Myocardial ischemia during physical exercise in patients with stable coronary artery disease: predictability and prevention

• Published in: International journal of cardiology Vol. 75; no. 2; pp. 179 - 186
• Main Authors: Hauer, Klaus, Niebauer, Josef, Weiss, Claus, Marburger, Christian, Hambrecht, Rainer, Schlierf, Günter, Schuler, Gerhard, Zimmermann, Rainer, Kübler, Wolfgang
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 15.09.2000; Elsevier Science
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Coronary Angiography; Coronary Disease - rehabilitation; Coronary heart disease; Exercise Test; Exercise testing; Exercise Therapy - adverse effects; Female; Heart; Heart Rate; Holter monitoring; Humans; Lactic Acid - blood; Male; Medical sciences; Middle Aged; Myocardial ischemia; Myocardial Ischemia - diagnosis; Myocardial Ischemia - etiology; Myocardial Ischemia - physiopathology; Myocardial Ischemia - prevention & control; Predictive Value of Tests; Target heart rate; Types of exercise; Coronary angiography; Myocardial ischemia; Holter monitoring; Types of exercise; Target heart rate; Exercise testing; Human; Cardiovascular disease; Myocardial disease; Coronary heart disease; Vascular disease; Prevention; Heart rate; Ischemia; Risk factor; Myocardium; Complication; Exercise tolerance test; Predictive factor
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/S0167-5273(00)00321-1

Aims: We assessed whether exercise-induced myocardial ischemia during intensive group exercise sessions can be predicted in patients with coronary artery disease and stable angina pectoris. Methods and results: Twenty-three patients underwent cardiac catheterization, 201-thallium scintigraphy, and exercise testing prior to participation in group training sessions. Heart rates and myocardial ischemia were documented by Holter monitoring. The individual training heart rate was calculated as a percentage of the maximal heart rate achieved during symptom-limited exercise testing. Myocardial ischemia occurred significantly more often during group exercise sessions (15 of 23 patients) than during treadmill testing (4 of 23 patients, P<0.001). Maximal heart rate (145±23 vs. 134±21 beats/min, P<0.004) and maximal plasma lactate concentrations (6.0±2.9 vs. 4.3±2.0 mmol/l, P<0.05) were significantly higher than during symptom-limited exercise testing. Ischemic episodes occurred significantly more often during jogging than during competitive ball games or interval training. Myocardial ischemia occurred in patients who exceeded their individual target training heart rates (43 of 44 episodes; P<0.001). Duration of ischemic episodes did not correlate with any marker obtained at the beginning of the study. Conclusion: These data demonstrate that routine diagnostic procedures do not sufficiently identify patients at risk for exercise-induced myocardial ischemia. Ischemic events are only effectively prevented by choosing adequate types of exercise and, above all, by the strict adherence to individual target heart rates.