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Percutaneous Transluminal Coronary Angioplasty Improves Oxygen Uptake Kinetics During the Onset of Exercise in Patients With Coronary Artery Disease^*

^* From the Second Department of Internal Medicine (Drs. Adachi, Sato, Marumo, and Hiroe), Tokyo Medical and Dental University, Tokyo, Japan; The Cardiovascular Institute (Dr. Koike), Tokyo, Japan; Musashino Red Cross Hospital (Dr. Niwa), Tokyo, Japan; and Hokushin General Hospital (Dr. Takamoto), Nagano, Japan.

Correspondence to: Akira Koike, MD, The Cardiovascular Institute, 3-10, Roppongi 7-chome, Minato-ku, Tokyo 106-0032, Japan; e-mail: koike{at}cepp.ne.jp

Study objectives: Although percutaneous transluminal coronary angioplasty (PTCA) is known to have beneficial effects on exercise capacity, its effects on the cardiovascular response during the onset of exercise have not been clarified. The present study was undertaken to determine the effects of PTCA on the kinetics of oxygen uptake (O₂) during constant-work-rate exercise in patients with coronary artery disease, as well as on their indexes of maximal work capacity.

Methods: Seventeen patients with coronary artery disease who received successful PTCAs performed a 50-W constant-work-rate exercise test for 6 min and a symptom-limited incremental exercise test both before and 4 months after the PTCA procedure. O₂ was calculated from breath-by-breath analysis of respired gases. The time constant of O₂ kinetics during the onset of 50-W exercise was determined by fitting a single exponential function to the O₂ response.

Results: In 14 patients without coronary restenosis, the time constant of O₂ kinetics was significantly shortened from (mean ± SD) 57.4 ± 12.6 before PTCA to 48.2 ± 9.5 s after PTCA (p = 0.0035), indicating improved kinetics of the O₂ response. In these subjects, the peak O₂ obtained during maximal exercise testing also increased from 23.1 ± 3.5 to 26.5 ± 3.2 mL/min/kg, respectively (p = 0.0005). However, there was no improvement in these indexes in the patients who had restenosis after undergoing PTCA (n = 3).

Conclusion: Indexes of cardiopulmonary exercise testing, which reflect an efficiency of oxygen flow to the exercising muscle, can be used as an objective, noninvasive, and cost-effective guide for understanding which patients will not have coronary restenosis following PTCA.

Key Words: coronary artery disease • oxygen uptake • percutaneous transluminal coronary angioplasty • restenosis

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