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PubMed1990

Exercise test predictors of ambulatory silent ischemia during daily life in stable angina pectoris.

The predictive value of several exercise test parameters in identifying stable angina patients at risk of silent myocardial ischemia during daily life were examined. A total of 97 patients with coronary artery disease, stable angina and ambulatory electrocardiographic data were evaluated. Of the 86 patients with a positive exercise test, 39 (group 1) had greater than or equal to 1 episodes of ST-segment depression and 47 (group 2) did not develop ST changes during ambulatory electrocardiographic monitoring. Comparison of the exercise test parameters between the 2 groups revealed early onset of ischemia during exercise tests as the single most significant (p less than 0.0005) predictor of ambulatory silent ischemia. The other exercise test parameters showing significant differences between the 2 groups were the peak exercise heart rate (117 +/- 23 vs 126 +/- 20 beats/min, p less than 0.05) and peak systolic blood pressure (160 +/- 27 vs 176 +/- 27 mm Hg, p less than 0.01), both of which were significantly lower in the group 1 patients. These data were used to derive simple mathematical formulas for calculating the risk of ambulatory silent ischemia. These results demonstrate that stable angina patients at risk of silent ischemia during daily life can be accurately identified by evaluation of selected exercise test parameters.

Activities of Daily Living↗
PubMed1988

[Reproducibility of the exercise test and coronary vasomotor tonus].

The effect of coronary vasomotor tone on exercise test reproducibility was evaluated in two groups of patients. All had an apparently stable angina, a positive first exercise test and at least one significant stenosis at coronary arteriography. Group A patients (n = 30) had a positive ergonovine test (dynamic stenosis) whereas this test was negative (fixed stenosis) in group B patients (n = 29). Patients of both groups underwent two exercise tests without treatment, each of these tests being performed on a different day of the same week, at the same time and according to Bruce's procedure. The reproducibility of angina was poor in group A patients: 6/15 (40 p. 100) as against 18/20 (90 p. 100) in group B patients (p less than 0.05). Moreover, the initially positive exercise test subsequently become negative in 6 of the group A patients and in none of the group B patients (p less than 0.05). The time elapsed before ischaemia appeared was globally increased to the same extent in both groups, but individual variations were more pronounced in group A: a more than 1 minute variation was noted in 63 p. 100 of group A patients and in 18 p. 100 of group B patients (p less than 0.01). Similarly, the double product of ischaemia (-1 mm) varied by more than 20 p. 100 in 37 p. 100 of group A patients and in 14 p. 100 of group B patients. In contrast, the maximum stress parameters were increased to the same degree in both groups, including the double product duration.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1993

Ischemic threshold during two exercise testing protocols and during ambulatory electrocardiographic monitoring.

OBJECTIVES: The aim of this study was to examine the dependence of the ischemic threshold during exercise testing on the exercise protocol employed and to determine the relation between the ischemic thresholds observed during exercise and during daily activity. BACKGROUND: The ischemic threshold (heart rate at 1-mm ST segment depression) during daily activity has been reported to be lower than that observed during exercise testing. Recent reports have hypothesized that this difference is probably dependent on the exercise protocol employed. METHODS: Twenty-two patients with known coronary artery disease, not receiving antianginal medications, were evaluated by repeated exercise testing according to the Bruce and the modified Davidson protocols and by 48-h ambulatory electrocardiographic monitoring. RESULTS: Although the heart rate at 1-mm ST segment depression was somewhat lower with the Davidson than with the Bruce protocol (112 +/- 14 vs. 115 +/- 14 beats/min), the rate-pressure product at 1-mm ST segment depression was similar during the two protocols (16,900 +/- 4,000 vs. 17,700 +/- 3,600). The mean heart rate (100 + 12 beats/min) at 1-mm ST segment depression during ambulatory ischemic episodes (n = 137) was significantly lower than that observed during both exercise protocols (p < 0.001 for both comparisons). CONCLUSIONS: Exercise-induced ischemia occurs at a relatively fixed threshold that is mainly dependent on myocardial oxygen demand and is independent of the exercise protocol employed. Ischemia on ambulatory monitoring, however, occurs at a much more variable threshold that is commonly lower than that observed during exercise and is therefore dependent on other factors in addition to increased demand.

Aged↗
PubMed1992

Safety and clinical use of exercise testing one to three days after percutaneous transluminal coronary angioplasty.

To evaluate both the safety and clinical use of predischarge symptom-limited exercise testing after successful uncomplicated percutaneous transluminal coronary angioplasty (PTCA), 100 patients were randomized to undergo exercise testing (n = 50) or no exercise testing (n = 50). There were no differences in clinical or angiographic characteristics between the groups. Exercise testing was performed 38 +/- 14 hours after PTCA. Patients who exercised achieved 71 +/- 12% of predicted maximal heart rate, with 38% reaching greater than or equal to stage III of the Bruce protocol. No patient in either group developed cardiac complications during 48-hour follow-up. Of the 11 patients with a positive test result, 92% had angiographically incomplete revascularization. Attending physicians (n = 16) were questioned both before and after exercise testing about when, after discharge, they would allow their patient to perform each of 11 specific activities of daily living. Questionnaires were administered to physicians at similar time frames for patients in the no-exercise group. Comparison of the responses between initial and repeat questionnaires showed that patients in the exercise group (with a test result negative for ischemia) were allowed to perform 7 of 11 activities, including return to work, earlier (p less than 0.05) than the no-exercise patients. These data indicate that in this well-defined group of patients, symptom-limited exercise testing early after PTCA appears to be safe, and alters physician management in allowing patients with a negative test result to return to various activities at an earlier date. Such testing may be useful in counseling patients after PTCA.

Activities of Daily Living↗
PubMedDate not supplied

[Carbohydrate and lipid metabolites and blood serum enzymes in humans during graded exercise test in long-term anti-orthostatic hypokinesia].

Exercise tests were carried out before as well as on days 128 and 248 of a 370-day head-down tilt study. The test subjects, who took part in the study, were divided into two groups that used different regimens of countermeasures (drugs and exercise). During exercise tests the following serum parameters were measured: lactate, pyruvate, glucose, triglycerides, nonesterified fatty acids, lactate dehydrogenase, alpha-hydroxybutyrate dehydrogenase, malate dehydrogenase, creatine phosphokinase. Decrease or delayed increase in the concentration of energy substrates (nonesterified fatty acids and triglycerides) after a standard exercise test is a metabolic manifestation of deconditioning changes induced by head-down tilting. Insufficient supply of a working human body with readily utilizable lipid substrates causes inadequate activation of energy forming enzymes and excessive buildup of metabolites, i. e. lactate and pyruvate. The efficacy of corrective and prophylactic measures was verified by biochemical data.

Alcohol Oxidoreductases↗
PubMed1987

Routine exercise testing or thallium-201 scintigraphy for prediction of cardiac events post-myocardial infarction?

The efficacy of 12 lead exercise testing and rest/exercise 201Tl scintigraphy as indicators of coronary anatomy and prognosis was compared in 46 low risk survivors of acute myocardial infarction. The non invasive procedures were performed at discharge, and cardiac catheterization was performed six weeks post discharge. On exercise testing, ST depression in leads remote from the site of infarction was considered to indicate multivessel disease and reversible ischaemia. On 201Tl scintigraphy, a perfusion defect remote from the site of infarction indicated multivessel disease, while a defect which reperfused at rest indicated reversible ischaemia. During the mean follow-up of 13 +/- 3 months, 14(30%) patients experienced cardiac events. Thallium scintigraphy was a more sensitive, but less specific, indicator of multivessel disease than exercise testing. Both exercise testing and 201Tl scintigraphy had a similar sensitivity (79% vs 79%), specificity (78% vs 88%) and predictive accuracy (78% vs 85%) for predicting subsequent cardiac events. Thus, in our patient population, 201Tl scintigraphy could not be demonstrated to be superior to routine exercise testing in low risk patients post myocardial infarction.

Adult↗
PubMed1992

Exercise testing at 3 weeks, 6 weeks and 18 months after infarction and the outcome at 3 years in young patients (under 55 years).

To examine the prognostic value of routine postinfarction exercise tests in young patients, exercise tests were carried out at 3 and 6 weeks and 18 months after infarction in 149 patients aged under 55 years at the time of the index infarction. The patients also had coronary angiography and left ventriculography a mean of 3 months after infarction. Three years after infarction, only two of the 149 patients have died, reinfarction occurred in only seven (4.7%) patients; unstable angina in four (3%) patients and coronary artery surgery was needed in 31 (20.8%) patients; 16 in the first, 10 in the second, and 5 in the third year of follow-up. Angina on exercise testing at 6 weeks was the only variable with any predictive value. Eighteen (38%) of the 47 patients with, compared to 12 (11.8%) of the 102 patients without, angina on exercise testing at 6 weeks had coronary surgery (less than 0.001). None of the other exercise variables reliably predicted death, or other complications, including coronary surgery. Ten (13.8%) of the 75 patients excluded from the study died during follow-up; six of them within 6 weeks of infarction. Four (67%) of these patients were excluded from the study because of heart failure. Therefore, the 3-year outcome in young survivors of a myocardial infarction is good and is not reliably predicted by exercise testing at 3 and 6 weeks or 18 months.

Adult↗
PubMedDate not supplied

Exercise testing of the child with obesity.

As the prevalence of childhood obesity increases, exercise testing of obese children is likely to increase as well. This article discusses the implications of pediatric obesity for exercise testing and provides some recommendations for conducting tests and evaluating results. Studies comparing obese and nonobese children during exercise testing indicate that obese children are capable of meeting the challenges of exercise testing to nearly the same extent as their nonobese peers. Their physiologic responses, at least for the levels of obesity reported in the literature, are not sufficiently different from their nonobese counterparts to necessitate major changes in test protocols. Laboratory staff should pay special attention to fostering confidence in the obese child during the pretest routine.

Anaerobic Threshold↗
PubMed1990

[Prognostic significance of silent ischemia in the exercise test in patients with coronary disease].

To evaluate the prognostic significance of silent ischemia during exercise testing, 152 consecutive patients (143 males, 9 females) with a mean SD of 55 +/- 7 years (age range 32-73) who underwent exercise testing and coronary arteriography within 3 months were studied. All patients had the following characteristics: 1) a positive electrocardiographic exercise test response; 2) significant coronary artery disease on the arteriography; 3) uninterrupted clinical follow-up for a minimum of 6 months. The 152 patients were divided in 2 groups: group I: 56 patients (37%) with ischemic ST-segment depression during exercise testing without angina (silent ischemia); group II: 96 patients (63%) with ischemic ST-segment depression and angina (symptomatic ischemia). Patients in group I and group II showed similar time to ST-segment depression (3.6 +/- 1.5 min vs 3.2 +/- 1.4 min; p = NS), maximal ST-segment depression and peak heart rate-systolic pressure product (21,151 +/- 7,124 vs 20,456 +/- 6,024; p = NS). Exercise duration was longer in group I than in group II (5.6 +/- 2.1 min vs 4.8 +/- 1.5 min; p less than 0.001). The extent of coronary artery disease defined by the number of significant narrowed coronary vessels, left ventricular end diastolic pressure and ejection fraction were similar in the 2 groups. Sixty six patients who underwent coronary bypass surgery were not included in the analysis. The remaining 86 patients (40 in group I and 46 in group II) were medically treated. The mean follow-up period was 43,5 +/- 25 months (range 6-101).2+ myocardial ischemia during exercise testing.

Adult↗
PubMed2004

Do the right precordial leads during exercise testing contribute to detection of coronary artery disease?

BACKGROUND: It is still unknown whether or not the additional right precordial leads (RPL) during exercise testing contribute to detection of coronary artery disease (CAD). HYPOTHESIS: The aim of this study was to evaluate the RPL during exercise testing for the detection of CAD. METHODS: The study included 157 consecutive patients (116 men and 41 women, mean age 66 years) suspected of having CAD, who underwent conclusive treadmill exercise testing (heart rate reached at least 85% of the predicted maximum or positive electrocardiogram [ECG] changes were exhibited) and coronary angiography. During exercise testing, the ECG was recorded with the standard 12 leads and 4 RPL (V3R, V4R, V5R, V6R). RESULTS: Of the 157 patients, 67 had CAD (> 75% stenosis in at least one major coronary artery), and 64 had positive ST changes in the standard ECG leads during exercise testing. Using the conventional 12-lead method, sensitivity and specificity were 76 and 86%, respectively. Only three patients exhibited positive changes in the RPL leads; all had > 0.1 mV ST elevation in one of the RPL leads with > 0.1 mV ST elevation in aVR. Two of these patients had significant right coronary artery lesions and the other had a lesion of the left anterior descending artery which perfused the inferior as well as the anteroseptal area. In the standard 12 leads, one of the patients with an abnormal RPL and a right coronary lesion was negative, while the other two patients were positive. Combining RPL with the conventional 12-lead method, sensitivity and specificity were 78 and 86%, respectively. Therefore, RPL did not improve the accuracy of the exercise ECG. CONCLUSION: The use of RPL during exercise testing may contribute to the detection of ischemia perfused by the right coronary artery; however, it does not improve the diagnostic accuracy of the exercise test.

Aged↗
PubMed1996

[ST segment depression during recovery after treadmill exercise test in stable patients with previous myocardial infarction].

BACKGROUND: The significance of exercise-induced ST segment depression is well known while limited data are available on the clinical/prognostic power of ST depression occurring only during recovery. Aim of the study was to clarify the clinical/prognostic value of "recovery only" ST depression in stable patients late from myocardial infarction (AMI) and to determine whether the addition of recovery data to exercise parameters improves the interpretation of exercise test. METHODS: From a population of 766 consecutive patients (mean age: 57.2 +/- 8.6 yrs.; male: 89%) who underwent a Bruce Treadmill test at least 1 year after a Q wave AMI and whose exercise data were prospectively entered in the database of our Institution, 4 different Groups were identified: 1) 99 patients with a negative exercise test; 2) 53 patients with "exercise only" ST depression; 3) 140 patients with "exercise and recovery" ST depression; 4) 31 patients with "recovery only" ST depression. The main clinical and exercise data and a cardiac follow-up (average mean length: 1530 +/- 600 day) were evaluated by one-way analysis of variance, Bonferroni T-test, chi-square, relative risk (RR) with 95% confidence intervals (CI), Kaplan-Meler method and log-rank. RESULTS: Baseline clinical parameters were similar in the 4 Groups except for older age in Group 3 compared to Group 2 (< 0.05) and higher prevalence of anterior AMI in Group 4 compared to others (= 0.004). Patients with exercise and recovery ST depression or with "recovery only" ST depression had significantly less exercise tolerance than patients with negative exercise test or "exercise only" ST depression [exercise duration (< 0.05, Group 1 vs. 3, vs. 4; Group 2 vs. 3), peak rate pressure product (< 0.05), maximal heart rate (< 0.05; Group 1 vs. 2; vs. 3; vs. 4)]. Exercise-induced ST depression was higher and angina was significantly more frequent in patients with exercise and recovery ST depression as well as an high Mark's risk score (< 0.001). Only patients with exercise and recovery ST depression demonstrated significantly higher risk of overall mortality (RR: 1.35, CI: 1.04-1.74), unstable angina (RR: 1.34, CI: 1.09-1.65) or revascularisation procedures (RR: 1.51, CI: 1.25-1.83). Relative risk of patients with "recovery only" ST depression was similar to that of subjects with "exercise only" ST depression. CONCLUSIONS: In stable patients with old Q wave AMI, "recovery only" ST depression is rate, but does represent a true sign of ischemia. It could be associated with indirect indexes of worse ventricular function. The prognostical power of "recovery only" ST depression is mild, although similar to that of "exercise only" ST depression. Moreover the presence of ST depression not only during exercise but also during the recovery phase identifies patients with more severe prognosis. Therefore the inclusion of findings from the recovery phase in the analysis of the exercise test could increase the predictive power of the test itself.

Aged↗
PubMed1993

Exercise testing in special situations.

This article discusses exercise testing in valvular heart disease, hypertension, and the evaluation of patients for surgery. It also provides information on the effects of drugs on the exercise test and the clinical significance of block patterns and arrhythmias encountered during exercise.

Arrhythmias, Cardiac↗
PubMed1986

Usefulness of early exercise testing after non-Q-wave myocardial infarction in predicting prognosis.

The value of an early symptom-limited maximal exercise test in predicting coronary anatomy, left ventricular ejection fraction and hemodynamics was assessed prospectively in 64 patients after an acute non-Q-wave myocardial infarction (MI). Exercise tests and cardiac catheterization were performed at a median of 6 and 7 days, respectively, after non-Q MI. Forty-one percent of the patients had a negative exercise test response (no angina, less than 1 mm of ST depression and normal blood pressure responses). Twenty-five percent had a positive response (1 to 1.9 mm of ST depression or angina); 34% had a "strongly positive" exercise test response (at least 2 mm of ST depression or abnormal blood pressure responses). A negative response predicted the absence of 3-vessel disease (at least 70% stenosis) or critical stenoses (at least 90% stenosis) involving major coronary arteries (negative predictive accuracy 92%), whereas a strongly positive response predicted their presence (positive predictive value 77%, specificity 88%). Cardiac index and mean pulmonary artery wedge pressure did not vary significantly among the 3 exercise groups, whereas left ventricular ejection fraction was slightly higher in the exercise test group with a positive response (p less than 0.025). Thus, in patients who have had a non-Q MI, early exercise testing can be used to predict the extent and severity of coronary artery disease, and the decision to perform coronary angiography should be guided by the exercise test results.

Adult↗
PubMed1975

Maximal treadmill exercise testing in the management of the post-myocardial infarction patient.

Treadmill exercise tests were performed on 32 active duty military personnel 9 to 11 months after acute myocardial infarction to enable more objective selection of candidates for return to military service. Treadmill exercise tests were terminated at heart rates averaging 92 percent maximal predicted rate for age, or when chest discomfort with ischemic ECG changes occurred. The incidence of lipid abnormalities, hypertension, and other coronary risk factors did not differ among the groups. However, treadmill exercise tests appeared to identify a high risk group. Treadmill exercise testing in young postmyocardial infarction patients suggests that those with ischemic responses are at high risk of subsequent cardiac complications. Early surgery in this group may be warranted. The more frequently encountered negative response appears to be associated with a benign clinical course and better immediate prognosis.

Acute Disease↗
PubMed1994

Usefulness of exercise testing shortly after acute myocardial infarction for predicting 10-year mortality.

Previous studies on the prognostic value of exercise test variables after acute myocardial infarction (AMI) are limited methodologically and have yielded inconsistent results. This study determined whether 6 exercise test variables (systolic blood pressure, ST-segment depression or elevation, exercise capacity, arrhythmias, and angina pectoris) after controlling for age and sex, enhance 6 clinical variables (digoxin, previous AMI, history of systemic hypertension and angina, Killip class, and stress) as predictors of cardiovascular death and act as independent predictors as well. The present study followed 258 patients for 10.6 years, each of whom had AMI between 1977 and 1980 and an exercise test before hospital discharge. By 1988, 71 of the 258 patients had died, 56 of cardiovascular causes. This study is unique because exposure and outcome variables are clearly defined and follow-up was complete and longer than in previous studies. Multivariate survival analysis using an exponential model was tested to evaluate the conditional effects of the exercise test and clinical variables and to control for confounders. The model combined the exercise test and clinical variables. Results are reported with hazard ratios (HR) and 95% confidence intervals (CI). For important clinical risk predictors, the HRs with CIs are: digoxin use, HR 4.0 (CI 1.8, 8.5); history of prior AMI, HR 2.4 (CI 1.2, 4.7); history of systemic hypertension, HR 2.5 (CI 1.3, 4.5); angina, HR 2.4 (CI 1.3, 4.5); and stress, HR 4.2 (CI 2.2, 7.9).(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiography↗
PubMed1994

Clinical exercise testing in interstitial lung disease.

Clinical exercise testing has become an essential tool used in the early diagnosis, in the monitoring of treatment effectiveness, and in the assessment of impairment owing to ILD. Despite the assorted causes, the responses to exercise demonstrated by these diseases are generally similar. Although much has been learned about how these diverse diseases functionally impair the exercise capacity of the patient, further study is required if we are to understand fully the various physiologic abnormalities manifested by patients with ILD during exercise.

Biomechanical Phenomena↗
PubMed1990

Risk stratification in patients with non Q wave myocardial infarction: a role for thallium exercise testing.

The ability of maximal exercise thallium testing to stratify patients after non Q wave myocardial infarction was prospectively examined in 20 patients. Patients were enrolled in the study if there was no evidence of residual ischemia nor congestive heart failure during initial hospitalization. The thallium exercise test showed four patients to be at high risk, three of whom had successful revascularization. The remaining 16 patients were considered to be at low risk. There were no re-admissions for unstable angina, no myocardial infarctions and no deaths in the follow-up period (average 15 months). Thus patients with no evidence of early ischemia, no signs of left ventricular failure and a negative maximum thallium exercise test are at low risk following non Q wave myocardial infarction.

Adult↗
PubMed1991

Comparison of yearling, two-year-old and adult Thoroughbreds using a standardised exercise test.

The purpose of this study was to compare exercise measurements in yearling, two-year-old and adult Thoroughbreds using a standardised treadmill incremental exercise test. Peak oxygen consumption (VO2 peak: 128.0 +/- 2.1, 140.0 +/- 2.1, 163.7 +/- 3.4; ml/kg/min +/- se, P less than 0.05), peak packed cell volume (PCV peak: 0.50 +/- 0.01, 0.58 +/- 0.01, 0.64 +/- 0.01 litres/litre +/- se, P less than 0.05) and the maximum number of steps completed in the exercise test (STEPmax: 7.7 +/- 0.1, 8.1 +/- 0.1, 8.6 +/- 0.1; steps +/- se, P less than 0.05) increased with age and degree of physical activity. Peak venous lactate concentration (LACpeak: 21.3 +/- 1.5, 19.5 +/- 1.7, 14.4 +/- 1.7; mmol/litre +/- se, P less than 0.05) and peak respiratory exchange ratio (Rpeak) were significantly higher in both groups of younger horses compared to the adult racehorses. Peak heart rate (HRpeak: 230 +/- 2, 231 +/- 3, 229 +/- 3; beats/min +/- se) did not change with age or training. The rate of change of VO2 between steps in the exercise test (VO2trans) was significantly lower in the adult racehorses at the highest exercise intensities. The slopes of the linear approximation between R (LinR bx), the natural log transformation of venous lactate concentration (LogLAC bx), and heart rate (HR bx) with velocity were significantly lower in the trained adult racehorses. The slope of venous lactate concentration normalised to per cent VO2peak (LogLAC per cent bx) was significantly lower and R breakpoint (R brkpt) normalised to per cent VO2peak was significantly higher in the trained adult racehorses. There was a more rapid decrease in venous lactate and a more rapid return to initial R values in the adult horses relative to the younger, untrained horses. No significant age or training effects were found in the remainder of the post exercise measurements. These results indicate that aerobic power and exercise capacity increased with age and training. Anaerobic power was already well developed even at a young age.

Age Factors↗