Exercise stress testing before and after successful multivessel percutaneous transluminal coronary angioplasty

Controversy exists regarding the diagnostic accuracy, optimal technique, and timing of exercise testing after percutaneous coronary intervention. The objectives of the present study were to analyze variables and the power of exercise testing to predict restenosis or a new lesion, 6 months after the procedure. Eight-four coronary multi-artery diseased patients with preserved ventricular function were studied (66 males, mean age of all patients: 59 ± 10 years). All underwent coronary angiography and exercise testing with the Bruce protocol, before and 6 months after percutaneous coronary intervention. The following parameters were measured: heart rate, blood pressure, rate-pressure product (heart rate x systolic blood pressure), presence of angina, maximal ST-segment depression, and exercise duration. On average, 2.33 lesions/patient were treated and restenosis or progression of disease occurred in 46 (55 percent) patients. Significant increases in systolic blood pressure (P = 0.022), rate-pressure product (P = 0.045) and exercise duration (P = 0.003) were detected after the procedure. Twenty-seven (32 percent) patients presented angina during the exercise test before the procedure and 16 (19 percent) after the procedure. The exercise test for the detection of restenosis or new lesion presented 61 percent sensitivity, 63 percent specificity, 62 percent accuracy, and 67 and 57 percent positive and negative predictive values, respectively. In patients without restenosis, the exercise duration after percutaneous coronary intervention was significantly longer (460 ± 154 vs 381 ± 145 s, P = 0.008). Only the exercise duration permitted us to identify patients with and without restenosis or a new lesion.

Efeitos do labetalol na resposta da pressão arterial ao esforço em pacientes hipertensos / Effects of labetalol on the response of arterial blood pressure to exercise in hypertensive patients

Nove pacientes do sexo feminino, portadores de hipertensao arterial primaria, com pressao diastolica entre 100 e 120mm Hg, foram submetidos a tratamento da pressao arterial com labetalol (bloqueador alfa e beta). Em todos, a pressao diastolica tornou-se menor que 95 mm Hg. Foram comparadas as respostas tensionais e a frequencia cardiaca apos exercicio em cicloergometro, antes e depois do tratamento. Houve diminuicao significativa da pressao sistolica em repouso como em todos os estagios do exercicio, apos o uso do medicamento. Conclue-se que o labetalol demonstrou, ao exercicio, acao "hipotensora" satisfatoria nas doses utilizadas para controle da hipertensao em repouso