@article{28b6372db53b45f89dfccaed4c289f0a,
title = "Clinical relevance of exercise-induced ventricular arrhythmias in suspected coronary artery disease",
abstract = "Because there is controversy regarding the clinical relevance of exercise-induced ventricular arrhythmias, we analyzed their significance in 383 patients who had undergone both exercise thallium-201 stress-testing and cardiac catheterization. Two-hundred twenty-one patients (58%) had no exercise-induced ventricular arrhythmias while 162 (42%) did. There was no difference between patients with and without exercise-induced ventricular arrhythmias in terms of previous myocardial infarction (p = 0.61), incidence of fixed thallium-201 defects (0.06), number of diseased vessels (p = 0.09) and resting left ventricular ejection fraction (p =0.06). In contrast, evidence of provocable ischemia (redistribution on thallium-201 and ST-segment depression on the electrocardiogram) were more likely (p < 0.02) to be seen in patients with exercise-induced ventricular arrhythmias. Discriminant function analysis revealed that these 2 variables best separated patients with and without exercise-induced ventricular arrhythmias. In a 4- to 8-year follow-up, 89 patients had adverse cardiac events. Of these 89, there were 41 deaths, 9 nonfatal myocardial infarctions and 39 coronary revascularization procedures performed later than 3 months after catheterization. Patients with exercise-induced ventricular arrhythmias were more likely (p = 0.01) to have these events than those without these arrhythmias. Moreover, these arrhythmias provided independent prognostic information beyond that provided by the thallium-201 stress test and coronary angiography. We conclude that exercise-induced ventricular arrhythmias are associated with exercise-induced ischemia and provide prognostic information which adds marginally to that provided by other noninvasive and invasive parameters in ambulatory patients being evaluated for chest pain.",
author = "Marieb, {Mark A.} and Beller, {George A.} and Gibson, {Robert S.} and Lerman, {Bruce B.} and Sanjiv Kaul",
note = "Funding Information: Because there is controversy regarding the clinical refevance of exercise-hxiuced ventricular arrhythmias, we anafyxed their significance in 363 patients who had undergone both exercise thaiiium-201 stress-testing and cardiac catheterization. Two-hundred twenty-one patients (58%) had no exercise-induced ventrieuiar arrhythmias while 162 (42%) did. There was no ditterenee between patients with and witbout exercise-hxfuced ventricular arrhythmias in terms of previous myocardiai infarction (p = 0.61), imidence of fixed thallium-201 defects (0.06), number of diseased vessels (p = 0.09) and resting feft ventriwfar ejection fraction (p = 0.06). in contrast, evidence of provocabfe ischemia (redistribution on thallium-201 and ST-segment depression on the electrocardiogram) were more iike-fy (p <0.02) to be seen in patients with exercise-induced ventricular arrhythmias. Discriminant function analysis revealed that these 2 variabies best separated patients with and without exercise-induced ventricular arrhythmias. in a 4-to 6-year follow-up, 89 patients had adverse cardiac events. of these 69, there were 41 deaths, 9 nonfatal myo-cardiai infarctions and 39 coronary revascuiariza-tkm procedures performed later than 3 months after catheterization. Patients with exercise-induced ventricular arrhythmias were more likely (p = 0.01) to have these events than those without these arrhythmias. Moreover, these arrhythmias provided independent prognostic information beyond that provided by the thallium-201 stress test and coronary angiography. We conclude that exercise-induced ventricular arrhythmias are associated with exercise-huiuced ischemia and provide prognostic information which adds marginally to that provided by other noninvasive and invasive parameters in ambulatory patients being evaluated for chest pain. (Am J Cardid 1990;66:172-176) From the Division of Cardiology, Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, Virginia. This study was supported in part by grant ROl-HL-26205 from the National Institutes of Health, Bethesda, Maryland. Dr. Lerman is the recipient of an Established Investigator Award from the American Heart Association, Dallas, Texas. Dr. Kaul is the recipient of a Clinical Investigator Award (K08-HL-01833) and the FIRST Award (R29-HL-38345) from the National Institutes of Health. Manuscript received January 17, 1990, revised manuscript received and accepted March 12,199O. Address for reprints: Sanjiv Kaul, MD, Division of Cardiology, Box 158, University of Virginia, Charlottesville, Virginia 22908.",
year = "1990",
month = jul,
day = "15",
doi = "10.1016/0002-9149(90)90583-M",
language = "English (US)",
volume = "66",
pages = "172--178",
journal = "The American journal of cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "2",
}