Demonstration of exercise-induced painless myocardial ischemia in survivors of out-of-hospital ventricular fibrillation |
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| Authors: | B Sharma R Asinger G S Francis M Hodges R P Wyeth |
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| Affiliation: | 1. Department of Medicine, Mount Auburn Hospital, Cambridge, Massachusetts;2. Harvard Medical School, Boston, Massachusetts;3. National Heart and Lung Institute, Imperial College, London, United Kingdom;4. Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom;5. Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, United Kingdom;6. British Heart Foundation Centre of Excellence, King''s College London, London, United Kingdom;7. Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;8. Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland;9. Department of Medicine, Division of Cardiology, Mount Auburn Hospital, Cambridge, Massachusetts;2. Punjab Agriculture Department, Shahkot, Pakistan;3. Soil and Environmental Sciences Division, Nuclear Institute for Agriculture and Biology (NIAB), Faisalabad, Pakistan;4. Institute of Soil and Environmental Sciences, University of Agriculture, Faisalabad, Pakistan;5. Department of Fisheries and Aquaculture, University of Veterinary and Animal Sciences, Lahore, Pakistan;6. Department of Environmental Sciences and Engineering, Government College University, Faisalabad, Pakistan;1. Department of Mathematics, Universidad Autónoma de Occidente Calle 25 No. 115-85, Cali, Colombia;2. Department of Mathematics, Universidad del Valle Calle 13 No. 100-00, Cali, Colombia;1. Department of Occupational and Environmental Health, Peking University School of Public Health, Peking University Institute of Environmental Medicine, Beijing, China;2. Beijing Municipal Institute of Labor Protection, Beijing, China;3. George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia;4. Department of Cardiology, Peking University Third Hospital, Beijing, China;5. Department of Chemistry, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China;6. Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China |
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| Abstract: | To ascertain if myocardial ischemia is the mechanism of out-of-hospital ventricular fibrillation (VF), left ventricular (LV) function was assessed at rest and during submaximal exercise in 15 patients who survived out-of-hospital VF. They were separated into asymptomatic (9 patients, group A) and symptomatic (6 patients, group S) groups for a history of angina or myocardial infarction. Both groups had significant (at least 70% diameter stenosis) coronary artery disease. At catheterization no patient had angina during exercise, but 12 of 15 had ST depression or increased ST depression (group A, 1.9 +/- 1.4 mm; group S, 1.1 +/- 1.2 mm) and 11 had abnormal wall motion. From rest to exercise, patients in group S had increased LV end-diastolic pressure (from 21 +/- 9 to 37 +/- 11 mm Hg, p = 0.009) and volume (from 100 +/- 25 to 107 +/- 26 ml/m2, p = 0.006), with no significant change in LV ejection fraction (from 40 +/- 13 to 42 +/- 12%). In group A LV end-diastolic pressure increased from 19 +/- 4 to 31 +/- 8 mm Hg (p = 0.001), but neither end-diastolic volume nor ejection fraction changed significantly (from 83 +/- 13 to 92 +/- 23 ml/m2 and from 55 +/- 13% to 46 +/- 13%, respectively). Thus, patients with coronary artery disease who survive out-of-hospital VF may have evidence of myocardial ischemia during exercise without pain. Painless ischemia may have a role in out-of-hospital VF. |
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