Are the clinical and hemodynamic events during exercise stress testing in invasive studies in patients with angina pectoris reproducible?

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Abstract
The effect of exercise on resting hemodynamics and the reproducibility of clinical and hemodynamic events during 2 successive exercise periods 25 min apart were evaluated in 20 patients with stable angina pectoris. Comparison of the resting data during the 1st and 2nd control periods (C1 and C2) separated by an exercise period showed that the values for heart rate (HR) were higher (76 .+-. 11 vs. 79 .+-. 11 beats/min [mean .+-. SD]; P < 0.05) while brachial arterial systolic pressure (BASP) (142 .+-. 13 vs. 137 .+-. 13 mmHg; P < 0.05), brachial arterial mean pressure (BAMP) (103 .+-. 10 vs. 99 .+-. 9 mmHg; P < 0.05), pulmonary arterial mean pressure (PAMP) (22 .+-. 5 vs. 18 .+-. 5 mmHg; P < 0.01), and left ventricular end-diastolic pressure (LVEDP) (18 .+-. 4 vs. 15 .+-. 4 mm Hg; P < 0.001) were lower during C2. Angina was experienced by all 20 patients during both exercise studies (Ex1 and Ex2) and the group mean values for the duration of exercise to angina, ST-segment depression, HR and rate-pressure product at the onset of angina were similar during Ex1 and Ex2. In 5 of the 20 patients exercise duration to angina varied by 60 s or more during the 2 exercise studies and 2 of these patients had to be exercised at higher work loads to induce angina during Ex2. Comparison of hemodynamic data at the onset of angina induced by Ex1 and Ex2 showed that the group values for LVEDP (29 .+-. 6 vs. 25 .+-. 6 mm Hg), PAMP (33 .+-. 8 vs. 29 .+-. 10 mm Hg), BASP (167 .+-. 15 vs. 162 .+-. 16 mm Hg) and BAMP (120 .+-. 10 vs. 115 .+-. 10 mm Hg were lower (P < 0.02) during Ex2. Clinical and electrocardiographic events, HR, rate-pressure product and cardiac output during 2 successive exercise periods were reproducible but LVEDP and PAMP were consistently lower during the Ex2. These results should be considered when the effects of therapeutic interventions are studied during invasive exercise testing in angina pectoris.