title: Attenuation of myocardial ischemia with repeated exercise in subjects with chronic stable angina: relation to myocardial contractility, intensity of exercise and the adenosine triphosphate-sensitive potassium channel.
abstract: OBJECTIVE
  This study characterized the attenuation of myocardial ischemia observed with re-exercise to determine whether: 1) a differing exercise intensity modifies this attenuation; 2) it could be explained by contractile down-regulation or stunning; 3) it is mediated by activation of ATP-sensitive potassium channels (K+-ATP).
  
  
  BACKGROUND
  Subjects with ischemic heart disease (IHD) frequently note less angina with re-exercise after a brief rest. Potential mechanisms of this 'warm-up' phenomenon have been little explored.
  
  
  METHODS
  IHD subjects with a positive exercise test were studied. Groups I and II (12 subjects each) underwent 2 successive Naughton protocol exercise echocardiography tests (with 1 min instead of 2 min stages for Group II). Group D (10 subjects) had type II diabetes, were on > or =10 mg daily of the K+-ATP blocker, glibenclamide, and underwent the group I exercise protocol. The ischemic threshold or rate-pressure product at 1 mm ST segment depression, ST depression corresponding to the peak rate-pressure product of the first exercise (maximum ST depression equivalent), and left ventricular wall motion indexes before and immediately after each exercise were analyzed.
  
  
  RESULTS
  Exercise-induced myocardial ischemia with re-exercise was similarly attenuated in groups I, II, and D. The ischemic threshold was raised by nearly 20% with re-exercise (p=0.001, p=0.02, and p=0.02, respectively) and the maximum ST depression equivalent was nearly halved on re-exercise (p=0.005, p=0.006, and p=0.001, respectively). Exercise-induced wall motion dysfunction was attenuated with re-exercise. In group I, wall motion returned to the initial baseline score prior to exercise 2, whereas in the more intense protocol of group II, wall motion dysfunction persisted prior to exercise 2.
  
  
  CONCLUSIONS
  Thus, the attenuation of myocardial ischemia observed with re-exercise appears to be independent of the intensity of the exercise protocol and is not explained by down-regulation of myocardial contractility induced by the initial ischemic stimulus. Since results were similar in diabetic subjects on robust doses of glibenclamide, this phenomenon does not appear to be mediated by K+-ATP activation.
authors.affiliation: Quebec Heart Institute/Laval Hospital, Laval University, Ste-Foy, Canada. peter.Bogaty@med.ulaval.ca
authors.forename: P
authors.initials: P
authors.lastname: Bogaty
authors.forename: J G
authors.initials: JG
authors.lastname: Kingma
authors.forename: N M
authors.initials: NM
authors.lastname: Robitaille
authors.forename: S
authors.initials: S
authors.lastname: Plante
authors.forename: S
authors.initials: S
authors.lastname: Simard
authors.forename: L
authors.initials: L
authors.lastname: Charbonneau
authors.forename: J G
authors.initials: JG
authors.lastname: Dumesnil
mesh_terms: D000255:Adenosine Triphosphate / Q000502:physiology*; D000320:Adrenergic Fibers / Q000502:physiology; D000368:Aged; D000787:Angina Pectoris / Q000150:complications*; D002908:Chronic Disease; D018592:Cross-Over Studies; D004452:Echocardiography; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D015221:Potassium Channels / Q000502:physiology*; D016037:Single-Blind Method
chemical_list: D015221:Potassium Channels; D000255:Adenosine Triphosphate