Clinical significance of symptomatic and silent myocardial ischemia during exercise test in patients with effort angina pectoris--investigation of hemodynamic responses during supine ergometer exercise test.

Thirty one patients with stable effort angina who had no prior myocardial infarctions underwent symptom-limited ergometer exercise test. Hemodynamic responses during exercise were assessed to determine whether or not the limiting symptoms were related to the severity of exercise-induced myocardial ischemia. Twenty-two subjects (Group I) were limited by angina and nine (Group II) were limited by other symptoms. There were no differences in age, sex distribution, prevalence of diabetes mellitus, and left ventricular ejection fraction between the two groups. Multivessel coronary artery diseases, however, were more frequent in group I (16/22 vs 3/9: p less than 0.05). Maximal work load (46.6 +/- 16.0 vs 62.5 +/- 13.4 W: p less than 0.05), exercise duration (4.7 +/- 2.0 vs 7.2 +/- 1.4 min: p less than 0.005), and maximal oxygen consumption (12.4 +/- 4.1 vs 19.3 +/- 3.3 ml/kg/min: p less than 0.005) were significantly lower in group I. The magnitude of ST depression was not different between the two groups (2.0 +/- 0.8 vs 1.8 +/- 0.7 mm: NS). At maximal exercise, heart rate, mean blood pressure, cardiac index, and stroke work index (SWI) were significantly lower in group I (p less than 0.05) and pulmonary capillary wedge pressure was significantly higher in group I (31.1 +/- 6.1 vs 25.1 +/- 5.6 mmHg: p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)