Aortic and peripheral blood pressure during isometric and dynamic exercise.

The purpose of this study was to compare aortic blood pressure (AOR) to peripheral measurements by the Riva-Rocci/Korotkov (RRK) and Finapres continuous finger pressure (FIN) methods during dynamic and static exercise. A tip manometer was introduced in the ascending aorta after coronary angiography in 7 cardiac patients with good exercise capability. Static exercise was of moderate intensity and led to an increase of average diastolic and systolic AOR of 20 and 18 mmHg, respectively. The corresponding RKK values were 20 and 30 mmHg and the FIN values were 16 and 14 mmHg, respectively. In maximal cycle ergometry the discrepancies were larger, especially in the 4 subjects who reached 80% or more of predicted maximal work load. Diastolic and systolic increases in AOR in these 4 subjects were 12 and 38 mmHg, respectively. The RRK values were 17 and 76 mmHg. Increases in FIN values of 17 and 74 mmHg for diastolic and systolic measurements, respectively, were found. The peripheral FIN and RRK measurements give a systolic increase that is twice as large as that for AOR. It is concluded that RRK and FIN greatly overestimate the load to the cardiovascular system in dynamic exercise. When the cardiovascular load is estimated by the rate-pressure product, RRK produces an increase of 197%, FIN of 181%, while AOR gives an increase of only 133%. This suggests that the present criteria for blood pressure in exercise testing should be critically examined.

The anatomic evolution of coronary artery disease demonstrated by coronary arteriography in 256 nonoperated patients.

Coronary arteriography was performed twice in 256 nonoperated patients, including 92 surgical candidates who were recatheterized because of the long wait for surgery. Criteria to define progression and regression were established in advance. Analysis of separate segments, reflecting separate lesions, revealed that progression percentages increased proportionally with the degree of initial narrowing and the interval between catherizations, ranging from 1.2% to more than 20%. The highest progression percentages were shown by the proximal right coronary artery, the left anterior descending artery distal to the first septal and first diagonal branches, and the obtuse marginal branch of the circumflex artery. In 56.3% of the patients, progression was found in at least one segment, ranging from 40% in patients who were recatheterized within 1 year to 92% in patients who were recatheterized after 5 years or longer (p less than 0.025). In 12 patients (4.7%), regression had occurred; in two cases obstructions had reverted to less than 50% narrowing. Regression was associated with progression in other branches in three cases. Indications for recatheterization did not correlate significantly with progression, but a higher progression percentage was found in patients who had sustained a myocardial infarction during follow-up than in those who had not (p less than 0.05). Comparison of potential surgical procedures based on the first and second angiogram revealed that at the second catheterization more distal anastomoses were required to achieve complete revascularization in 29.3% of the patients and that left ventricular contractions had deteriorated markedly in 15.6%. These fractions correlated with the duration of the interval between catheterizations.

Regression of coronary artery obstructions demonstrated by coronary arteriography.

To determine the incidence and clinical features of regression of coronary artery obstructions we reviewed the angiograms of 93 nonoperated and 201 operated patients who had repeated coronary arteriographic studies. Regression of obstructions was found in 4 nonoperated cases (4.3%), all involving the left anterior descending artery. This was associated with improvement of the patient's clinical condition in only 1 case. No regressions were found in the surgical cases. Our data demonstrate that regression of coronary artery obstructions is rare and unrelated to clinical parameters.