori ; Izawa, Hideo ; Nishizawa, Takao ; Nonokawa, Makoto ; Isobe, Satoshi ; Noda, Akiko ; Nagata, Kohzo ; Ishihara, Hitoshi ; Yokota, Mitsuhiro. / Biphasic relaxation-frequency relations in patients with effort angina pectoris : A new marker of myocardial demand ischemia. In: American Heart Journal. 2003 ; Vol. 146, No. 1. pp. 75-83.
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title = "Biphasic relaxation-frequency relations in patients with effort angina pectoris: A new marker of myocardial demand ischemia",
abstract = "Background: Relaxation-frequency relations (RFR) during demand ischemia have not been fully examined in patients with effort angina pectoris (AP). We sought to clarify the effects of pacing and exercise on RFR in patients with AP. Methods: We recorded left ventricular (LV) pressures during rapid atrial pacing and symptom-limited supine bicycle exercise. RFR were analyzed in 24 patients with AP and 10 controls. Results: LV pressure half-time (T 1/2 ) in controls was gradually shortened with an increase in heart rate (HR) during pacing (-19{\%} ± 6{\%} at peak HR). The changes in T 1/2 during pacing were biphasic with initial shortening (-12{\%} ± 5{\%} at the critical HR) followed by prolongation (-3{\%} ± 7{\%} at peak HR) in all patients with AP. The critical HR, at which T 1/2 was minimum, preceded the HR at 0.1-mV ST-segment depression, and finally chest pain occurred. The critical HR was correlated negatively with the severity of ischemia as assessed by thallium-201 scintigraphy. T 1/2 was remarkably shortened during exercise in controls (-41{\%} ± 10{\%} at peak exercise). In patients with AP, 2 distinct patterns of RFR were observed during exercise. T 1/2 was shortened progressively (-37{\%} ± 8{\%} at peak exercise) in 15 patients, whereas RFR remained biphasic (-21{\%} ± 10{\%} at the critical HR and -11{\%} ± 11{\%} at peak exercise) in the other 9 patients. Coronary angiography and exercise scintigraphy suggested more severe ischemia in patients with biphasic RFR during exercise. Conclusions: Impaired RFR might be the most sensitive parameter of pacing-induced ischemia. The critical HR was closely related with severity of ischemia. Adverse effects of ischemia on LV relaxation may be alleviated by exercise.",
author = "Hisashi Umeda and Mitsunori Iwase and Hideo Izawa and Takao Nishizawa and Makoto Nonokawa and Satoshi Isobe and Akiko Noda and Kohzo Nagata and Hitoshi Ishihara and Mitsuhiro Yokota",
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Umeda, H, Iwase, M, Izawa, H, Nishizawa, T, Nonokawa, M, Isobe, S, Noda, A, Nagata, K, Ishihara, H & Yokota, M 2003, 'Biphasic relaxation-frequency relations in patients with effort angina pectoris: A new marker of myocardial demand ischemia', American Heart Journal, vol. 146, no. 1, pp. 75-83. https://doi.org/10.1016/S0002-8703(03)00149-2

Biphasic relaxation-frequency relations in patients with effort angina pectoris : A new marker of myocardial demand ischemia. / Umeda, Hisashi; Iwase, Mitsunori; Izawa, Hideo; Nishizawa, Takao; Nonokawa, Makoto; Isobe, Satoshi; Noda, Akiko; Nagata, Kohzo; Ishihara, Hitoshi; Yokota, Mitsuhiro.

In: American Heart Journal, Vol. 146, No. 1, 01.07.2003, p. 75-83.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Biphasic relaxation-frequency relations in patients with effort angina pectoris

T2 - A new marker of myocardial demand ischemia

AU - Umeda, Hisashi

AU - Iwase, Mitsunori

AU - Izawa, Hideo

AU - Nishizawa, Takao

AU - Nonokawa, Makoto

AU - Isobe, Satoshi

AU - Noda, Akiko

AU - Nagata, Kohzo

AU - Ishihara, Hitoshi

AU - Yokota, Mitsuhiro

PY - 2003/7/1

Y1 - 2003/7/1

N2 - Background: Relaxation-frequency relations (RFR) during demand ischemia have not been fully examined in patients with effort angina pectoris (AP). We sought to clarify the effects of pacing and exercise on RFR in patients with AP. Methods: We recorded left ventricular (LV) pressures during rapid atrial pacing and symptom-limited supine bicycle exercise. RFR were analyzed in 24 patients with AP and 10 controls. Results: LV pressure half-time (T 1/2 ) in controls was gradually shortened with an increase in heart rate (HR) during pacing (-19% ± 6% at peak HR). The changes in T 1/2 during pacing were biphasic with initial shortening (-12% ± 5% at the critical HR) followed by prolongation (-3% ± 7% at peak HR) in all patients with AP. The critical HR, at which T 1/2 was minimum, preceded the HR at 0.1-mV ST-segment depression, and finally chest pain occurred. The critical HR was correlated negatively with the severity of ischemia as assessed by thallium-201 scintigraphy. T 1/2 was remarkably shortened during exercise in controls (-41% ± 10% at peak exercise). In patients with AP, 2 distinct patterns of RFR were observed during exercise. T 1/2 was shortened progressively (-37% ± 8% at peak exercise) in 15 patients, whereas RFR remained biphasic (-21% ± 10% at the critical HR and -11% ± 11% at peak exercise) in the other 9 patients. Coronary angiography and exercise scintigraphy suggested more severe ischemia in patients with biphasic RFR during exercise. Conclusions: Impaired RFR might be the most sensitive parameter of pacing-induced ischemia. The critical HR was closely related with severity of ischemia. Adverse effects of ischemia on LV relaxation may be alleviated by exercise.

AB - Background: Relaxation-frequency relations (RFR) during demand ischemia have not been fully examined in patients with effort angina pectoris (AP). We sought to clarify the effects of pacing and exercise on RFR in patients with AP. Methods: We recorded left ventricular (LV) pressures during rapid atrial pacing and symptom-limited supine bicycle exercise. RFR were analyzed in 24 patients with AP and 10 controls. Results: LV pressure half-time (T 1/2 ) in controls was gradually shortened with an increase in heart rate (HR) during pacing (-19% ± 6% at peak HR). The changes in T 1/2 during pacing were biphasic with initial shortening (-12% ± 5% at the critical HR) followed by prolongation (-3% ± 7% at peak HR) in all patients with AP. The critical HR, at which T 1/2 was minimum, preceded the HR at 0.1-mV ST-segment depression, and finally chest pain occurred. The critical HR was correlated negatively with the severity of ischemia as assessed by thallium-201 scintigraphy. T 1/2 was remarkably shortened during exercise in controls (-41% ± 10% at peak exercise). In patients with AP, 2 distinct patterns of RFR were observed during exercise. T 1/2 was shortened progressively (-37% ± 8% at peak exercise) in 15 patients, whereas RFR remained biphasic (-21% ± 10% at the critical HR and -11% ± 11% at peak exercise) in the other 9 patients. Coronary angiography and exercise scintigraphy suggested more severe ischemia in patients with biphasic RFR during exercise. Conclusions: Impaired RFR might be the most sensitive parameter of pacing-induced ischemia. The critical HR was closely related with severity of ischemia. Adverse effects of ischemia on LV relaxation may be alleviated by exercise.

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