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CLINICAL STUDY: MYOCARDIAL ISCHEMIA

The warm-up effect protects against ischemic left ventricular dysfunction in patients with angina

^a Cardiology Department, John Radcliffe Hospital, Oxford, United Kingdom

Manuscript received May 19, 2000; revised manuscript received October 20, 2000, accepted November 22, 2000.

Reprint requests and correspondence: Dr. A. D. Kelion, Nuclear Cardiology Department, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom

OBJECTIVES

The goal of this study was to investigate whether the "warm-up" effect in angina protects against ischemic left ventricular (LV) dysfunction.

BACKGROUND

After exercise, patients with coronary disease demonstrate persistent myocardial dysfunction, which may represent stunning, as well as warm-up protection against further angina, which may represent ischemic preconditioning. The effect of warm-up exercise on LV function during subsequent exercise has not been investigated.

METHODS

Thirty-two patients with multivessel coronary disease and preserved LV function performed two supine bicycle exercise tests 30 min apart. Equilibrium radionuclide angiography was performed before, during and up to 60 min after each test. Global LV ejection fraction and volume changes and regional ejection fraction for nine LV sectors were calculated for each acquisition.

RESULTS

Onset of chest pain or 1 mm ST depression was delayed and occurred at a higher rate-pressure product during the second exercise test. Sectors whose regional ejection fraction fell during the first test showed persistent reduction at 15 min (68 ± 20 vs. 73 ± 20%, p < 0.0001). These sectors demonstrated increased function during the second test (71 ± 20 vs. 63 ± 20%, p = 0.0005). The reduction at 15 min and the increase during the second test were both in proportion to the reduction during the first test. Effects on global function were only apparent when the initial response to exercise was considered.

CONCLUSIONS

The warm-up effect is accompanied by protection against ischemic regional LV dysfunction. The degree of stunning and protection after exercise is related to the severity of dysfunction during exercise, consistent with results from experimental models.

Abbreviations and Acronyms   ECG = electrocardiogram or electrocardiographic   EDV = end-diastolic volume   EF = ejection fraction   ERNA = equilibrium radionuclide angiography   ESV = end-systolic volume   LV = left ventricle or ventricular   RPP = rate-pressure product

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