[Evaluation of exercise training with exercise intensity below anaerobic threshold in coronary artery disease patients].
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Biomedical subjects
Publications and source records attributed to K Ebine.
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Left ventricular performance, survival rate and subjective symptoms were analyzed in 243 cases of angina pectoris (147 cases of A-C bypass and 96 cases of medical treatment) and 58 cases of left ventricular aneurysm (21 cases of surgical treatment and 37 cases of medical treatment). Left ventricular performance of angina pectoris were improved in surgical group 6 months after A-C bypass with the significance of p less than 0.02-0.05. However, in the medical group, it showed unchanged or aggravated tendency during average 18 months. Similar results were obtained in the patients with left ventricular aneurysm and furthermore, aggravation of EF and Max dp/dt/p in some medically treated cases was observed. Operative death by A-C bypass was seen in 4 cases (2.7%) and 5 years cumulative survival rate was 92.6% including late death cases died during average 30.1 months in the medical group and its 5 years survival rate was 77.3%. For left ventricular aneurysm, no operative death was recognized and the 5 years cumulative survival rate was 95%. Whereas during average 32.7 months in the medical group, 8 cases died and 5 years cumulative survival rate was 78.6%. Improvement of subjective symptoms after treatment for both ischemic heart diseases was also conspicuous in the surgical group.
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One hundred and eight patients with suspected ischemic heart disease were evaluated by exercise thallium-201 myocardial imaging (T1-IM), coronary arteriography and graded treadmill exercise test (GTX). They were divided into four groups; Group I consisted of 21 patients without significant coronary artery disease (less than 75% diameter stenosis), Group II of 47 patients with significant coronary artery disease (greater than or equal to 75% diameter stenosis) but without previous myocardial infarction, Group III of 24 patients who had previous myocardial infarction with additional coronary artery disease, and Group IV of 16 patients who had previous myocardial infarction without additional coronary artery disease. In Group I, T1-IM showed positive findings in only two patients (9.5%), whereas GTX showed positive findings in seven (33.3%) and borderline findings in four (19.0%). In Group II, T1-IM showed positive findings in 34 patients (74.5%), while GTX showed positive findings in 31 (66.0%) and borderline findings in 12 (25.5%). In Group II, the sensitivity of T1-IM and GTX for identifying severe stenosis (more than 99%) were 95.0% (19 of 20 patients) and 75.0% (15 of 20), respectively, but only 50.0% (four of eight) and 50.0% (four of eight), respectively, for identifying less severe stenosis (about 75%). In Group III, the sensitivity for detecting infarcted lesion by T1-IM was 95.8% (23 of 24 patients), but the sensitivity for detecting ischemic area in the non-infarcted lesion was 41.7% (10 of 24). In Group IV, a significant defect was detected by TI-IM, corresponding to the infarcted site in 14 of 16 patients (87.5%), and periinfarcted ischemia was shown in seven of the 14 patients (50.0%). In both Group III and IV, GTX was positive in only 50% and 31.3%, respectively. We conclude that T1-IM is a useful technique in the diagnosis of myocardial ischemia, especially severe coronary stenosis, and is more specific than GTX. However, we must be careful for evaluating ischemic, but not infarcted lesion by T1-IM in patients with myocardial infarction.
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