Exercise may cause myocardial ischemia at the anaerobic threshold in cardiac rehabilitation programs

Exercise may cause myocardial ischemia at the anaerobic threshold in cardiac rehabilitation programs

Author Fuchs, Angela Rúbia Cavalcanti Neves Autor UNIFESP Google Scholar
Meneghelo, Romeu Sergio Google Scholar
Stefanini, Edson Autor UNIFESP Google Scholar
De Paola, Angelo Amato Vincenzo Autor UNIFESP Google Scholar
Smanio, Paola Emanuela Poggio Google Scholar
Mastrocolla, Luiz Eduardo Google Scholar
Ferraz, Almir Sergio Google Scholar
Buglia, Susimeire Google Scholar
Piegas, Leopoldo Soares Google Scholar
Carvalho, Antonio Carlos Autor UNIFESP Google Scholar
Institution Instituto Dante Pazzanese de Cardiologia Serviço de Reabilitação Cardiovascular
Instituto Dante Pazzanese de Cardiologia Seção Médica de Medicina Nuclear
Instituto Dante Pazzanese de Cardiologia Departamento de Saúde
Universidade Federal de São Paulo (UNIFESP)
Abstract Myocardial ischemia may occur during an exercise session in cardiac rehabilitation programs. However, it has not been established whether it is elicited when exercise prescription is based on heart rate corresponding to the anaerobic threshold as measured by cardiopulmonary exercise testing. Our objective was to determine the incidence of myocardial ischemia in cardiac rehabilitation programs according to myocardial perfusion SPECT in exercise programs based on the anaerobic threshold. Thirty-nine patients (35 men and 4 women) diagnosed with coronary artery disease by coronary angiography and stress technetium-99m-sestamibi gated SPECT associated with a baseline cardiopulmonary exercise test were assessed. Ages ranged from 45 to 75 years. A second cardiopulmonary exercise test determined training intensity at the anaerobic threshold. Repeat gated-SPECT was obtained after a third cardiopulmonary exercise test at the prescribed workload and heart rate. Myocardial perfusion images were analyzed using a score system of 6.4 at rest, 13.9 at peak stress, and 10.7 during the prescribed exercise (P < 0.05). The presence of myocardial ischemia during exercise was defined as a difference ≥2 between the summed stress score and summed rest score. Accordingly, 25 (64%) patients were classified as ischemic and 14 (36%) as nonischemic. MIBI-SPECT showed myocardial ischemia during exercise within the anaerobic threshold. The 64% prevalence of ischemia observed in the study should not be looked on as representative of the whole population of patients undergoing exercise programs. Changes in patient care and exercise programs were implemented as a result of our finding of ischemia during the prescribed exercise.
Keywords Exercise test
Anaerobic threshold
Myocardial ischemia
Coronary artery disease
Language English
Date 2009-03-01
Published in Brazilian Journal of Medical and Biological Research. Associação Brasileira de Divulgação Científica, v. 42, n. 3, p. 272-278, 2009.
ISSN 0100-879X (Sherpa/Romeo, impact factor)
Publisher Associação Brasileira de Divulgação Científica
Extent 272-278
Origin http://dx.doi.org/10.1590/S0100-879X2009000300008
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000264200100008
SciELO ID S0100-879X2009000300008 (statistics in SciELO)
URI http://repositorio.unifesp.br/handle/11600/4918

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