Myocardial perfusion and perfusion reserve in endurance-trained men

PURPOSE: This study was undertaken to determine whether endurance training is associated with changes in myocardial perfusion in humans. METHODS: Myocardial perfusion was measured in eleven trained and nine sedentary men at rest and during adenosine-stimulated hyperemia using positron emission tomography (PET). Left ventricular (LV) dimensions and mass were measured using echocardiography. Myocardial work per gram of tissue was calculated as (cardiac output. mean arterial blood pressure)/LV mass. RESULTS: LV mass was significantly higher and myocardial work per gram of tissue lower in the trained than in the untrained subjects. Basal (0.78 +/- 0.10 and 0.76 +/- 0.15 mL. min-1. g-1, P = NS) and adenosine-stimulated perfusion (3.46 +/- 0.91 and 3.14 +/- 0.70 mL. min-1. g-1, P = NS) were similar between trained and untrained men, respectively. Consequently, myocardial perfusion reserve was similar in both groups (4.4 +/- 1.2 and 4.1 +/- 0.7, P = NS). In addition, coronary resistance at baseline (115 +/- 17 vs 119 +/- 22, mm Hg. mL. min-1. g-1, P = NS) and during adenosine infusion (28 +/- 8 vs 30 +/- 8, mm Hg. mL. min-1. g-1, P = NS) were similar in both groups. Resting myocardial work correlated with resting myocardial perfusion in both groups, but the relationship between perfusion and work was different between the groups so that perfusion for a given myocardial work was significantly higher in trained subjects (0.56 +/- 0.04 and 0.34 +/- 0.05 mL. (mm Hg. L)-1, P < 0.001). CONCLUSIONS: These findings suggest that endurance trained subjects do not have different resting or adenosine-stimulated myocardial perfusion. However, the relationship between myocardial perfusion and work appears altered in the athletes.     

Cardio-respiratory responses to rowing ergometry and treadmill exercise soon after myocardial infarction

PURPOSE: The aim of this study was to compare the cardio-respiratory differences between rowing ergometry and treadmill exercise in beta-blocked men participating in exercise rehabilitation soon after myocardial infarction (postMI). METHODS: Eleven males all receiving beta-blockade medication were measured for oxygen consumption (VO2), respiratory exchange ratio (RER), and rating of perceived exertion (RPE) at individualized submaximal exercise target heart rates (THR) during 6 min of exercise on each of a motorized treadmill and a rowing ergometer 2-6 wk (4.9 +/- 1.4) postMI. RESULTS: The mean THR of the group, predetermined from an exercise ECG stress test, was 107 +/- 16 beats x min(-1). No significant difference was found between rowing versus treadmill VO2 (19.4 +/- 3.2 vs 19.7 +/- 4.2 mL x kg(-1) x min(-1); P = 0.53) or RPE (12.6 +/- 1 vs 12.7 +/- 1; P = 0.72). RER was significantly greater (P = 0.02) during rowing (0.99 +/- 0.07) compared with treadmill exercise (0.94 +/- 0.07). CONCLUSION: Exercising at a specified submaximal THR during rowing versus treadmill exercise in beta-blocked men participating in very early cardiac rehabilitation represents the same VO2 and RPE. A significantly greater RER was, however, apparent during rowing compared with treadmill exercise; thus, agreement was shown with previous studies on healthy individuals where rowing ergometry was less metabolically efficient than treadmill exercise. The results suggest that establishing a THR from a standard treadmill stress test soon after MI is not only suitable for walking/treadmill exercise but also in setting exercise intensity for rowing ergometry.     

Atrioventricular plane displacement in untrained and trained females

PURPOSE: Female athletes often demonstrate changes in cardiac dimensions that are less prominent than in male athletes, and results from longitudinal studies are conflicting. The atrioventricular plane displacement (AVPD) in the heart is used as an index of left ventricular systolic function with the assumption that it is a more sensitive method for measuring myocardial contractility compared with left ventricular ejection fraction. The aim of the present study was to determine the effect of a short period of endurance training on cardiac dimensions in sedentary female subjects and to measure the AVPD at rest and during submaximal workload. METHODS: Twelve sedentary female subjects (21.9 +/- 1.3 yr, 168.8 +/- 3.5 cm, 64.0 +/- 6.6 kg, and 42.6 +/- 2.9 mL x kg(-1) x min(-1) in maximal oxygen uptake) were examined with echocardiography before and after a period of interval training (varying from 2 to 5 min at 90-95% of maximal heart rate, 3 d x wk(-1), 8 wk). RESULTS: Maximal oxygen uptake increased by 18% to 50.4 +/- 3.1 mL x kg(-1) x min(-1) (P < 0.001). Left ventricular mass increased from 123.9 to 139.2 g (P = 0.007). There was a significant increase in posterior wall thickness but no change in cavity size. The AVPD did not change at rest but increased significantly from 15.6 to 17.6 mm (P < 0.001) during exercise at 85-90% of maximal heart rate. CONCLUSION: This study shows that a short period of aerobic endurance training induces changes in the female heart, both in cardiac dimensions at rest and in left ventricular systolic function at submaximal workload. AVPD during submaximal exercise discriminate well between the untrained and trained healthy heart.     

Repeatability of cold pressor test-induced flow increase assessed with H(2)(15)O and PET.

The aim of this study was to evaluate the repeatability of endothelium-related myocardial blood flow (MBF) responses to cold pressor testing (CPT) as assessed by PET. METHODS: In 10 age-matched control subjects (26.6 +/- 3.4 y) and 10 tobacco smokers (24.9 +/- 3.3 y) MBF was assessed at rest and after repeated CPT (CPT1 and CPT2, 40 min apart) using PET with H(2)(15)O. CPT was performed by a 2-min immersion of the subject's foot in ice water. MBF values were corrected for cardiac workload (rate.pressure product), and the repeatability of CPT-related MBF values was assessed according to Bland and Altman. RESULTS: Corrected MBF at CPT1 and CPT2 were comparable in control subjects (1.79 +/- 0.37 vs. 1.70 +/- 0.35 mL/min/g; P = not significant [NS]) and in smokers (1.97 +/- 0.42 vs. 1.80 +/- 0.41 mL/min/g; P = NS). Repeatability coefficients in control subjects and smokers were 0.46 mL/min/g (27% of the mean MBF) and 0.51 mL/min/g (27%), respectively. MBF increased significantly after CPT in both groups but tended to be lower in smokers (P = 0.08). CONCLUSION: PET measured MBF combined with CPT is a feasible and repeatable method for the evaluation of endothelium-related changes of MBF.     

Impact of hormone replacement on myocardial fatty acid metabolism: Potential role of estrogen

BACKGROUND: Estrogen increases fatty acid utilization and oxidation and may decrease glucose use in human skeletal muscle, whereas these effects are attenuated by progesterone. Whether these ovarian hormones exhibit similar effects on myocardial metabolism is unknown. METHODS AND RESULTS: Myocardial blood flow and oxygen consumption, as well as glucose and fatty acid metabolism, were examined retrospectively by use of positron emission tomography in 24 postmenopausal women receiving estrogen (n = 7), estrogen plus progesterone (n = 8), or no hormone replacement (n = 9) and in 22 age-matched men. Myocardial blood flow was higher in women regardless of hormone replacement status. Myocardial oxygen consumption was higher in women taking estrogen only when compared with men (7.3 +/- 1.6 micromol.g(-1).min(-1) vs 4.6 +/- 1.2 micromol.g(-1).min(-1), P < .001). Glucose utilization was not affected by gender or hormone replacement. Whereas fatty acid levels and the degree of myocardial fatty acid uptake were not distinguished by gender or hormone use, myocardial fatty acid utilization was higher in women taking estrogen when compared with men (259 +/- 68 nmol.g(-1).min(-1) vs 176 +/- 50 nmol.g(-1).min(-1), P = .01) and trended higher when compared with women not receiving hormonal therapy (185 +/- 46 nmol.g(-1).min(-1), P = .07) but was not different from that of women taking estrogen plus progesterone (205 +/- 58 nmol.g(-1).min(-1), P = not significant). CONCLUSIONS: In postmenopausal women, estrogen use is associated with increased myocardial fatty acid utilization. Thus, when the cardiac effects of hormone replacement therapy are being assessed, alterations in myocardial substrate metabolism should be considered.     

Complement and immunoglobulin levels in athletes and sedentary controls

Eleven marathon runners (42.7 +/- 2.1 yrs, 54.2 +/- 1.8 ml.kg-1.min-1) and nine sedentary controls (44.2 +/- 1.2 yrs, 33.3 +/- 1.1 ml.kg-1.min-1) were studied during 30 min of rest, a graded maximal treadmill test using the Balke protocol, and 45 min of recovery to determine the effects of training and acute exercise on complement and immunoglobulin levels. Three baseline and five recovery blood samples were obtained in addition to repeated 5-min samples during exercise. Data for the exercise period were analyzed using a multiple regression approach to repeated measures ANOVA to allow comparison between groups on a percent VO2max basis. Groups did not differ during any of the three phases for IgG, IgA, or IgM. Resting levels of complement C3 (0.89 +/- 0.05 vs 1.27 +/- 0.10 g/L, P less than 0.001) and C4 (0.19 +/- 0.02 vs 0.29 +/- 0.03 g/L, P less than 0.001) were significantly lower in athletes than in controls. Exercise complement C3 [F(1,18) = 14.1, P = 0.001] and C4 [F(1,18) = 7.6, P = 0.013], and recovery complement [F(1,18) = 19.4, P less than 0.001] and C4 [F(1,18) = 13.5, P = 0.002] were also lower in the athletes than in sedentary controls. Acute increases during exercise were not associated with changes in catecholamines or cortisol. These data suggest that blood concentrations of C3 and C4, but not IgG, IgA, or IgM, are decreased during rest, graded maximal exercise, and recovery in marathon runners in comparison with sedentary controls.     

Short-term effects of marathon running: no evidence of cardiac dysfunction.

PURPOSE: The purpose of this study was to analyze the short-term effects of a marathon race (Madrid Marathon) on both markers of cardiac damage and echocardiographic parameters in a group of 22 runners (17 male and 5 female; 34 +/- 5 yr; VO2max: 55.7 +/- 9.1 mL x kg(-1) x min(-1) with a wide range of fitness levels. METHODS: Venous blood samples were collected from each subject 48 h before the race, at race finish, and 6, 24, and 48 h postexercise for the determination of myoglobin, total creatine kinase catalytic activity (total CK), mass concentration of creatine kinase isoenzyme MB (CK-MB mass), and cardiac isoforms of troponin T and I (TnT-c and TnI-c, respectively). In addition, echocardiographic parameters (M-mode two-dimensional and Doppler analysis) indicative of both left ventricular (LV) systolic and diastolic function were obtained three times from each runner: 2-5 d before the race, at race finish, and 24-36 h after exercise. RESULTS: Except in one subject, levels of TnT-c and TnI-c were within normal limits (<0.1 ng x mL(-1)) in all the samples collected before or after the race. Overall LV systolic function was not altered by marathon running. Finally, LV diastolic function was transiently altered after the race since the ratio between peak early and late transmitral filling velocities (E/A) was significantly reduced at race finish (P < 0.01) and returned to resting levels after 24-36 h. CONCLUSIONS: Our findings suggest that marathon running does not adversely affect the hearts of healthy individuals independently from their training status.     

Effect of training on the physiological factors of performance in elite marathon runners (males and females)

This study examined the effect of 8 weeks of specific marathon training before the Olympic trials on the physiological factors of the marathon performance in top-class marathon runners. Five males and four females, age 34 +/- 6 yr (+/- SD) with a marathon performance time of 2 h 11 min 40 s +/- 2 min 27 s for males and 2 h 35 min 34 s +/- 2 min 54 s for females, performed one test ten and two weeks before the trials. Between this period they trained weekly 180 +/- 27 km and 155 +/- 19 km with 11 +/- 7 and 7 +/- 0% of this distance at velocity over 10000 m for males and females, respectively. The purpose of this test was to determine in real conditions i. e. on level road: VO2 peak, the energy cost of running and the fractional utilisation of VO2 peak at the marathon velocity (vMarathon). They ran 10 km at the speed of their personal best marathon performance on a level road and after a rest of 6 min they ran an all-out 1000 m run. VO2 peak increased after the 8 weeks of pre-competitive training (66.3 +/- 9.2 vs 69.9 +/- 9.4 ml x min(-1) x kg(-1), p = 0.01). Moreover, since the oxygen cost of running at vMarathon did not change after this training, the fractional utilization (F) of VO2 peak during the 10 km run at vMarathon decreased significantly after training (94.6 +/- 6.2% VO2 peak vs 90.3 +/- 9.5% VO2 peak, p = 0.04). The high intensity of pre-competitive training increased VO2 peak and did not change the running economy at vMarathon and decreased the fractional utilization of VO2 peak at vMarathon.     

Comparison between exercise and trans-oesophageal atrial pacing in patients with coronary artery disease: technetium-99m methoxy isobutyl isonitrile simultaneous evaluation of ventricular function and myocardial perfusion.

In this study we compared the results of exercise and trans-oesophageal atrial pacing (TAP) technetium-99m methoxyisobutyl isonitrile (99mTc-SESTAMIBI) cardiac imaging in the evaluation of left ventricular (LV) function and myocardial perfusion in patients with angiographically proven coronary artery disease. Ten patients (8 men and 2 women, mean age 59 +/- 6 years) were submitted to 3 separate injections of 99mTc-SESTAMIBI, one under control conditions, one after exercise and one after TAP. LV ejection fraction, as measured by electrocardiogram (ECG) gated first pass, decreased from 49 +/- 5% under control conditions to 42 +/- 6% during exercise (P less than 0.05 versus control) and to 43 +/- 8% during TAP (P less than 0.05 versus control and insignificant change versus exercise). Segmental myocardial perfusion analysis was performed on a total of 150 myocardial segments. On both exercise and TAP 99mTc-SESTAMIBI studies, 103 segments (69% of the total) were normal, 32 (21%) had reversible, and 15 (10%) irreversible, perfusion defects. Relative regional tracer uptake was not statistically different between exercise and TAP in normal regions (91.1 +/- 9.1% versus 90.7 +/- 8.5%, respectively), in regions with reversible (61.9 +/- 12% versus 62.4 +/- 10.4%, respectively) and irreversible perfusion defects (55.8 +/- 7.8% versus 58.8 +/- 9.5%, respectively). Our results demonstrated that 99mTc-SESTAMIBI TAP cardiac imaging shows similar results to 99mTc-SESTAMIBI exercise myocardial scintigraphy in the assessment of LV function and myocardial perfusion in patients with coronary artery disease.     

Effects of intermittent hypoxia training on exercise performance, hemodynamics, and ventilation in healthy senior men

The efficacy and safety of intermittent hypoxia training (IHT) were investigated in healthy, 60- to 74-yr-old men. Fourteen men (Gr 1) who routinely exercised daily for 20 to 30 min were compared with 21 (Gr 2) who avoided exercise. Their submaximal work-load power values before the IHT training were 94 +/- 3.7 and 66 +/- 3.1, respectively. Before and after 10 days of IHT, the ventilatory response to sustained hypoxia (SH; 12% O(2) for 10 min), work capacity (bicycle ergometer), and forearm cutaneous perfusion (laser Doppler) were determined. During SH, no negative electrocardiogram (ECG) changes were observed in either group, and the ventilatory response to SH was unaltered by IHT. In Gr 1, IHT (normobaric rebreathing for 5 min, final Sa(O(2)) = 85% to 86%, followed by 5 min normoxia, 4/day) produced no changes in hemodynamic indixes and work capacity. In Gr 2, IHT decreased blood pressure (BP) by 7.9 +/- 3.1 mmHg (p < 0.05) and increased submaximal work by 11.3% (p < 0.05) and anaerobic threshold by 12.7% (p < 0.05). The increase in HR and BP caused by a 55 W-work load was reduced by 5% and 6.5%, respectively (p < 0.05). Cutaneous perfusion increased by 0.06 +/- 0.04 mL/min/100 g in Gr 1 and by 0.11 +/- 0.04 mL/min/100 g in Gr 2 (p < 0.05). Hyperemia recovery time increased significantly by 15.3 +/- 4.6 sec in Gr 1 and by 25.2 +/- 11.2 sec in Gr 2. Thus, healthy senior men well tolerate IHT as performed in this investigation. In untrained, healthy senior men, IHT had greater positive effects on hemodynamics, microvascular endothelial function, and work capacity.     

Effect of aerobic exercise training on renal responses to sodium in hypertensives

INTRODUCTION: Aerobic exercise training has been shown to improve cardiovascular function and lower blood pressure (BP) in older adults. The exact mechanism(s) by which aerobic exercise training elicits these changes are unknown; however, it is possible that changes in renal hemodynamics may play a role. PURPOSE: The present study was undertaken to examine the effect of aerobic exercise training on renal hemodynamics in older hypertensive individuals. METHODS: Renal plasma flow (RPF) and glomerular filtration rate (GFR) were determined by plasma and urinary clearances of 131I-hippuran and 99mTc-DTPA after 8 d of low (20 mEq) and high (200 mEq) Na+ diets in 31 older (63 +/- 1 yr), hypertensive (152 +/- 2/88 +/- 1 mm Hg) individuals at baseline and following 6 months of aerobic exercise training (at 75% VO2max, three times a week, 40 min per session). RESULTS: Following 6 months of aerobic exercise training, a significant increase was seen in maximal aerobic capacity (VO2max: 18.3 +/- 0.7 vs 20.7 +/- 0.7 mL.kg.min(-1), P = 0.017) as well as a significant decrease in resting systolic (152 +/- 2 vs 145 +/- 2 mm Hg, P = 0.037) and mean arterial (109 +/- 1 vs 105 +/- 1 mm Hg, P = 0.021) BP. No significant (P < 0.05) effects were seen of aerobic exercise training on RPF (208.8 +/- 12.2 vs 197.1 +/- 13.1 mL.min(-1).1.73 m(-2)), GFR (68.9 +/- 3.6 vs 69.0 +/- 3.9 mL.min(-1).1.73 m(-2)), or filtration fraction (35.3 +/- 2.3 vs 37.1 +/- 2.4%) on the low Na+ diet or RPF (210.6 +/- 12.8 vs 212.1 +/- 11.7 mL.min(-1).1.73 m(-2)), GFR (72.9 +/- 4.1 vs 77.3 +/- 4.3 mL.min(-1).1.73 m(-2)), or filtration fraction (37.1 +/- 2.5 vs 37.7 +/- 3.0%) on the high Na+ diet. CONCLUSIONS: Our results suggest that changes in renal hemodynamics do not contribute to the reduction in resting BP in older hypertensive persons.     

American women in the marathon

American women have made great advances in the sport of marathon running over the past 4 decades. The purpose of this study was to examine the trend of marathon times among American female runners between 1976 and 2005, and to compare physiological characteristics of male and female runners. The best marathon times of American female and male marathon runners for each year (1976-2005) were collected from several published sources. Two research studies were reviewed that examined a variety of physiological variables of female and male elite distance runners. While the best marathon times of American men have remained fairly constant in recent decades ( approximately 2:10:00), the best times of American women have decreased dramatically from 2:47:10 in 1976 to 2:21:25 in 2005, a decrease of 15.6% over the 30-year period. The physiological characteristics of elite American female marathon runners differ from those of elite male marathon runners (e.g. maximal oxygen uptake = 67.1 +/- 4.2 mL/kg/min vs 74.1 +/- 2.6 mL/kg/min). These differences are comparable with the differences seen in marathon performance. Over the past 30 years, participation by women in marathon running has grown dramatically and during that same period the marathon performances of women have improved at a remarkable rate.     

Effect of antianginal medication on resting myocardial perfusion and pharmacologically induced hyperemia

BACKGROUND: Patients scheduled for myocardial perfusion imaging are often taking several antianginal drugs. There is presently no consensus concerning a regimen of discontinuation before either rest or pharmacologic stress myocardial perfusion imaging. Whether antianginal treatment affects diagnostic sensitivity and specificity is not well documented.Methods and results The effect of the three most commonly used antianginal drugs (nitroglycerin, 400 microg [NTG]; metoprolol, 50 mg [MET]; and amlodipine, 5 mg [AML]) on myocardial perfusion was tested in 49 patients (age, 63 +/- 8 years; 43 men) allocated prospectively to one of the treatments (NTG, n = 25; MET, n = 14; and AML, n = 10). All patients had documented coronary artery disease and were scheduled for elective percutaneous coronary intervention. Patients were studied once on treatment and once off treatment with an interval of 1 to 3 weeks. For NTG, the measurements were performed on the same day with an interval of 1 hour. The MET and AML groups were also studied during dipyridamole-induced hyperemia (0.56 mg. kg(-1). min(-1) for 4 minutes). So that a quantitative value of myocardial perfusion in milliliters per gram per minute could be obtained, myocardial perfusion was quantified with nitrogen 13 ammonia positron emission tomography as an average of the midventricular perfusion in each of the 3 vascular territories. NTG treatment increased the overall resting perfusion (0.75 +/- 0.18 vs 0.86 +/- 0.22, P <.05), whereas resting perfusion was reduced after MET treatment (0.92 +/- 0.14 vs 0.82 +/- 0.17, P <.05). AML treatment did not alter resting perfusion (0.87 +/- 0.22 vs 0.87 +/- 0.23, P = NS). Dipyridamole-induced hyperemia was reduced after treatment with MET (2.02 +/- 0.66 vs l.57 +/- 0.52, P <.001), whereas the hyperemic response was unchanged after treatment with AML (1.54 +/- 0.49 vs 1.86 +/- 0.91, P = NS). CONCLUSIONS: Antianginal medication can alter both resting and hyperemic myocardial perfusion and might affect the ability to detect flow-limiting stenosis. NTG increases perfusion, MET reduces perfusion, and AML does not affect perfusion. Larger-scale trials are warranted to establish a consensus for optimal antianginal medication for patients undergoing perfusion imaging.     

Left ventricular function and perfusion in elderly endurance athletes

PURPOSE: To study the extent to which lifelong physical training can affect cardiovascular capacity, left ventricular function, and myocardial perfusion in elderly men. METHODS AND RESULTS: Ten healthy male veteran endurance athletes aged 73 +/- 3 yr (mean +/- SD) and a control group of 12 sedentary or moderately physically active healthy subjects aged 75 +/- 2 yr were studied. Echocardiographic examinations at rest and exercise stress tests were performed. Gated blood pool scans and myocardial perfusion scintigraphy were recorded at rest and during exercise. Maximal VO2 was 41 +/- 7 mL.kg-1.min-1 in the athletes and 26 +/- 5 mL.kg-1.min-1 in the controls (P < 0.001). Echocardiographic measures of systolic and diastolic function at rest were better in the athletes. The ejection fraction during exercise was also higher in the athletes (P = 0.003). Seven of the 10 athletes, but none of the controls, had pathological myocardial perfusion findings. CONCLUSIONS: By endurance training, a high level of physical capacity can be maintained late in life. The superior cardiovascular function in the veteran athletes, compared with the untrained controls was due to both better systolic and diastolic left ventricular function. Myocardial perfusion defects in athletes should be judged with caution, as this finding is common both in veteran athletes and as previously shown, in young athletes.     

Effects of increased lipid concentration and hyperemic blood flow on the intrinsic myocardial washout kinetics of (99m)TcN-NOET.

Bis(N-ethoxy,N-ethyldithiocarbamato)nitrido technetium (V) ((99m)Tc) ((99m)TcN-NOET) is a myocardial perfusion imaging agent demonstrating significant redistribution and currently in phase III clinical trials. Previous studies have suggested that (99m)TcN-NOET is bound intravascularly. Therefore, we sought to determine whether modifications in the vascular compartment would provide further insights into the mechanisms of (99m)TcN-NOET myocardial washout and redistribution. METHODS:(99m)TcN-NOET cardiac washout was studied ex vivo in 15 isolated perfused rat hearts after bolus injection (1.5 MBq) in the absence (n = 6) or presence of bovine serum albumin ([BSA] 0.03%) with (n = 5) or without (n = 4) bound lipids. The intrinsic myocardial washout of the tracer was also studied in vivo in 6 dogs after intracoronary bolus injection of the tracer (0.75 MBq) before and after hyperlipidemia induced by intravenous administration of 300 mL of 20% intralipids (n = 3) or hyperemia induced by intravenous infusion of the adenosine A(2A) receptor agonist ATL-146e (0.3 micro g/kg/min; n = 6). RESULTS: On isolated hearts, there was no significant myocardial washout of (99m)TcN-NOET with Krebs-Henseleit buffer. Addition of BSA without bound lipids resulted in a significant cardiac washout of the tracer (P < 0.001 by repeated measures ANOVA). The presence of lipids bound to BSA further accelerated the washout rate of (99m)TcN-NOET (half-life [t(1/2)], 431.5 +/- 23.2 min vs. 242.9 +/- 63.2 min; P < 0.05). In vivo in dogs, intralipid administration significantly increased the intrinsic washout rate of (99m)TcN-NOET (t(1/2), 108.0 +/- 23.9 min vs. 51.8 +/- 11.8 min; P < 0.05). In addition, vasodilatation with ATL-146e resulted in a 4.9-fold increase in coronary flow (P < 0.05 vs. baseline) and a significantly faster intrinsic (99m)TcN-NOET myocardial washout (t(1/2), 81.1 +/- 12.1 min vs. 40.7 +/- 7.3 min; P < 0.05). CONCLUSION: The myocardial washout kinetics of (99m)TcN-NOET are affected by a variety of intravascular factors, supporting the hypothesis that the tracer is most likely localized on the vascular endothelium. The potential impact of variations in circulating lipid levels among patients on clinical imaging with (99m)TcN-NOET requires further investigation.     

Exercise capacity of cardiac asymptomatic hereditary hemochromatosis subjects

PURPOSE: The exercise capacity of cardiac asymptomatic subjects with hereditary hemochromatosis (HH) has not been well described. In this study, we tested whether the iron overload associated with HH affected exercise capacity with a case control study design. METHODS: Forty-three HH and 21 normal control subjects who were New York Heart Association functional class I underwent metabolic stress testing using the Bruce protocol at the clinical center of the National Institutes of Health. Exercise capacity was assessed with minute ventilation (.VE), oxygen uptake (.VO2), and carbon dioxide production (.VCO2) using a breath-by-breath respiratory gas analyzer. RESULTS: The exercise capacity of HH subjects was not statistically different from that of control subjects (exercise time 564 +/- 135 vs 673 +/- 175 s, P = 0.191; peak .VO2 29.6 +/- 6.4 vs 32.5 +/- 6.7 mL.kg(-1).min(-1), P = 0.109; ventilatory threshold 19.0 +/- 3.4 vs 21.0 +/- 5.0 mL.min(-1).kg(-1), P = 0.099; data are for HH vs control subjects). Ventilatory efficiency was comparable between groups (.VE/.VCO2 slope 23.7 +/- 3.2 vs 23.4 +/- 4.2, P = 0.791). No significant correlation between the markers of iron levels and the markers of exercise capacity was noted. Iron depletion by 6-month phlebotomy therapy in 18 subjects who were newly diagnosed did not affect exercise testing variables (exercise time 562 +/- 119 vs 579 +/- 118 s, P = 0.691; peak .VO2 29.5 +/- 3.7 vs 29.1 +/- 4.7 mL.kg(-1).min(-1), P = 0.600; ventilatory threshold 18.5 +/- 2.8 vs 17.9 +/- 3.8 mL.kg(-1).min(-1), P = 0.651; data are from before and after phlebotomy therapy). Abnormal ischemic electrocardiographic responses and complex arrhythmias were more frequently seen in HH subjects. CONCLUSIONS: The aerobic exercise capacity of asymptomatic HH subjects seems not to be statistically different from that of normal subjects. The iron levels do not seem to affect exercise capacity in asymptomatic HH subjects.     

Flattening of oxygen pulse during exercise may detect extensive myocardial ischemia

PURPOSE: Flattening of oxygen pulse curve during incremental cardiopulmonary exercise testing has been proposed for the improvement of diagnostic accuracy of exercise-induced myocardial ischemia. In this study, we compare the oxygen pulse response to incremental treadmill exercise in patients with and without ischemia as detected by myocardial perfusion scintigraphy. METHODS: Eighty-seven patients referred to exercise myocardial perfusion scintigraphy were also evaluated with incremental treadmill cardiopulmonary exercise testing. One investigator prospectively identified patients who presented transient exercise-induced perfusion defects on 99mTc sestamibi myocardial scintigraphies. Another investigator evaluated the response of oxygen pulse to incremental exercise testing without knowledge of electrocardiographic response or scintigraphic findings. RESULTS: Exercise myocardial perfusion scintigraphy detected transient perfusion defects in 36% of the patients. Compared with patients with normal perfusion studies, patients with exercise-induced ischemia presented similar peak double product, peak oxygen uptake, and anaerobic threshold. Oxygen pulse at 25% of peak (ischemia: 9.7 +/- 2 mL per beat; no ischemia: 9.3 +/- 2 mL per beat), 50% of peak (11.2 +/- 3 vs 10.8 +/- 3 mL per beat), 75% of peak (12.5 +/- 3 vs 11.9 +/- 3 mL per beat), and at peak exercise (13 +/- 4 vs 13 +/- 4 mL per beat) were not different in exercise-induced ischemia and normal groups, respectively. However, patients who presented extensive transient perfusion defects during exercise had a lower peak oxygen pulse (12.8 +/- 3.8 vs 16.4 +/- 4.6 mL per beat; P < 0.05). CONCLUSION: The analysis of the oxygen pulse response to incremental exercise test does not identify mild myocardial ischemia. Flattening of oxygen pulse response during incremental exercise might be present only with extensive myocardial ischemia.     

Recovery pattern of baroreflex sensitivity after exercise

PURPOSE: To test the association between exercise mode and the recovery pattern of baroreflex sensitivity (BRS) after exercise. METHODS: The study population included healthy male subjects (N = 12, age: 31 +/- 3 yr). Four different interventions were performed in a randomized order: 1) aerobic exercise session on a bicycle ergometer, 2) light resistance exercise session, 3) heavy resistance exercise session, and 4) control intervention with no exercise. All interventions lasted 40 min. R-R intervals and continuous blood pressure were measured before (10 min) and 30-180 min after the interventions. BRSLF was calculated by the transfer function method from the low-frequency band (LF, 0.04-0.15 Hz) of the R-R intervals and systolic blood pressure spectra. RESULTS: BRSLF had blunted until 30 min after aerobic and light resistance exercise (11.1 +/- 4.3 and 10.0 +/- 3.6 vs 17.5 +/- 7.0 ms.mm Hg(-1), P = 0.002 for both, compared with the control intervention, respectively). However, BRSLF was significantly blunted until 60 min after heavy resistance exercise (9.3 +/- 2.3 vs 15.1 +/- 4.7 ms.mm Hg(-1), P = 0.005, compared with the control intervention). The high-frequency power of R-R intervals (0.15-0.4 Hz) was significantly reduced, and the LF power of systolic blood pressure oscillation was significantly augmented 30 min after heavy resistance exercise (P < 0.01 for both), whereas both indices were restored to the control level by 30 min after aerobic and light resistance exercise. CONCLUSION: BRS after acute exercise is associated with exercise intensity, showing relatively rapid recovery after aerobic and light resistance exercise and delayed recovery after heavy resistance exercise. The delayed BRS pattern after heavy resistance exercise is regulated by delicate interplay between the withdrawal of vagal outflow and the probably increased sympathetic vasomotor tone documented by measurements of heart rate and blood pressure variability.     

Exercise training in women with heart disease: influence of hormone replacement therapy

PURPOSE: To examine the central and peripheral cardiovascular effects of exercise training in postmenopausal women with CAD with and without hormone replacement therapy (HRT and N-HRT). METHODS: Thirty-eight female cardiac patients referred for cardiac rehabilitation were divided into HRT ( N= 18) or N-HRT (N = 20) groups. Peak oxygen uptake (VO2) peak and ventilatory anaerobic thresholds (AT) were determined, in addition to submaximal cardiac output (Q). Peripheral measures of resting and peak ischemic blood flows (BF) were also measured. Measurements were all repeated after 12 and 26 wk of exercise training consisting of 1 h of walking at 75-80% of the measured VO2peak at baseline (T1) for 5 d.wk(-1). RESULTS: VO2peak mL.kg(-1).min(-1) at baseline (14.9 +/- 0.4) increased by 5% after 12 wk (15.6 +/- 0.4) and significantly by 15% (17.2 +/- 0.5) after 26 wk of exercise training (P < 0.001). The HRT group was significantly younger than the N-HRT group (58 vs 65 yr; P < 0.01) and had significantly higher VO2peaks at baseline (15.7 vs 14.2 mL.kg(-1).min(-1); P < 0.05), yet either did not influence changes in other variables. At fixed submaximal work rates, there was a significant training bradycardia ( P < 0.01), but insignificant changes in Q or stroke volume regardless of HRT status. Resting and peak ischemic calf BF and vascular conductance increased significantly ( P < 0.001) at 12 and 26 wk, with no difference found according to HRT status. CONCLUSIONS: The cardiovascular responses to training in postmenopausal women with CAD appear to be consistent regardless of HRT status and dominated by peripheral adaptations.     

Effect of transmyocardial laser revascularization on myocardial perfusion and left ventricular remodeling after myocardial infarction in rats

PURPOSE: To monitor perfusion changes in remote myocardium caused by transmyocardial laser revascularization (TMLR) and to investigate the influence of TMLR on left ventricular morphology and function. MATERIALS AND METHODS: The coronary arteries were ligated in 32 Wistar rats. Eight weeks later, cine magnetic resonance (MR) imaging was performed in both the treatment (n = 12) and control group (n = 8). TMLR was then performed in the remote myocardium in the treated group. Twelve weeks after myocardial infarction, cine MR imaging, including dobutamine-induced (10 micro g per kilogram of body weight per minute via the tail vein) stress, was repeated and followed with hemodynamic measurements in both groups and with perfusion MR imaging (in-plane resolution, 140 x 140 micro m) of the isolated heart at rest and during nitroglycerin-induced stress in the TMLR group (n = 10). RESULTS: Left ventricular dilatation and hypertrophy were enhanced in the TMLR group (change in end-diastolic volume at 8-12 weeks: control group, 24.6 micro L +/- 16.7 and TMLR group, 81.7 micro L +/- 15.7; change in left ventricular mass: control group, 54.5 mg +/- 19.2 and TMLR group, 124.1 mg +/- 30.7; P <.03 for both). Ejection fractions at rest were approximately equal (control group, 40% +/- 2; TMLR group, 38% +/- 2; P value not significant), but during dobutamine-induced stress, the ejection fraction was higher in the TMLR group (54.4% +/- 4.9; control group, 47.4% +/- 4.8; P <.05). TMLR-treated areas were better perfused than was untreated myocardium (difference in perfusion: TMLR-treated vs control region, 3.89 mL/min/g +/- 0.83 at rest vs 2.29 mL/min/g +/- 1.06 during nitroglycerin-induced stress; P <.05 for both). Hemodynamic measurements revealed no differences between groups. CONCLUSION: High-spatial-resolution perfusion MR imaging depicted a significant perfusion improvement after TMLR. Post-myocardial infarction remodeling of the left ventricle was found to be enhanced.