Christine Halphen

Prognostic value of exercise testing soon after myocardial infarction.

The prognostic value of a limited treadmill exercises test performed one day before hospital discharge after acute myocardial infarction was studied in 210 consecutive patients who had no over heart failure and had been free of chest pain for at least four days. No complications occurred. During a one-year follow-up period 28 of 43 patients (65 per cent) who had chest pain during the test reported angina, as compared with 60 of 167 (36 per cent) who had no chest pain during test (P less than 0.001). The one-year mortality rates were 2.1 per cent (three of 146) in patients without changes in the S-T segment during exercise and 27 per cent (17 of 64) in those with depression of the S-T segment (P less than 0.001). Sudden death occurred in one of 146 (0.7 per cent) patients who showed no change in the S-T segment and in 10 of 64 (16 per cent) with depression of the segment (P less than 0.001). Thus, a limited treadmill exercise test performed before hospital discharge after acute myocardial infarction is safe and can predict mortality in the subsequent year.

Coronary artery disease in young women: Clinical and angiographic features and correlation with risk factors

Coronary arteriography was performed because of suspected coronary disease in 239 women less than 45 years of age. Normal coronary arteries were found in 112 women, and a further 23 had insignificant stenosis (less than 50 percent narrowing of luminal diameter). Of the remaining 104 women, 56 had one vessel, 22 two vessel and 26 three vessel disease. Hyperlipidemia, hypertension, diabetes, smoking and a family history of coronary disease were significantly more frequent in women with significant stenosis than in women with normal arteries. Significant coronary disease was found in 55 percent (100 of 182) of women with more than two risk factors but in only 7 percent (4 of 57) of those with less than two risk factors (P less than 0.0001). Evaluation of symptoms and the resting electrocardiogram also discriminated between women with and without coronary disease, but exercise testing was of little value. Only 4 of the 46 women with previous myocardial infarction had normal or near-normal coronary arteries. Among women with segmental wall motion abnormalities on ventriculography, the site was anterior in 90 percent (19 of 21) of women who used oral contraceptive drugs but in only 60 percent (21 of 35) of nonusers (P less than 0.05). However, in most respects, coronary artery disease in young women does not appear to differ from coronary disease in other patients.

Clinical predictors of angina following myocardial infarction

Abstract To determine if angina following myocardial infarction could be predicted before hospital discharge we prospectively evaluated 219 consecutive patients admitted to the coronary care unit with acute myocardial infarction. Of the 166 who survived to one year, angina was present before infarction in 53 per cent and after infarction in 61 per cent. Angina did not recur postinfarction in 26 per cent of the patients who had angina before infarction. However, in 47 per cent of those without previous angina it developed postinfarction. Although postinfarction angina correlated with the presence of angina before infarction (p To improve our ability to predict angina after infarction we performed exercise tests to 5 metabolic equivalents (METS), or 70 per cent of age-predicted maximal heart rate, before hospital discharge on all patients less than 70 years old who were without chest pain within four days or without overt heart failure. Of the 105 patients exercised, 31 (86 per cent) of the 36 with positive tests had angina during the subsequent year compared to only 25 (36 per cent) of the 69 with negative tests (p We conclude that the presence of angina prior to infarction and a positive limited exercise test performed before hospital discharge are predictive of angina following infarction. Myocardial infarction abolishes angina in a quarter of the patients, but angina develops postinfarction in nearly half of the patients who did not have angina previously.

Assessment of left ventricular regional wall motion by color kinesis technique: comparison with angiographic findings.

The analysis of segmental wall motion using two‐dimensional (2‐D) echocardiography is subjective with high interobserver variability. Color kinesis is a new technique providing a color‐encoded map of endocardial motion. We evaluated the accuracy of color kinesis and 2‐D for assessment of regional asynergy compared with left ventricular angiography as a reference method. Fifteen patients admitted for myocardial infarction were studied by echocardiography the day before left ventricular angiography. The left ventricle was divided into seven segments. Each segment was classified by two independent observers as normal or abnormal in 2‐D and color kinesis. Accuracy of color kinesis and 2‐D was evaluated and compared to left ventricular angiography. Color kinesis is significantly superior to 2‐D for all seven segments (mean 0.80/0.68, P = 0.05), except for the septum (0.67/0.60, P = NS). Interobserver variability studied by chi‐square statistic is lower with color kinesis (0.70) than with 2‐D (0.57). We conclude that these data suggest that color kinesis is a useful method for assessing systolic wall motion in all segments, except the septum and for improving the accuracy of segmental ventricular function and interobserver variability.

Silent pericardial effusion in late pregnancy: a new entity.

Of 123 healthy pregnant women examined systematically by M-mode and two-dimensional echocardiography at various stages of gestation, 46 were in their late pregnancy (32nd–38th week) of whom 19 (41.3%) showed unexpected signs of pericardial effusion on the echocardiogram. Following Horowitz’s criteria, the effusion was large in 2, moderate in 4, and small in 13 cases; in all women the condition was clinically silent. Clinical examination was normal in all but 3 women, in whom high blood pressure returned to normal after delivery. The ECG was usually normal (16 of 19 cases) or showed nonspecific ST-T changes. The entity appeared in late pregnancy (not before the 32nd week), was transient, and no longer could be seen within a month after delivery of a normal child. Cause of the effusion was attributed to excessive water and salt retention in those women with an abnormal echocardiogram who at this late stage of gestation had a mean weight gain significantly higher (P<0.03) than in others (13.60±4.28 vs 10.96±3.7 kg) — an observation not reported before in normal pregnancy. Since pericardial effusion cannot be detected by clinical examination or ECG, echocardiography affords a safe and reliable diagnostic approach.