Myocardial Oxygen Consumption Index in Patients with Coronary Artery Disease

One hundred and thirty-six men with coronary artery disease were randomly assigned to a hospital-based or home-based exercise program of 3 sessions per week. A treadmill test was carried out with the modified Naughton protocol. After 3 months, 125 patients (92%) with a mean age of 55 ± 11 years had completed the study. Maximum workload achieved increased by 65% [(12.40 ± 1.32 vs. 7.50 ± 0.85 metabolic equivalent units (METs)] in the hospital-based group, and by 17% (8.86 ± 0.9 vs. 7.56 ± 0.78 METs) in the home-based group ( p = 0.0001). The heart rate-blood pressure product, an index of myocardial oxygen consumption, decreased at rest by 19% in the hospital-based group but was unchanged in the home-based group ( p = 0.0001). The heart rate-blood pressure product at 5 and 7 METs activity level decreased 28% and 26%, respectively, in the hospital-based group vs. 8% and 2% in the home-based group ( p = 0.0001). It was concluded that hospital-based exercise training in patients with coronary artery disease improves functional capacity and decreases the myocardial oxygen consumption index at rest and during exercise.

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Tolerance to acute normovolemic hemodilution with coronary artery disease depends on heart rate as determinant for myocardial oxygen consumption

European Journal of Anaesthesiology ◽

10.1097/00003643-200606001-00159 ◽

2006 ◽

Vol 23 (Supplement 37) ◽

pp. 45

Author(s):

S. Cromheecke ◽

S. Lorsomradee ◽

V. Van Damme ◽

Ph. Van der Linden ◽

S. De Hert

Keyword(s):

Coronary Artery Disease ◽

Heart Rate ◽

Oxygen Consumption ◽

Coronary Artery ◽

Myocardial Oxygen Consumption ◽

Acute Normovolemic Hemodilution ◽

Normovolemic Hemodilution ◽

Artery Disease

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Small, Oral Dose of Clonidine Reduces the Incidence of Intraoperative Myocardial Ischemia in Patients Having Vascular Surgery

Anesthesiology ◽

10.1097/00000542-199610000-00004 ◽

1996 ◽

Vol 85 (4) ◽

pp. 706-712 ◽

Cited By ~ 124

Author(s):

Klaus-Dieter Stuhmeier ◽

Bernd Mainzer ◽

Jochen Cierpka ◽

Wilhelm Sandmann ◽

Jorg Tarnow

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Coronary Artery Disease ◽

Heart Rate ◽

Coronary Artery ◽

Myocardial Ischemia ◽

Oral Dose ◽

Fluid Volume ◽

Arterial Blood ◽

Artery Disease

Background Most new perioperative myocardial ischemic episodes occur in the absence of hypertension or tachycardia. The ability of alpha 2-adrenoceptor agonists to inhibit central sympathetic outflow may benefit patients with coronary artery disease by increasing the myocardial oxygen supply and -demand ratio. Methods A randomized double-blind study design was used in 297 patients scheduled to have elective vascular surgical procedures to evaluate the effects of 2 micrograms/kg-1 oral clonidine (n = 145) or placebo (n = 152) on the incidence of perioperative myocardial ischemic episodes, myocardial infarction, and cardiac death. Continuous real-time S-T segment trend analysis (lead II and V5) was performed during anesthesia and surgery and correlated with arterial blood pressure and heart rate before and during ischemic events. Dose requirements for vasoactive and antiischemic drugs to control blood pressure and heart rate as well as episodes of myocardial ischemia (i.e., catecholamines, beta-adrenoceptor antagonists, nitrates, and systemic vasodilators) and fluid volume load were recorded. Results Administration of clonidine reduced the incidence of perioperative myocardial ischemic episodes from 39% (59 of 152) to 24% (35 of 145) (P < 0.01). Hemodynamic patterns, percentage of ischemic time, and the number of ischemic episodes per patient did not differ. Nonfatal myocardial infarction developed after operation in four patients receiving placebo compared with none receiving clonidine (day 2 to 21; P = 0.07). The incidence of fatal cardiac events (1 vs. 2) was not different. Dose requirements for vasoactive and antiischemic drugs did not differ between the groups, but the amount of presurgical fluid volume was slightly greater in patients receiving clonidine (951 +/- 388 vs. 867 +/- 381 ml; P < 0.03). Conclusion A small oral dose of clonidine, given prophylactically, can reduce the incidence of perioperative myocardial ischemic episodes without affecting hemodynamic stability in patients with suspected or documented coronary artery disease.

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