Metabolic Response of Diabetic Patients with Obesity and No Obesity during Bruce Treadmill Test

Background: Physical exercise alters many biochemical parameters of human body. For that reason, it is recommended as a cure for many diseases of modern life like obesity and diabetics. This study investigates the biochemical and hormonal changes in diabetic, hypertensive and obese individuals after Bruce treadmill tests of different durations and intensities. Method: Our sample consisted of 59 individuals, divided into four groups: A: 12 normal body-weight diabetics, B: 11 overweight diabetics, C: 14 normal body-weight non-diabetics and D: 22 overweight non-diabetics. 66.1% of them were men. The comparisons were done between: 1) Diabetics versus non-diabetics;2) Over-weight versus normal body-weight persons;3) Over-weight diabetics versus normal weight diabetics;4) Over-weight non-diabetics versus normal body-weight non-diabetics of 5) Hypertensives versus non-hypertensives. All individuals performed an intense, short duration treadmill exercise test, independently of the presence or not of DM2, hypertension and obesity. Results: The participants with DM2 (obese and non-obese) had decreased levels of glucose, triglycerides and TSH (P Conclusion: Our results proved that the physical exercise, even if it has short duration like that of the Bruce test, has beneficial results in persons with DM2, obesity and arterial hypertension, as well as in normal persons.

Exertional esophageal pH-metry and manometry in recurrent chest pain

AIM: To investigate the diagnostic efficacy of 24-h and exertional esophageal pH-metry and manometry in patients with recurrent chest pain. METHODS: The study included 111 patients (54% male) with recurrent angina-like chest pain, non-respon- sive to therapy with proton pump inhibitors. Sixty-five (59%) had non-obstructive lesions in coronary artery angiography, and in 46 (41%) significant coronary artery narrowing was found. In all patients, 24-h esophageal pH-metry and manometry, and treadmill stress tests with simultaneous esophageal pH-metry and manometry monitoring were performed. During a 24-h examination the percentage of spontaneous chest pain (sCP) episodes associated with acid reflux or dysmotility (symptom index, SI) was calculated. Patients with SI > 50% for acid gastroesophageal reflux (GER) were classified as having GER-related sCP. The remaining symptomatic individuals were determined as having non-GER-related sCP. During the stress test, the occurrence of chest pain, episodes of esophageal acidification (pH < 4 for 10 s) and esophageal spasm with more than 55% of simultaneous contractions (exercise-provoked esophageal spasm or EPES) were noted. RESULTS: Sixty-eight (61%) individuals reported sCP during 24-h esophageal function monitoring. Eleven of these (16%) were classified as having GER-related sCP and 53/68 (84%) as having non-GER-related sCP. The exercise-provoked chest pain during a stress test occurred in 13/111 (12%) subjects. In order to compare the clinical usefulness of 24-h esophageal function monitoring and its examination limited only to the treadmill stress test, the standard parameters of diagnostic test evaluation were determined. The occurrence of GER- related or non-GER-related sCP was assumed as a "gold standard". Afterwards, accuracy, sensitivity and specificity were calculated. These parameters expressed a prediction of GER-related or non-GER-related sCP occurrence by the presence of chest pain, esophageal acidification and EPES. Accuracy, sensitivity and specificity of chest pain during the stress test predicting any sCP occurrence were 28%, 35% and 80%, respectively, predicting GER- related sCP were 42%, 0% and 83%, respectively, and predicting non-GER-related sCP were 57%, 36% and 83%, respectively. Similar values were obtained for exercise-related acidification with pH < 4 longer than 10 s in the prediction of GER-related sCP (44%, 36% and 92%, respectively) and EPES in relation to non-GER-related sCP (48%, 23% and 84%, respectively). CONCLUSION: The presence of chest pain, esophageal acidification and EPES had greater than 80% specificity to exclude the GER-related and non-GER-related causes of recurrent chest pain.

Rehabilitation training improves exercise tolerance after percutaneous coronary intervention

The aim of this present study was to investigate the effects of training on exercise tolerance of patients with coronary heart disease after percutaneous coronary intervention.Fifty-seven cases of coronary heart disease after percutaneous coronary intervention were divided randomly into the rehabilitation training group（26 cases） and control group（31 cases）.Patients in the rehabilitation training group received rehabilitation training at different stages and exercise intensities 3 d after percutaneous coronary intervention for 3 months.The heart rate,blood pressure,ECG changes in treadmill exercise test,and the frequency of anginal episodes were observed.The results showed that NST and ΣST of ECG and the frequency of anginal episodes were significantly reduced in the rehabilitation training group.In addition,exercise tolerance was improved and the total exercise time was lengthened in these patients.Moreover,ST segment depression time and emergence time of angina with exercise were also lengthened compared with controls（P 〈 0.05,or 0.01）.However,the heart rate and blood pressure before and after exercise of the two groups were similar.The study indicated that rehabilitation training could significantly relieve angina,amend ischemic features of ECG,and improve exercise tolerance of coronary heart disease patients after percutaneous coronary intervention.

Limited value of recovery phase-limited ST segment depression of treadmill exercise test

Background Clinical meaning of recovery phase limited ST segment depression of a treadmill exercise test is controversial.The aim of this study was to re-assess the diagnostic and prognostic value of ST segment depression during the recovery phase with the active phase of a treadmill exercise test in suspected coronary artery disease patients.Methods Clinical,exercise and angiographic data were retrospectively collected from 602 patients in the study.Five hundred and seventy-six patients developed ST segment depression during the active phase of the treadmill exercise test （group 1） and 26 patients developed ST segment depression only during the recovery phase （group 2）.Results With similar major clinical features,the prevalence of significant coronary artery stenosis and average Gensini scores were lower in the recovery phase-limited depression patients （group 2 vs.group 1,50.0% vs.66.9%,P=0.031 and group 2 vs.group 1,1.5 vs.8.5,P=0.04）.At a median follow up of 50.9 months for 22 group 2 and 34.8 months for 438 group 1 patients,the prevalence of total cardiac events was higher in group 1 than in group 2 patients （RR 1.60,95% Cl 1.00-2.54,P=0.049）.Conclusion The present study provides preliminary evidence that the diagnostic and prognostic value of recovery phaselimited ST segment depression of treadmill exercise test is limited.

Predictive treadmill score to identify coronary artery disease

Background Exercise treadmill testing（ETT） is widely used for the diagnosis of coronary artery disease（CAD）.The high false-positive and false-negative rates hamper its clinical application.Hypothesis：We examined a hypothesis that combined ETT and risk-factors of CAD to develop an easily applied predictive treadmill score（PTS） and the superiority of the novel score over the conventional ETT criteria was tested.This score can improve the diagnostic accuracy of treadmill testing for Chinese patients with suspected CAD and plan management strategies for such patients.Methods The present study comprised a retrospective analysis of 300 ETTs of Chinese patients with chest pain referred to suspected CAD who also had coronary angiography within one month after ETT.Clinical characteristics and ETT results of those with and without angiographic CAD were compared.A logistic regression model was used to construct a PTS that could accurately predict clinically significant CAD,defined as the presence of at least one 〉 70 % angiographic stenosis in a major epicardial coronary artery.The accuracy of the new PTS was compared to conventional criteria of ETT for CAD diagnosis.Results The study included 185 patients with clinically significant CAD（61.6 %） and 115（38.4 %） without CAD.Patients with significant CAD were older,more cigarettes smokers,and had higher prevalence of hypercholesterolemia,diabetes mellitus and serum CRP concentration.The PTS for CAD was derived from the logistic regression equation：Y（-1,1） =-6.94 ＋ 0.07Age ＋ 0.56Smoking ＋ 0.7DM ＋ 0.6TC /HDL ＋ 0.6ST ＋ 3.5Symptom-0.01HR.According to the derived Y value,the study subjects were classified as low,intermediate and high risk CAD groups,if Y 〈-1,-1 ≤ Y ≤ 1,and Y 〉 1 respectively.The area under the curve（AUC） of our PTS on the receiver operating curve（ROC） was 0.863.Using the PTS,the specificity,false-positive rate and the predictive accuracy for CAD detection were significantly improved compared to conventional ETT diagnostic criteria（73.6% vs.56.9%;26.4% vs.43.1%;77.6% vs.71.8%,P 〈 0.05）.Conclusions A new predictive treadmill score for CAD diagnosis was validated and found superior to the conventional criteria of ETT for the diagnosis of CAD in Chinese patients presenting with chest pain.