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Exercise training does not alter complexity or frequency of ventricular ectopy in coronary disease patients
ABSTRACTS
THE TIMING AND MECHANISM OF WITNESSED CORONARY HEART DISEASE DEATHS Sidney Goldstein, MD, FACC; Donald Romhilt, MD, FACC; Richard Hutchinson, MD, FACC; Robert Schlant, MD, FACC; Rafael Sobrino, MD, FACC; Lawrence Friedman, MD: Joel Verter, MD, AMIS Study Group
WEDNESDAY, PM PROGNOSIS DISEASE 2:00-3:30
In order to establish theclinical mechanism and timing from onset to symptoms (Sx), witnessed deaths (WD) were studied in a large secondary prevention of coronary heart disease (CHD) trial. Of 352 CHD deaths, 271 (77%) were WD. Of the WD, 43% (119/271) occurred in<1 hour, 42% (113/271) from l-24 hours. In the first hour, death occurred instantly without acute Sx in 65% (77/119). An additional 35% (42/119) occurred in the remainder of the first hour from onset of symptoms. Definite or presumed arrhythmia was the mechanism of death in 98% (117/119) of WD <1 hour and 66% (75/113) of WD occurring between 1-24 hours after Sx (p< .OOl). Shock or congestive heart failure was the mechanism of death in 2% (2/119) in the
UNSTABLE ANGINA: NHLBI COOPERATIVE STUDY GROW TO COMPARE MEDICAL AND SURGICAL THERAPY: LONG TERM MORBIDITY AND MORTALITY R. Conti, M.D., F.A.C.C., L. Becker, M.D., F.A.C.C., T. Biddle, M.D., F.A.C.C., A. Hutter, M.D., F.A.C.C., L. Resnekov, M.D., F.A.C.C.. R. Rosati. M.D., F.A.C.C., R. Russell, M.D., F.A.C.C., J. Schroeder, M.D.. F.A.C.C., M. Walk, M.D., F.A.C.C., T. Louis, Ph.D., M.Mock, M.D., F.A.C.C., University of Florida, Gainesville, Florida
EXERCISE TRAINING DOES NOT ALTER COMPLEXITY OR FREQUENCY OF VENTRICULAR ECTOPY IN CORONARY DISEASE PATIENTS Lawrence Laslett, MD, Patti Scott Baier, RN, Linda Paumer, MA, Ezra Amsterdam, MD, FACC, James H. Foerster, MD, University of California, Davis, CA
THE SURVIVAL OF NONOPERATED PATIENTS WITH ISCHEMIC HEART DISEASE: THE CASS EXPERIENCE Michael B. Mock, MD, FACC; Ivar Ringqvist, MD; Lloyd Fisher. PhD. FACC: Katherine Davis. PhD: Bernard Chaitman. MD, FACC; Nicholas Kouchoukos, MD,'FACC'; George Kaiser, ’ MD, FACC; Edwin Alderman, MD, FACC; Richard Russell, MD, FACC; Suzanne Mullin, RN; Thomas Killip, MD, FACC; David Fray, BS, Mayo Clinic, Rochester, Minnesota
It has been hypothesized that exercise training (ET) of patients (pts) with coronary disease may have the potential to reduce the severity of ventricular ectopy (PVC). To evaluate this possibility, 24-hr ambulatory ECG monitoring was performed on'all participants in a conunity cardiac exercise rehabilitation program at entry and after six months' ET. Nineteen pts who either took no antiarrhythmic medicine (no-med) (7 pts) or were on a constant regimen of antiarrhythmic medicine throughout ET (med) (12 pts) were included in this study. The characteristics of these subjects were mean age 56 + 8, previous infarction 10, experiencing angina 10, past coronary bypass graft six. All pts but one were male. Functional capacity increased from a mean of 7.8 + 2.3 METS to 9.3 + 2.3 METS by 22% (pc.001) during ET. Hean frequency of PVC's was 13 + 19/hr before ET and 31 + 99 after ET (p=NS). Using Lown PVC grading, 14 pts were unchanged after ET, 1 improved and 4 worsened. When Lown grades 0, 1, 2 are classified as Group I and grades 3, 4, 5 as Grotip II, 8 pts remained in I, 8 pts remained in II, 2 pts worsened from I to II, and 1 pt improved from II to I. Thus, despite a 22% increase in functional capacity, no evidence of improvement in PVC complexity or frequency was demonstrated secondary to exercise training in this study.
APaiL28,
1982
AND TREATMENT
OF ISCHEMtC
HEART
The NHLBI trial began in Jan. 1972. The final pt was randomized in Dec. 1976. 288 hospitalized pts were randomized (147 Med-141 Surg) during initial phase of treatment. Median follow-up of Med pts was 68 and Surg pts 65 months as of 3124181. RESULTS: MI and mortality are expressed in terms of original random assignment to Med or Surg therapy. MI occurred in 18% (27/147) Med pts compared to 33% (47/141) Surg pts (p
The NHLBI Collaborative Coronary Artery Surgery Study (CASS) registry enrolled 20,088 patients from 1975 to 1979 without previous coronary artery bypass graft surgery. The cumulative 5-year survival of medically managed patients has been analyzed to determine the survival of different subsets of patients with obstructive coronary disease treated medically. The vital status of 99.7% of the patients is known. The survival curves were calculated using the life table method and were compared by the log rank statistic. The 5-year survival of patients with no significant coronary artery disease was 96%. The 5-year survival was 89%, 82%, and 62% for patients with one, two and threevessel disease. The 5-year survival of patients with normal LV function with one, two and three-vessel disease was 94%, 90%, and 82%. The 5-year survival of patients with poor LV performance and one and two-vessel disease was 62% compared to 33% for patients with three-vessel disease (P70%) obstructions was 68%, 57%, and 46% respectively (P<0.0001). These results from the CASS registry emphasize that LV function is a more important predictor of subsequent survival than the number of diseased vessels. The number of proximal obstructions was found to be of greater prognostic significance than the location of the obstructions in the coronary arteries excluding left main disease.
March 1992
The American Journal of CARDIOLOGY
Volume 49
1007
THE TIMING AND MECHANISM OF WITNESSED CORONARY HEART DISEASE DEATHS Sidney Goldstein, MD, FACC; Donald Romhilt, MD, FACC; Richard Hutchinson, MD, FACC; Robert Schlant, MD, FACC; Rafael Sobrino, MD, FACC; Lawrence Friedman, MD: Joel Verter, MD, AMIS Study Group
WEDNESDAY, PM PROGNOSIS DISEASE 2:00-3:30
In order to establish theclinical mechanism and timing from onset to symptoms (Sx), witnessed deaths (WD) were studied in a large secondary prevention of coronary heart disease (CHD) trial. Of 352 CHD deaths, 271 (77%) were WD. Of the WD, 43% (119/271) occurred in<1 hour, 42% (113/271) from l-24 hours. In the first hour, death occurred instantly without acute Sx in 65% (77/119). An additional 35% (42/119) occurred in the remainder of the first hour from onset of symptoms. Definite or presumed arrhythmia was the mechanism of death in 98% (117/119) of WD <1 hour and 66% (75/113) of WD occurring between 1-24 hours after Sx (p< .OOl). Shock or congestive heart failure was the mechanism of death in 2% (2/119) in the
UNSTABLE ANGINA: NHLBI COOPERATIVE STUDY GROW TO COMPARE MEDICAL AND SURGICAL THERAPY: LONG TERM MORBIDITY AND MORTALITY R. Conti, M.D., F.A.C.C., L. Becker, M.D., F.A.C.C., T. Biddle, M.D., F.A.C.C., A. Hutter, M.D., F.A.C.C., L. Resnekov, M.D., F.A.C.C.. R. Rosati. M.D., F.A.C.C., R. Russell, M.D., F.A.C.C., J. Schroeder, M.D.. F.A.C.C., M. Walk, M.D., F.A.C.C., T. Louis, Ph.D., M.Mock, M.D., F.A.C.C., University of Florida, Gainesville, Florida
EXERCISE TRAINING DOES NOT ALTER COMPLEXITY OR FREQUENCY OF VENTRICULAR ECTOPY IN CORONARY DISEASE PATIENTS Lawrence Laslett, MD, Patti Scott Baier, RN, Linda Paumer, MA, Ezra Amsterdam, MD, FACC, James H. Foerster, MD, University of California, Davis, CA
THE SURVIVAL OF NONOPERATED PATIENTS WITH ISCHEMIC HEART DISEASE: THE CASS EXPERIENCE Michael B. Mock, MD, FACC; Ivar Ringqvist, MD; Lloyd Fisher. PhD. FACC: Katherine Davis. PhD: Bernard Chaitman. MD, FACC; Nicholas Kouchoukos, MD,'FACC'; George Kaiser, ’ MD, FACC; Edwin Alderman, MD, FACC; Richard Russell, MD, FACC; Suzanne Mullin, RN; Thomas Killip, MD, FACC; David Fray, BS, Mayo Clinic, Rochester, Minnesota
It has been hypothesized that exercise training (ET) of patients (pts) with coronary disease may have the potential to reduce the severity of ventricular ectopy (PVC). To evaluate this possibility, 24-hr ambulatory ECG monitoring was performed on'all participants in a conunity cardiac exercise rehabilitation program at entry and after six months' ET. Nineteen pts who either took no antiarrhythmic medicine (no-med) (7 pts) or were on a constant regimen of antiarrhythmic medicine throughout ET (med) (12 pts) were included in this study. The characteristics of these subjects were mean age 56 + 8, previous infarction 10, experiencing angina 10, past coronary bypass graft six. All pts but one were male. Functional capacity increased from a mean of 7.8 + 2.3 METS to 9.3 + 2.3 METS by 22% (pc.001) during ET. Hean frequency of PVC's was 13 + 19/hr before ET and 31 + 99 after ET (p=NS). Using Lown PVC grading, 14 pts were unchanged after ET, 1 improved and 4 worsened. When Lown grades 0, 1, 2 are classified as Group I and grades 3, 4, 5 as Grotip II, 8 pts remained in I, 8 pts remained in II, 2 pts worsened from I to II, and 1 pt improved from II to I. Thus, despite a 22% increase in functional capacity, no evidence of improvement in PVC complexity or frequency was demonstrated secondary to exercise training in this study.
APaiL28,
1982
AND TREATMENT
OF ISCHEMtC
HEART
The NHLBI trial began in Jan. 1972. The final pt was randomized in Dec. 1976. 288 hospitalized pts were randomized (147 Med-141 Surg) during initial phase of treatment. Median follow-up of Med pts was 68 and Surg pts 65 months as of 3124181. RESULTS: MI and mortality are expressed in terms of original random assignment to Med or Surg therapy. MI occurred in 18% (27/147) Med pts compared to 33% (47/141) Surg pts (p
The NHLBI Collaborative Coronary Artery Surgery Study (CASS) registry enrolled 20,088 patients from 1975 to 1979 without previous coronary artery bypass graft surgery. The cumulative 5-year survival of medically managed patients has been analyzed to determine the survival of different subsets of patients with obstructive coronary disease treated medically. The vital status of 99.7% of the patients is known. The survival curves were calculated using the life table method and were compared by the log rank statistic. The 5-year survival of patients with no significant coronary artery disease was 96%. The 5-year survival was 89%, 82%, and 62% for patients with one, two and threevessel disease. The 5-year survival of patients with normal LV function with one, two and three-vessel disease was 94%, 90%, and 82%. The 5-year survival of patients with poor LV performance and one and two-vessel disease was 62% compared to 33% for patients with three-vessel disease (P
March 1992
The American Journal of CARDIOLOGY
Volume 49
1007