Clinical investigations: interventional cardiologyImproved myocardial performance during repetitive exercise testing: The role of extracellular superoxide dismutase activity in a model of exercise-induced myocardial preconditioning
Section snippets
Methods
Fifty patients, 42 men and 8 women with a mean age of 59 ± 6 and 54 ± 5 years, respectively, with chronic stable angina pectoris and exercise-induced early severe myocardial ischemia were studied. All patients were in sinus rhythm and had angiographic documentation of significant coronary artery disease (detection of at least 1 major branch with a stenosis >70%). All cardioactive drugs, xanthine oxidase inhibitors, and non-steroidal anti-inflammatory agents were discontinued 5 days before the
Results
The study patients were divided in 2 groups according to the extent of myocardial ischemia at peak exercise of the fourth compared with the first exercise test, as assessed with thallium-201 scintigraphy. Patients with reduced myocardial ischemia at the peak of the fourth compared with the peak of the first exercise test comprised group I (n = 37), whereas patients with an increased (n = 12) or unchanged (n = 1) extent of myocardial ischemia comprised group II (n = 13). As shown in Table II,
Discussion
The main finding of this study is that repetitive episodes of exercise-induced ischemia influence the ischemic response to a subsequent episode of exercise-induced ischemia in patients with coronary artery disease.
Maybaum et al,5 Tomai et al,7, 10 and Okazaki et al30 have also addressed the issue of myocardial adaptation to exercise-induced myocardial ischemia in humans. Although only partially comparable, our results were in accordance with their conclusions, which suggest that the increased
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Treadmill exercise test with dual isotope scintigraphy documents the second window of preconditioning in humans
2008, AtherosclerosisCitation Excerpt :Nevertheless, this intervention results in limitation of the jeopardized myocardium. Using one isotope only, Michaelides et al. [25] found a significant improvement in the distribution of Tl-201 a few minutes after an exercise test, hence describing the existence of the first window of preconditioning in humans. Ischemic preconditioning and the more easily applicable postconditioning [26–28] are two endogenous mechanisms, which may confer additional protection to the heart after thrombolysis or PCI or any other pharmacological intervention in order to obtain a significant limitation of the infract size.
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