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Correlation between the hemodynamic parameters and exercise induced changes of the p wave in the ischemic heart disease



Correlation between the hemodynamic parameters and exercise induced changes of the p wave in the ischemic heart disease



Shikoku Acta Medica 41(6): 397-412



A supine exercise test was performed to assess the relation of exercise-induced changes of the P wave and the hemodynamic parameters in 49 cases with old myocardial infarction (MI), 32 cases with angina pectoris (AP) and 23 cases of control subjects (Control). Exercise caused apparent increase in the amplitude of P wave in lead II and P terminal force (PTF) in lead V1. There was, however, no significant change in the amplitude of P wave in lead II among 3 groups. Changes of PTF-V1 in control group were significantly smaller than those in MI and AP groups (Control: 0.015 .+-. 0.02 to 0.024 .+-. 0.01, AP: 0.028 .+-. 0.02 to 0.059 .+-. 0.02, MI: 0.031 .+-. 0.02 to 0.066 .+-. 0.03 mm .cntdot. sec.). Left ventricular end-diastolic pressure (LVEDP) and cardiac index (CI) were elevated in all three groups after the exercise test. Change of LVEDP was pronounced in ischemic heart disease. Exercise caused apparent elevation of CI and a little increase of LVEDP in control group. There was a relatively low correlation between PTF-V1 and LVEDP at rest (r = 0.391, p < 0.01). But after exercise, PTF-V1 correlated with LVEDP more closely (r = 0.625, p < 0.01). CI was not correlated with PTF-V1 at rest and slightly correlated after the exercise. Criteria of abnormal response of PTF-V1 to the exercise for the evaluation of cardiac dysfunction (LVEDP .gtoreq. 18 mmHg) were set as follows. 1) PTF-V1 exceeded 0.04 mm.cntdot.sec. after exercise, 2) PTF-V1 increased more than 0.02 mm .cntdot. sec. after exercise, in case whose PTF-V1 exceeded 0.04 mm .cntdot. sec. before exercise. Diagnostic accuracy of these criteria were examined, and the sensitivity of 90.5 percent, the specificity of 83.3 percent and the predictive accuracy of 93.1 percent were found. PTF-V1 changed remarkably after the exercise in patients with ischemic heart disease. Evaluation of the change of PTF-V1 after exercise was useful for the diagnosis of the latent failure of the left ventricular function.

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