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Biomedical subjects

D A Weiner

Publications and source records attributed to D A Weiner.

At least 19 recordsLinked to original sources
PubMed1995

Long-term prognostic value of exercise testing in men and women from the Coronary Artery Surgery Study (CASS) registry.

Many prior studies involving a predominantly male population have demonstrated the importance of exercise test results in determining the outcome of patients with coronary artery disease. The prognostic significance of exercise testing in women is unknown. In our study, a total of 3,086 men and 747 women underwent maximal treadmill exercise testing, coronary angiography, and were prospectively followed for up to 16 years. They were divided into 3 groups (high, intermediate, and low risk) on the basis of exercise testing. Sixteen-year survival based on exercise test groups ranged from 38% to 61% in men and from 44% to 79% in women (p < 0.001). Among men, 12-year survival was enhanced by coronary artery bypass surgery versus medical therapy in the high-risk subgroup (69% vs 55%, respectively, p = 0.0025), but the 2 therapies were similar in the intermediate- and low-risk subgroups. Among women, neither medical nor surgical therapy resulted in improved 12-year survival rates in any of the 3 subgroups. These results suggest that exercise testing is helpful in assessing long-term survival in men and women. However, only exercise testing in men could identify a high-risk subset whose survival was enhanced by coronary artery bypass graft surgery.

Adult↗
PubMed1995

Significance of silent myocardial ischemia during exercise testing in women: report from the Coronary Artery Surgery Study.

To evaluate the significance of silent myocardial ischemia during exercise testing in women compared to men, we analyzed the data on 1087 women and 3834 men who underwent exercise testing and coronary angiography from the Coronary Artery Surgery Study (CASS) registry. The patients were divided into three groups on the basis of the results of exercise testing: group 1, silent ischemia (253 women, 853 men); group 2, symptomatic ischemia (156 women, 1250 men); and group 3, no ischemia (678 women, 1731 men). The survival rate at 12 years for women was 80% for group 1, 75% for group 2, and 86% for group 3 (p = 0.0022); the survival rate for men was 69% for group 1, 69% for group 2, and 76% for group 3 (p < 0.001). In both men and women with silent ischemia, the 12-year survival rate was related to the severity of coronary artery disease (CAD) and ranged from 79% for women with one-vessel CAD to 46% for men with three-vessel CAD. Survival at 12 years was enhanced by coronary artery bypass graft surgery as compared to medical treatment in patients with silent ischemia and three-vessel CAD for men (61% vs 46%, respectively, p = 0.0014) but not for women (45% vs 50%, respectively, p = 0.98). These data suggest that silent ischemia in women and men adversely affects survival rate and that men may gain more benefit from coronary artery bypass graft surgery than women when three-vessel CAD is present.

Cardiac Catheterization↗
PubMed1992

Significance of silent myocardial ischemia after coronary artery bypass surgery.

The prevalence and prognostic significance of transient myocardial ischemia after coronary artery bypass grafting (CABG) were evaluated. In 3 studies, ischemia was found in an average of 24% of patients by ambulatory electrocardiographic monitoring at 3-12 months after CABG. An average of 36% of patients in 3 other studies experienced ischemic ST-segment depression during exercise testing at 4-50 months after CABG. Of the ischemic episodes, 77% were silent during exercise testing. In the Coronary Artery Surgery Study (CASS) randomized patient subsets, survival at 12 years was significantly lower for patients who had either silent or symptomatic ischemia during exercise testing at 6 months after CABG compared with those who had no ischemia.

Coronary Artery Bypass↗
PubMed1992

Safety and clinical use of exercise testing one to three days after percutaneous transluminal coronary angioplasty.

To evaluate both the safety and clinical use of predischarge symptom-limited exercise testing after successful uncomplicated percutaneous transluminal coronary angioplasty (PTCA), 100 patients were randomized to undergo exercise testing (n = 50) or no exercise testing (n = 50). There were no differences in clinical or angiographic characteristics between the groups. Exercise testing was performed 38 +/- 14 hours after PTCA. Patients who exercised achieved 71 +/- 12% of predicted maximal heart rate, with 38% reaching greater than or equal to stage III of the Bruce protocol. No patient in either group developed cardiac complications during 48-hour follow-up. Of the 11 patients with a positive test result, 92% had angiographically incomplete revascularization. Attending physicians (n = 16) were questioned both before and after exercise testing about when, after discharge, they would allow their patient to perform each of 11 specific activities of daily living. Questionnaires were administered to physicians at similar time frames for patients in the no-exercise group. Comparison of the responses between initial and repeat questionnaires showed that patients in the exercise group (with a test result negative for ischemia) were allowed to perform 7 of 11 activities, including return to work, earlier (p less than 0.05) than the no-exercise patients. These data indicate that in this well-defined group of patients, symptom-limited exercise testing early after PTCA appears to be safe, and alters physician management in allowing patients with a negative test result to return to various activities at an earlier date. Such testing may be useful in counseling patients after PTCA.

Activities of Daily Living↗
PubMed1992

Comparison of the clinical profile and outcome of women and men in cardiac rehabilitation.

Few data are available regarding the outcome of women in cardiac rehabilitation. To determine whether women differ from men in clinical profile and outcome, 225 consecutive patients were prospectively evaluated in an urban, multidisciplinary, exercise-based cardiac rehabilitation program. Among the 51 women (age 56 +/- 10) and 174 men (age 54 +/- 10), most were: white (84%), married (64%), employed (63%), had had myocardial infarction or revascularization, or both (66%), and traveled less than 10 miles to the program (92%). Risk profiles revealed obesity in 48% (mean Metropolitan Relative Weight = 124 +/- 22%), hypertension in 47%, smoking in 23%, diabetes in 16%, and mean cholesterol of 236 +/- 45 mg/dl. Compared with men, more women were nonwhite, unemployed, unmarried, hypertensive or diabetic (p less than 0.0001) and had higher cholesterol (p less than 0.01). Compliance rates were similar for women (51%) and men (63%) (p = not significant). Univariate predictors of program noncompliance differed between women and men. Initial exercise capacity was less for women than for men, but both groups achieved a similar training effect. Women increased their exercise time by 31% and peak METs by 30%, whereas men showed a 21% increase in exercise time and 16% increase in peak METs achieved (p less than 0.001). Thus, in this cardiac rehabilitation program, women have a less favorable risk factor profile and differ from men with regard to baseline demographics and predictors of program completion. Women, however, have similar rates of compliance and achieve the same improvement in functional capacity with training.

Adult↗
PubMed1992

Comparison of ischemic and physiologic responses during exercise tests in men using the standard and modified Bruce protocols.

The importance of low-level (warm-up) exercise for reducing exercise-induced myocardial ischemic symptoms in patients with coronary artery disease is well-recognized by clinicians. Whether altering the abruptness of exercise, such as that which occurs during different frequently used testing protocols, affects myocardial ischemic variables and maximal exercise capacity has not been resolved. This study seeks to determine the effects of altering the increment of work-rate change per exercise stage on both the ischemic threshold and maximal exercise capacity using 2 frequently used exercise testing protocols. Thirty-two patients with documented coronary artery disease and previously positive exercise tests (ischemic ST depression greater than or equal to 1.0 mm) performed symptom-limited exercise tests using both the standard and modified Bruce protocols in random order, 1 hour apart. Exercise electrocardiograms were analyzed to determine the ischemic threshold, defined as heart rate at onset of greater than or equal to 1.0 mm ischemic ST depression. Patients achieved a higher peak heart rate (124 +/- 19 vs 117 +/- 21 beats/min; p less than 0.0001), rate-pressure product (21.4 +/- 3.9 vs 19.8 +/- 4.1 beats/min x mm Hg x 10(3); p less than or equal to 0.0001) and oxygen consumption (VO2) (18.5 +/- 3.7 vs 16.5 +/- 4.4 ml/kg/min; p less than or equal to 0.001) with the standard than with the modified Bruce protocol. At matched submaximal exercise stages there were no differences in VO2, heart rate or oxygen pulse between protocols. Time to ischemic threshold was significantly reduced with the standard compared with the modified Bruce protocol (312 +/- 107 vs 607 +/- 221 seconds; p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Significance of silent myocardial ischemia during exercise testing in patients with diabetes mellitus: a report from the Coronary Artery Surgery Study (CASS) Registry.

To evaluate the significance of ischemic ST depression without anginal chest pain during exercise testing among patients with diabetes mellitus, the data on 45 such patients from the Coronary Artery Surgery Study registry were analyzed. These patients (group 1, silent ischemia) were compared with 37 diabetic patients with both ischemic ST depression and chest pain (group 2, symptomatic ischemia), with 31 diabetic patients without ischemic ST depression or chest pain (group 3, no ischemia), and with 429 patients without diabetes who had silent ischemia during exercise testing. All patients had documented coronary artery disease (CAD) (greater than 70% diameter narrowing). The 6-year survival among patients with silent ischemia was worse in diabetic than nondiabetic patients (59 vs 82%, respectively, p less than 0.001). By contrast, the 6-year survival among patients without ischemia was similar among diabetic and nondiabetic patients (93 vs 85%, respectively, p = 0.476). Among diabetic patients, survival at 6 years with medical treatment was 59% for group 1, 66% for group 2 and 93% for group 3 (p = 0.008). Survival among subsets of patients with diabetes and silent ischemia (group 1) based on the extent of CAD and left ventricular function ranged from 100 to 32% (p = 0.093). The survival of the 45 patients with diabetes mellitus and silent ischemia (group 1) treated medically was compared with that of 28 patients receiving coronary artery graft bypass surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Artery Bypass↗
PubMed1991

Prevalence and prognostic significance of silent and symptomatic ischemia after coronary bypass surgery: a report from the Coronary Artery Surgery Study (CASS) randomized population.

The prevalence and prognostic significance of postoperative myocardial ischemia, as detected by exercise testing, were prospectively assessed in 174 patients from the Coronary Artery Surgery Study (CASS) randomized surgical population who had exercise testing before and 6 months after coronary artery bypass graft surgery. Whereas the prevalence of symptomatic ischemia significantly decreased postoperatively (52% vs. 6%, p less than 0.001), the frequency of silent myocardial ischemia did not change (30% vs. 29%). Survival at 12 years after bypass surgery based on the 6-month postoperative exercise test results was significantly better for the 112 patients with no ischemia (80%) than for the 51 patients with silent ischemia (68%) or the 11 patients with symptomatic ischemia (45%). These data show that coronary artery bypass graft surgery diminishes the overall prevalence of symptomatic but not silent ischemia and that both silent and symptomatic ischemia adversely affect the postoperative prognosis of these patients.

Coronary Artery Bypass↗
PubMed1991

Risk stratification in angina pectoris.

Risk stratification of the patient with angina pectoris can be accomplished initially by the history, physical examination, and resting electrocardiogram. Noninvasive testing can add important prognostic information and identify patients who might benefit from revascularization procedures. An exercise electrocardiographic test usually is the initial test to determine risk, but exercise 201Th scintigraphy and exercise radionuclide angiography can provide important additional information regarding outcome in selected subsets of patients.

Angina Pectoris↗
PubMed1990

Physiologic responses to arm ergometry exercise relative to age and gender.

Arm ergometry exercise testing is a valuable alternative method used in the evaluation and management of patients with both cardiac disease and lower limb impairment. The purpose of this study is to provide information concerning the physiologic responses of normal healthy subjects to arm ergometry relative to age and gender, which could serve as a standard for comparison. Eighty healthy subjects (age 22 to 59 years) cycled at 75 to 80 rpm (on a bicycle adapted for arm ergometry) starting at a power output of 10 W, increasing at 10 W/2 min until exhaustion. Sixty subjects were classified on the basis of age into three groups, each with 10 men and 10 women. Men achieved significantly (p less than 0.001) higher power output (95 +/- 25 W) and oxygen consumption (20.7 +/- 3.9 ml/kg per min) than did women (56 +/- 19 W and 15.5 +/- 3.1 ml/kg per min, respectively). The heart rate response to total body oxygen demand during arm ergometry was significantly higher in women than in men (p less than 0.001). These findings were also present when men and women of each age group were analyzed separately. Older subjects reached a significantly (p less than 0.02) lower peak power output than did younger subjects although they reached a similar level of oxygen consumption. Separate regression equations for predicting oxygen consumption at each power output were formulated for men and women and validated in 20 other subjects. Small differences in measured and predicted oxygen consumption at each stage were found. These data provide additional information concerning arm ergometry testing and should prove useful in diagnostic exercise testing and cardiac rehabilitation.

Adult↗
PubMed1989

How to detect silent myocardial ischemia.

Anginal pain alone is not a sensitive marker of ischemia. In one study of 2,014 completely asymptomatic men, 2.5% were found to have silent ischemia when they underwent treadmill exercise testing. Another method of detection, ambulatory electrocardiographic monitoring, can be used in patients who cannot exercise or may be used to clarify results of exercise testing. Many investigators believe that the two tests provide complementary information on the patient's response to high demand and to daily-living activities. Other methods for determining necessary treatment and prognosis include dipyridamole with thallium perfusion scanning, nuclear exercise testing, coronary angiography, and catheterization. The cost, required frequency of retesting, and incidence of false results should be considered before screening is started.

Coronary Angiography↗
PubMed1989

The role of exercise-induced silent myocardial ischemia in patients with abnormal left ventricular function. A report from the Coronary Artery Surgery Study (CASS) registry.

To evaluate the significance of ischemic ST depression without anginal chest pain (silent ischemia) during exercise testing among patients with abnormal left ventricular function, the data on 121 such patients with proven coronary artery disease (CAD) from the Coronary Artery Surgery Study (CASS) registry were analyzed. The patients with silent ischemia (group 1) were compared to: 124 CAD patients with both ST depression and angina (symptomatic ischemia, group 2); 159 CAD patients with neither ST depression nor angina (no ischemia, group 3); and 37 patients without CAD (controls). Survival at 7 years with medical therapy was similar for groups 1 (55%) and 2 (60%), but was substantially better for group 3 (73%, p = 0.001). Among group 1 patients with silent ischemia, survival was related to the severity of CAD (p = 0.001). Patients with silent ischemia and three-vessel CAD had a poor 7-year survival rate (37%) when treated medically. A comparable but non-randomized group of patients with silent ischemia and three-vessel CAD who underwent coronary artery bypass surgery had a much better 7-year survival rate (83%, p less than 0.0001). These results suggest that among patients with CAD and abnormal left ventricular function, silent ischemia adversely affects survival and can identify a higher risk subset of patients whose survival might be improved after coronary bypass surgery.

Coronary Disease↗
PubMed1989

Monotherapy of stable angina with nicardipine hydrochloride: double-blind, placebo-controlled, randomized study.

The effect of nicardipine hydrochloride, a calcium-channel blocking agent, was studied in 46 patients with stable angina in a double-blind, placebo-controlled, randomized, repeated cross-over protocol, using a 30 or 40 mg dose of nicardipine or placebo three times a day. Mean resting heart rate and blood pressure did not change significantly with 30 mg nicardipine; heart rate increased from 81 +/- 10 to 88 +/- 13 beats min-1, systolic blood pressure decreased from 129 +/- 18 to 119 +/- 16 mmHg, and diastolic blood pressure from 81 +/- 12 to 74 +/- 11 mmHg (P less than 0.01 for all three variables) with a 40 mg dose. Using a treadmill exercise protocol, mean exercise duration increased from 5.4 +/- 1.8 to 6.0 +/- 1.8 min (P less than 0.01) with 30 mg nicardipine, and from 5.8 +/- 1.7 to 6.6 +/- 1.9 min (P less than 0.01) with 40 mg. Time to onset of angina increased from 4.6 +/- 1.9 to 5.2 +/- 1.7 min (P less than 0.05) with 30 mg and from 5.1 +/- 1.8 to 5.7 +/- 1.8 min (P = NS) with 40 mg. Mean anginal frequency and sublingual nitroglycerin consumption were low during the cross-over placebo period and did not change significantly during therapy with nicardipine. Non-cardiac side-effects were mild and required the withdrawal of only one patient from the study. However, during nicardipine therapy four patients had unstable angina and two developed a non-Q wave myocardial infarction. Of these patients, five were receiving a beta-adrenergic blocker that was discontinued prior to the study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗