Exercise Body Surface Potential Mapping in Single and Multiple Coronary Artery Disease: Discussion (Part 1)
There were three major findings in this study. First, exercise BSPM provided quantitative discrimination among individual patients and patient groups with single- and multiple-vessel CAD. On average, patients with underlying multiple-vessel CAD and angina-limited exercise had significantly greater exercise ST integral decrease than patients with single-vessel CAD and angina. The CAD patients who fatigued during exercise had the same degree of ST change as singlevessel disease CAD patients who achieved angina. Second, ischemic ST integral changes persisted for several minutes following cessation of exercise and the degree of persistent ST change was directly related to the degree of peak change. Third, there also were significant correlations between peak ST ischemic changes and quantitative coronary angiographic scores, particularly those that weighed collateral supply or provided an assessment of resting myocardium at ischemic risk. buy ortho tri-cyclen
There are several important implications of these findings. First, exercise ST integral BSPM in CAD patients provides a quantitative index of the amount of ischemic myocardium induced by exercise. On an individual basis the data suggest, for example, a patient with single-vessel CAD and exercise ST integral decrease of -10,000 p,V*s has greater functional ischemia, and probably risk of a larger infarction, than a patient with double- or triple-vessel CAD and exercise sum ST decrease of only — 3,000 fiV’s. Thus, single vs multiple CAD may not be the most important clinical determinant of the degree of myocardium at ischemic risk. Rather, the degree of functional ischemia, whether caused by single or multiple CAD, may be a more basic variable for the prediction of clinical outcome.