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PubMed1988

Do data from a previous exercise test influence the prognostic information given by a second routine exercise ECG test? A 13 1/2-year follow-up study in apparently healthy middle aged men.

A positive exercise ECG test in a middle-aged man without confounding disease is a strong indicator of occult coronary heart disease. In the years following a positive test mortality, but CHD events vary considerably compared with subjects having normal exercise tests. If a second exercise test is positive in the same subjects years later, this signifies a disease which is prone to progress in a very severe way in the ensuing years. A first normal test followed by a second pathologic test has an intermediate prognostic significance compared with two normal tests years apart. The clinical course indicates that preventive measures should be taken after observing a positive exercise test, and even more importantly if two positive tests are observed years apart.

Adult↗
PubMed1998

Predicting severe angiographic coronary artery disease using computerization of clinical and exercise test data.

Currently the standard exercise test is shifting from being a tool for the cardiologist to utilization by the nonspecialist. This change could be facilitated by computerization similar to the interpretation programs available for the resting ECG. Therefore, we sought to determine if computerization of both exercise ECG measurements and prediction equations can substitute for visual analysis performed by cardiologists to predict which patients have severe angiographic coronary artery disease. We performed a retrospective analysis of consecutive patients referred for evaluation of possible or known coronary artery disease who underwent both exercise testing with digital recording of their exercise ECGs and coronary angiography at two university-affiliated Veteran's Affairs medical centers and a Hungarian hospital. There were 2,385 consecutive male patients with complete data who had exercise tests between 1987 and 1997. Measurements included clinical and exercise test data, and visual interpretation of the ECG paper tracings and > 100 computed measurements from the digitized ECG recordings and compilation of angiographic data from clinical reports. The computer measurements had similar diagnostic power compared with visual interpretation. Computerized ECG measurements from maximal exercise or recovery were equivalent or superior to all other measurements. Prediction equations applied by computer were only able to correctly classify two or three more patients out of 100 tested than ECG measurements alone. beta-Blockers had no effect on test characteristics while ST depression on the resting ECG decreased specificity. By setting probability limits using the scores from the equations, the population was divided into high-, intermediate-, and low-probability groups. A strategy using further testing in the intermediate group resulted in 86% sensitivity and 85% specificity for identifying patients with severe coronary disease. We conclude that computerized exercise ST measurements are comparable to visual ST measurements by a cardiologist and computerized scores only minimally improved the discriminatory power of the test. However, using these scores in a stratification algorithm allows the nonspecialist physician to improve the discriminatory characteristics of the standard exercise test even when resting ST depression is present. Computerization permitted accurate identification of patients with severe coronary disease who require referral.

Coronary Angiography↗
PubMed1990

The estimation of post-test probability of coronary disease following exercise testing using the sequential application of two Bayesian methods.

Recent studies have revealed that Bayesian methods to estimate post-test probability following exercise testing differ in their sensitivity and specificity across the range of post-test probability. To take advantage of the relative strengths of each method, we combined two of these methods into a single method (DUAL BAYES) and compared it with the two original methods in 436 patients who underwent stress testing followed within 2 months by coronary arteriography. All patients had post-test probabilities determined using CADENZA (better sensitivity). Those CADENZA-derived probabilities greater than or equal to 50% were substituted with post-test probabilities determined by Diamond and Forrester's original TABULAR method (better specificity). Mean post-test probabilities were as follows: TABULAR 34, CADENZA 48, DUAL BAYES 37 (actual incidence 38%). Comparison of sensitivity and specificity at every fifth percentile of post-test probability revealed that the sensitivity of DUAL BAYES was better than that of TABULAR and equal to that of CADENZA at thresholds less than or equal to 10 and that the specificity was better than that of CADENZA and equal to that of TABULAR at thresholds greater than or equal to 60. Therefore using both methods as indicated above was better than using either method alone.

Algorithms↗
PubMed1990

[Evaluation of exercise test reproducibility in patients with ischemic cardiopathy].

We evaluated the repeatability of some measurements taken during the bicycle ergometer exercise test (exercise duration, heart rate and pressure rate product at angina and ST segment depression times) in 166 consecutive non-selected ambulatory patients with proven ischemic heart disease. One hundred and sixty-six patients with history of angina and/or myocardial infarction performed three exercise tests within seven days of wash-out. Eighty-six (58.1%) of these experienced angina and ischemic ST segment depression during all three tests (group 1), and 80 (48.2%) finished at least one test without angina or ST segment depression (group 2). The degree of angina (according to Canadian Cardiovascular Society classification) was higher in the first group than in the second one; on the contrary, exercise duration as well as pressure rate product at ischemic threshold, heart rate and pressure rate product at the onset of angina were significantly lower (0.001 less than p less than 0.05) in the former group. In group 1, we analyzed ergometric parameter measurement "repeatability" during the three consecutive exercise tests. The analysis of variance for repeated measurements showed that exercise duration and pressure rate product values at ischemic threshold did not vary significantly in the three tests, while other ergometric parameters showed a greater variability (0.001 less than p less than 0.05). Age, previous myocardial infarction or rest angina, the number of critically stenotic coronary vessels and the ejection fraction did not condition the repeatability of the test. In conclusion, in our population of non-selected ischemic patients only 52% developed angina and ischemic ST segment depression during all three exercise tests performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2000

Accuracy of a pretest questionnaire in exercise test protocol selection.

Proper exercise test protocol selection is essential to allow adequate time for observation of subjective and physiologic responses to exercise, as well as provider-patient interaction and patient comfort. This study evaluates the accuracy of a pretest questionnaire in predicting exercise capacity for exercise test protocol selection and compares the accuracy of this questionnaire when ramp versus step protocols are used.

Activities of Daily Living↗
PubMed2003

Improving the positive predictive value of exercise testing in women.

OBJECTIVE: To identify exercise test variables that can improve the positive predictive value of exercise testing in women. DESIGN: Cohort study. SETTING: Regional cardiothoracic centre. SUBJECTS: 1286 women and 1801 men referred by primary care physicians to a rapid access chest pain clinic, of whom 160 women and 406 men had ST depression of at least 1 mm during exercise testing. The results for 136 women and 124 men with positive exercise tests were analysed. MAIN OUTCOME MEASURES: The proportion of women with a positive exercise test who could be identified as being at low risk for prognostic coronary heart disease and the resulting improvement in the positive predictive value. RESULTS: Independently of age, an exercise time of more than six minutes, a maximum heart rate of more than 150 beats/min, and an ST recovery time of less than one minute were the variables that best identified women at low risk. One to three of these variables identified between 11.8% and 41.2% of women as being at low risk, with a risk for prognostic disease of between 0-11.5%. The positive predictive value for the remaining women was improved from 47.8% up to 61.5%, and the number of normal angiograms was potentially reducible by between 21.1-54.9%. By the same criteria, men had higher risks for prognostic disease. CONCLUSIONS: A strategy of discriminating true from false positive exercise tests is worthwhile in women but less successful in men.

Age Factors↗
PubMed1979

Maximal exercise testing--Bruce protocol.

Maximal treadmill exercise testing is feasible for the family physician's office especially in a group setting. The Bruce Exercise Test is described in detail and is helpful in the diagnosis of asymptomatic coronary heart disease, following the course of coronary heart disease, diagnosis of other cardiac disease, and in preventive testing and exercise prescription. Sensitivity and specificity of ST changes may be improved by recognizing factors which cause false positive and negative ST responses. The Bruce Test is safe when the procedure is followed meticulously. There have been 2,490 tests performed in the laboratory of three family physicians without serious morbidity. The screening exercise test with preventive exercise prescription is particularly pertinent to the present day concepts of family practice.

Adult↗
PubMed1990

Progressive exercise testing in closed head-injured subjects: comparison of exercise apparatus in assessment of a physical conditioning program.

Progressive exercise tests were performed on 12 closed head-injured subjects to determine 1) whether results differ when tests are performed on a treadmill, a bicycle ergometer, or mechanical stairs and 2) whether a 3-month general physical conditioning program results in an improvement in exercise performance. The subjects performed progressive exercise tests on each apparatus on entry into a residential transitional rehabilitation program and approximately 3 months later following participation in a physical conditioning program. On both the initial and 3-month exercise tests, maximal oxygen consumption (VO2 max) was significantly greater on the treadmill and the mechanical stairs than on the bicycle ergometer. The mean VO2 max was 74% of the predicted value on the initial exercise test and rose to 85% of the predicted value after the 3-month physical conditioning program. Oxygen consumption per kilogram of body weight at a given power output on a given apparatus showed no statistically significant difference between the initial and 3-month tests, indicating no change in exercise efficiency. On the 3-month test, a statistically significant decrease was noted in heart rate at rest and after the 4-minute period of recovery from maximal exercise on any given apparatus. The data obtained in this study indicate that 1) the treadmill and mechanical stairs are more suitable than the bicycle ergometer for assessing maximal exercise performance and 2) improved physical fitness following a physical conditioning program is associated with an improvement in cardiovascular function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Adults with Ebstein's anomaly--Cardiopulmonary exercise testing and BNP levels exercise capacity and BNP in adults with Ebstein's anomaly.

INTRODUCTION: Ebstein's anomaly is defined as the significant apical displacement of the part of the tricuspid valve causing significant tricuspid regurgitation and reduction of the functional right ventricle. The aim of the study was to evaluate exercise capacity with cardiopulmonary stress testing and to determine plasma BNP levels in adults with Ebstein's anomaly, and to establish their relation with echocardiogaphic grading of the lesion severity. MATERIALS AND METHODS: Study group consisted of 21 patients (16 males, aged 40.3+/-11.5 years). The control group: 19 healthy individuals (13 males, aged mean 39.9+/-9.3 years). On echocardiography the grade of the lesion severity was calculated (EGE) and used to define the following four groups: I < 0.5, II: 0.5-0.9, III: 1.0-1.49, IV > 1.5. The forced vital capacity (FVC), first second forced expiratory volume (FEV1), peak oxygen uptake (peak VO2), and VE/VCO2 slope were assessed with cardiopulmonary stress test and plasma BNP levels measured with radioimmunometric assay. RESULTS: In the studied group VO2 was lower than in control (21.9+/-5.4 vs. 33.6+/-8.3 mL/kg/min [p = 0.00001]), VE/VCO2 slope was higher in Ebstein's group (40.1+/-8.1, p = 0.00001). BNP levels were higher in the Ebstein group then in controls (35.9+/-25.0 vs. 17.2+/-9.9 pg/mL [p = 0.0002]) and did not differ significantly between EGE groups. PeakVO2 of 24.5+/-3.9 in patients from II EGE group were higher than in patients from EGE groups: III (17.2+/-5.2 p = 0.007) and IV (22.9+/-4.7 p = 0.05). CONCLUSIONS: Exercise capacity of adults with Ebstein's anomaly is significantly reduced and plasma BNP levels are higher compared to healthy individuals. Exercise capacity in patients with Ebstein's anomaly becomes gradually lower alongside the EGE severity; however, BNP levels do not correlate significantly with this parameter.

Adult↗
PubMed1993

Exercise testing in cardiac rehabilitation. Role in prescribing exercise.

Graded exercise tests provide useful information for the prescription of exercise for cardiac patients. The responses to graded exercise depend on the mode of testing. The observed heart rate and electrocardiographic responses during graded exercise are used to establish an appropriate level or intensity of exercise at which the patient may participate safely. This article specifically addresses the role of exercise testing for the prescription of exercise in cardiac rehabilitation.

Adult↗
PubMed2000

[The use of cardiopulmonary exercise test in patients with mitochondrial myopathies].

BACKGROUND: Exercise tests has been used in the diagnosis of metabolic myopathies. If there is an abnormal response pattern in mild mitochondrial myopathy (MM) and her role in the initial suspect diagnostic is unknown. SUBJECTS AND METHODS: Prospective study of 26 patients with mitochondrial myopathy (15 men, 11 women) and a control group of 14 sedentary volunteers (9 men, 5 woman) with similar antropometric characteristics. We have made pulmonary function tests and treadmill exercise with serial venous sampling of blood lactate, piruvate, ketone bodies, free fatty acids and creatinkinase. RESULTS: Patients with MM showed exercise limitation with lower maximal power (MM = 143 [47] vatts, C = 187 [40] vatts, p = 0.006), maximal oxygen uptake (MM = 27 [8] ml/min/kg, C = 40 [7] ml/min/kg, p = 0.001) and maximal oxygen pulse (MM = 11 [3] ml/beat, C = 14 [3] ml/beat, p = 0.006). For the same oxygen uptake the heart rate was higher and the anaerobic threshold was earlier in MM patients (MM = 48% [14], C = 62% [12], p = 0.01). We found a considerable slower maximal oxygen uptake in patients with lipid increase in muscle biopsy (n = 15). Acetoacetate curves, beta-hydroxybutyrate, free fatty acids and creatinkinase were similar in both groups. The exercise test was pathologic in 17/26 of the patients. The sensitivity of the exercise test for maximal oxygen uptake was 0.65. CONCLUSIONS: The cardiopulmonary exercise test is a useful test in the suspect initial diagnostic of patients with mild mitochondrial myopathy because the majority of patients show a pathologic test.

Adolescent↗
PubMed1983

Prognostic assessment of patients with coronary artery disease by exercise testing.

To assess whether exercise testing could help predict cardiac mortality, we analyzed 14 exercise and 10 clinical variables in 292 patients treated medically, who underwent treadmill exercise testing and cardiac catheterization and were followed annually for a mean of 2.5 years. None of the individual variables could accurately predict subsequent cardiac mortality with predictive values ranging from 6% to 44%. Combinations of variables were then analyzed in the subset of 113 patients with multivessel coronary disease. A high-risk subgroup (n = 59) consisting of patients with either severe exercise ischemia (greater than or equal to 2 mm ST depression lasting greater than or equal to 5 minutes involving greater than or equal to 3 leads) or left ventricular dysfunction (treadmill time less than or equal to 3 minutes, S3 gallop, or cardiac enlargement) had a mortality of 20%; this was significantly greater (p less than 0.01) than a low-risk subgroup (n = 54) with neither severe exercise ischemia nor left ventricular dysfunction whose mortality was 2%. We conclude that combining clinical and exercise variables to distinguish high- and low-risk subgroups of patients with similar coronary anatomy is useful in predicting cardiac mortality.

Adult↗
PubMed1979

Exercise testing in congenital aortic stenosis.

Treadmill exercise testing was performed on 23 patients with isolated congenital aortic stenosis. It was found that eight patients, with a negative exercise test and a normal rise in systolic blood pressure on exercise, had gradients less than 45 mmHg. Fifteen patients with gradients greater than 50 mmHg had positive exercise tests and their systolic blood pressure did not rise normally. It is suggested that the left heart studies to measure aortic valve gradients can safely be postponed if an exercise test is negative. Serial exercise testing of such patients will give an indication when left heart catheterization should be considered.

Adolescent↗
PubMed1998

[Prognosis of asymptomatic aortic valve stenosis evaluated with exercise test].

PURPOSE: to evaluate the exercise test as a prognostic factor for asymptomatic patients with aortic valve stenosis. METHODS: During 60 months 70 patients with aortic valve area < or = 1 cm2 without any other heart lesion were studied. The patients underwent Dopplerechocardiograms exercise tests (considered positive in the presence of electrocardiographic changes or symptoms) and clinical follow-up in order to determine the onset of symptoms or sudden death. RESULTS: The event-free probability was 50% after 16 months of follow-up. There was no relationship between the occurrence of events and the sex or to the transvalvar gradient. However, there was a statistically significant association between the incidence of events (p = 0.0124), valvar area (p = 0.0003) and exercise test results (p = 0.0001). CONCLUSION: Patients with significant aortic stenosis even without symptoms, have a low survival rate and the exercise test is a good prognostic factor during follow-up.

Adolescent↗
PubMed1993

Prognostic value of ischemia during Holter monitoring and exercise testing after acute myocardial infarction.

Exercise testing is generally accepted for prognostic assessment of patients after infarction, but the prognostic value of transient myocardial ischemia during ambulatory electrocardiographic monitoring remains controversial. Of 281 consecutive postinfarction patients, 173 patients (132 men, 41 women) were prospectively studied with 24-hour Holter monitoring 14 +/- 5 days after acute myocardial infarction, and with submaximal exercise testing after 15 +/- 7 days. Patients with either conduction disturbances or pacemaker rhythm and 71 patients with digitalis medication were excluded. Myocardial ischemia was defined as horizontal or descending ST depressions or transient ST elevations > or = 0.1 mV with or without angina pectoris. The follow-up period was 1 year. Myocardial ischemia was observed in 40 patients (23%) during Holter monitoring, and 96% of the episodes were asymptomatic. Ischemia occurred during exercise testing in 46 patients (27%), two thirds of whom had no symptoms. Ischemia was detected by both methods (group A) in 19 patients (11%), with exercise testing only (group B) in 27 patients (16%), and with Holter monitoring only (group C) in 21 patients (12%). In 106 patients (61%), ischemia could not be ascertained at all. The 4 groups were comparable with regard to sex and age distribution, coronary risk factors, and medication. During follow-up, 50 patients (29%) experienced clinical cardiac events: 6 patients died, 7 had recurrent myocardial infarction, 14 developed unstable angina pectoris and required immediate revascularization, and 23 patients had recurrent but stable angina.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Exercise testing as a rehabilitative/training tool.

Exercise testing is an exceedingly useful noninvasive method for assessing cardiovascular function not only at rest but also during programmed, supervised physical exercise. Exercise testing has been intensively studied to delineate the cardiovascular response in various disorders [3-5, 15, 19, 22, 23, 26, 32]. Exercise testing as a tool for rehabilitation and for training to perform physical activity is discussed here.

Child↗