'Warm-up' phenomenon detected by electrocardiographic ambulatory monitoring in adult and older patients

Claudio Napoli, Antonio Liguori, Francesco Cacciatore, Franco Rengo, Giuseppe Ambrosio, Pasquale Abete

Research output: Contribution to journalArticle


OBJECTIVE: Inducing tolerance to myocardial ischemia by repeated brief episodes of ischemia has been called 'ischemic preconditioning.' 'Warm-up' phenomenon refers to patients with coronary heart disease improving performance after a first exertion and may represent a clinical counterpart to ischemic preconditioning. The goal of this study was to assess whether the severity of myocardial ischemia would be attenuated by two repeated walking- induced ischemic episodes in adult and older patients. SUBJECTS: Thirty-eight adults (51 ± 5 years) and 39 older patients (76 ± 4 years) with stable angina and angiographic evidence of coronary stenosis. MEASUREMENTS: Holter monitoring was performed in adult and older patients walking on two consecutive occasions, with a 5-minute rest between walks, a distance known to have previously caused myocardial ischemia. RESULTS: Computer-assisted analysis recorded by ambulatory Holter monitoring revealed that the mean maximal ST-segment depression (P <.001) and ischemia duration decreased (P <.001), whereas the ischemic threshold increased (P <.001), from the first to the second walk in the adult but not in the older group. CONCLUSIONS: Myocardial ischemia is attenuated and ischemic threshold is increased between two brief ischemic episodes in adult but not in older patients. These results indicate that the 'warm-up' phenomenon, involved in increasing myocardial ischemic tolerance, is absent in the aging heart.

Original languageEnglish
Pages (from-to)1114-1117
Number of pages4
JournalJournal of the American Geriatrics Society
Issue number9
Publication statusPublished - Sep 1999


  • Ischemic preconditioning
  • Myocardial ischemia
  • Older patient
  • Stable angina
  • Warm-up phenomenon

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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