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PubMed1991

Exercise testing and left main coronary artery stenosis. Can patients with left main disease be identified?

Exercise testing is commonly used to evaluate patients with coronary artery disease who have serious anatomic characteristics. To study the characteristic exercise test variables in patients with left main coronary artery disease, the computerized data base of the Hungarian Institute of Cardiology Exercise Test Laboratory was used. Among 2,378 patients who had undergone a supine bicycle exercise test and who had abnormal coronary angiographic results, 65 patients with significant (greater than 50 percent diameter narrowing) stenosis of the left main coronary artery were found. The 65 patients were subgrouped according to their previous history and other vessel involvement. Nine patients had isolated left main coronary artery disease and no myocardial infarction (group 1); 28 patients had left main coronary artery stenosis and another diseased vessel but no prior myocardial infarction (MI) (group 2); and 28 patients had left main coronary artery disease, another diseased vessel, and a prior MI (group 3). For comparison, the 27 patients selected to be the control group (group C) had no history of MI but had significant stenosis of both the left anterior descending and the left circumflex arteries. Exercise time, calculated oxygen consumption, maximal work load, time to ST depression, prevalence of ST segment depression, and maximal ST depression were similar in the groups. Maximal heart rate and double product were higher in group 1, but we could find no single variable or group of variables characteristic of left main coronary artery disease.

Coronary Angiography↗
PubMedDate not supplied

A new unsupported upper limb exercise test for patients with chronic obstructive pulmonary disease.

UNLABELLED: PURPOSE This study aimed to develop a new unsupported upper limb exercise test (UULEX) for patients with chronic obstructive pulmonary disease (COPD). METHODS: The reproducibility of the UULEX was assessed in nine patients with COPD who performed the test on three occasions. A comparison of the UULEX and a supported incremental upper limb exercise test (SULEX) using an arm ergometer also was performed with 18 patients who had COPD. RESULTS: There were no significant differences in the maximum values for each cardiorespiratory variable and sensation of dyspnea between the three repetitions of the UULEX, and all the variables showed high reproducibility. During the supported test, maximum values for the cardiorespiratory variables were significantly higher, but the ratio of minute ventilation to carbon dioxide output was lower than during the unsupported exercise test. There were significant correlations for cardiorespiratory responses, arm muscle fatigue, and sensation of dyspnea between the two tests. CONCLUSIONS: The findings suggest that the new UULEX test is a reproducible and acceptable exercise test for patients with COPD that can be used as a simple method to evaluate upper limb function in these patients. Further studies are required to determine the external validity of the test and its sensitivity to interventions such as pulmonary rehabilitation.

Aged↗
PubMed1999

Cardiovascular effects of desipramine in children and adults during exercise testing.

OBJECTIVE: In light of recent reports of sudden death in children being treated with desipramine (DMI), 3 of which were associated with physical exercise, the authors examined the effects of DMI on exercise in children and adults before and during DMI treatment. METHOD: Before treatment, 22 subjects (9 children, 13 adults) participated in a graded treadmill exercise test. Outcome measures included exercise tolerance, cardiovascular, and electrocardiographic parameters at progressive intensity levels and serum norepinephrine (NE) levels before and after exercise testing. Subjects were then treated with DMI, titrated to an average DMI dosage of 3 mg/kg, and underwent repeated exercise testing. RESULTS: DMI treatment was associated with a significant elevation of circulating NE levels in the pre-exercise assessment. Exercise tolerance was not affected by DMI, and blood pressure and heart rate effects were modest. The cardiovascular impact of DMI treatment was similar in children and adults. One 31-year-old subject exhibited a brief episode of ventricular tachycardia associated with exercise during DMI treatment. CONCLUSIONS: DMI has only minor effects on the cardiovascular response to exercise, and these effects do not appear age-related. However, DMI may increase the risk of exercise-associated arrhythmias in rare individuals.

Adolescent↗
PubMed1997

Exercise testing and training in patients with malignant arrhythmias.

Patients with malignant arrhythmias are a challenge when they present to the laboratory for exercise testing and training. The complex metabolic and electrophysiological changes that occur during and after exercise may suppress or potentiate arrhythmias and alter the efficacy and safety of antiarrhythmic agents. The presence of an ICD adds a level of complexity to the study; however, a general understanding of how ICDs function and a review of the programmed parameters before the study will result in a lesser likelihood of complication and more efficient and appropriate action, should a complication occur. Exercise testing and training are valuable methods for the evaluation and treatment of patients with malignant ventricular arrhythmias. Exercise testing is a useful adjunctive technique in the exposure of arrhythmia and the evaluation of the efficacy and proarrhythmic potential of antiarrhythmic agents. These patients are excellent candidates for rehabilitation and exercise training programs, which may result in increased functional capacity and improved quality of life. With this knowledge and adherence to the appropriate guidelines for patient selection and testing, exercise testing and training of patients with malignant arrhythmias can be prescribed and conducted in a safe, controlled manner in an atmosphere of confidence and professionalism.

Arrhythmias, Cardiac↗
PubMed1991

Time domain analysis of oxygen uptake during pseudorandom binary sequence exercise tests.

Pseudorandom binary sequence (PRBS) exercise tests involve repeated switching between two work rates (WR) according to a computer-generated pattern. This paper presents an approach to analysis of O2 uptake (VO2) in the time domain. First, the autocorrelation function (ACF) of the input WR was recognized to be a triangular-shaped pulse that can be taken to be equivalent to a ramp increase followed by a ramp decrease in WR. Then the cross-correlation function of the input (WR) and the output (VO2) was treated as if it were the response to a triangular-shaped pulse. The cross-correlation function was analyzed by fitting a linear summation of the ramp form of a two-component exponential function to this triangular pulse. VO2 responses of eight subjects were obtained from two different PRBS tests, as well as step changes in WR. The first PRBS test consisted of 15 units, each 30 s in duration. Its ACF had a base width of 60 s. The ramp increase-ramp decrease model fit the data throughout the range of response. The second PRBS test had 63 units, each 5 s in duration; thus its ACF base width was 10 s. Again, the ramp model fit adequately. The data from the second PRBS test could be fit by the impulse form of the two-component exponential equation, although the fit in the first 30 s tended to be poorer. The time constants of VO2 dynamics estimated from step and PRBS tests were not significantly different. PRBS tests can be analyzed in the time domain, and the indicators of system dynamics reflect physiological properties similar to those investigated during step changes in WR.

Adult↗
PubMed1993

The prognostic value of exercise testing.

This article discusses the prognostic value contained in exercise testing in patients with cardiac diseases. Exercise testing is a valuable mean of risk stratification and assessment of therapeutic intervention of cardiac patients that complements history and physical examination in the management of these patients.

Angioplasty, Balloon, Coronary↗
PubMed1998

A submaximal all-extremity exercise test to predict maximal oxygen consumption.

PURPOSE: Submaximal aerobic exercise testing is utilized with a variety of populations to assess fitness level and predict maximal oxygen uptake (VO2peak) when a maximal test is not possible or preferable. Many submaximal tests have been developed on traditional exercise equipment, such as the treadmill and the cycle ergometer, but are not available for newer equipment such as an all-extremity ergometer. The purpose of this study was to develop and validate a submaximal exercise test using the Pro II Power Trainer, an all-extremity ergometer, in women ages 30-60 without disability and with varying fitness levels. A secondary purpose was to compare VO2peak values achieved during the all-extremity maximal test and the treadmill test. METHODS AND RESULTS: A linear regression equation was developed to predict VO2peak from submaximal data using heart rates and power output at the sixth and ninth minutes of the submaximal test. The linear regression derived for the submaximal all-extremity test was VO2peak L.min-1 = -0.01 (age in years) - 0.0029 (HR 1) - 0.0099 (HR2) - 0.0029 (PO1) + 0.0151(PO2) + 3.010. Predicted residual sum of squares of the linear equation revealed an R2 value of 0.722 and standard error of estimate of 0.216 L.min-1. Treadmill VO2 speak values correlated strongly with all-extremity VO2 speak values (r = 0.918) and were not significantly different (P, 0.05). CONCLUSION: A similar submaximal test needs to be developed for field estimates of VO2peak for subpopulations of individuals with physical disabilities such as rheumatoid arthritis, head or spinal cord injury, cerebral vascular accident, multiple sclerosis, amputation, and cerebral palsy.

Adult↗
PubMed1982

[Early submaximal exercise test after acute myocardial infarct. Is it a useful test?].

One hundred and twenty asymptomatic patients underwent a submaximal treadmill exercise 2-3 weeks after an acute myocardial infarction. These patients were subsequently followed from 15 to 54 months (average 2 years). Coronary events (cardiac death or angina) occurred in 14% of the patients with normal response, in 55% of those with ischemic response and in 12% of those with abnormal but non-ischemic response. The incidence of coronary events in patients with ischemic response is significantly higher than in the other two groups. However, among the patients who had a normal response, one out of seven suffered from a coronary event during the follow-up period. More than 25% of our patients with an ischemic response to the early exercise testing showed a non-ischemic response during a second one. On the other hand, more than 25% of our patients with normal early exercise test had an ischemic response when the test was performed at the end the follow-up period. Submaximal exercise testing of asymptomatic patients early after an acute myocardial infarction does not seem to be predictive of future coronary events and its long-term reproducibility is poor.

Adult↗
PubMed1986

Exercise tests and ventricular tachycardia.

All treadmill exercise tests done at the Palo Alto Veterans Administration Medical Center from 1973 to 1982 were reviewed to identify episodes of ventricular tachycardia (>/=3 consecutive ventricular ectopic complexes) or ventricular fibrillation occurring during or within 8 minutes of cessation of symptom-limited exercise. Of patients with a clinical diagnosis of coronary artery disease (900 tests), ventricular tachycardia occurred in 36 (4.0%) and ventricular fibrillation in 6 (0.7%). Of patients without known coronary disease (1,700 tests), ventricular tachycardia occurred in 12 (0.07%), and no patient had ventricular fibrillation. Most arrhythmias ceased spontaneously and only 5 patients required cardioversion. We conclude that exercise tests are safe, the incidence of ventricular tachycardia or ventricular fibrillation is low-these arrhythmias occurring largely in patients with known coronary disease-spontaneous return to sinus rhythm is common and no deaths were associated with 2,400 consecutive tests.

Coronary Disease↗
PubMed2003

Repetitive nerve stimulation and exercise testing.

Repetitive nerve stimulation and exercise testing are useful in the evaluation of patients with suspected disorders of the NMJ and muscle membrane excitability when performed with close attention to technical factors. They can be very helpful in the diagnosis of myasthenia gravis. Lambert-Eaton myasthenic syndrome, and botulism, as well as rare disorders of skeletal muscle membrane excitability, including paramyotonia congenita, myotonia congenita, myotonic dystrophy, and the periodic paralyses.

Electric Stimulation↗
PubMed1993

Prognostic significance of silent myocardial ischaemia during maximal exercise testing after a first acute myocardial infarction.

Clinical, exercise, and angiographic variables, and long-term follow-up were compared in patients, who, during maximal Bruce exercise testing after a first acute myocardial infarction (AMI), had positive responses to exercise testing (n = 116, 38% of 303) with (n = 23, group I) or without (n = 93, group II) angina. Group I patients more often (52 vs 19%, P < 0.001) had a history of pre-infarction angina. Group II had a greater proportion (75 vs 52%, P < 0.05) of inferior wall AMI, whereas group I had a greater proportion (30 vs 19%, P < 0.01) of non-Q wave AMI. Total exercise duration was significantly (P < 0.01) longer in group II (7.6 +/- 3.2 vs 5.5 +/- 3.1 min). Maximal exercise heart rate (144 +/- 22 vs 133 +/- 21, beats.min-1 P < 0.05) was also higher in group II. A greater proportion of group II patients (37 vs 9%, P < 0.05) had single-vessel disease, whereas multivessel disease was more common (91 vs 63%, P < 0.03) in group I. Left ventricular function was similar in both groups. During follow-up (48 +/- 22 months) the incidence of cardiac death (group I, 3.3%, group II, 4.8%), of recurrent infarction (group I, 4.8%, group II 3.3%), and of revascularization procedures (group I, 28.5%, group II, 19.8%) were similar in both groups. Although asymptomatic exercise-induced ischaemia was associated with better exercise performance and less extensive coronary disease than symptomatic ischaemia, it had the same long-term prognostic implications.

Adult↗
PubMed1976

Experience of computer-assisted ECG recording in 242 exercise tests.

242 computer-assisted exercise tests were studied. The computer performs simultaneous averaging of a 6- or 12-lead ECG, keeps track of the work load and time and labels all ECG records. Less than 1 per cent of atrial and ventricular extrasystoles were included in the computer average together with ordinary beats, while 80 per cent of all beats were averaged. Averaging reduced the peak-to-nadir QRS amplitude by 3-4 per cent at a sampling rate of 400/s and by 8-9 per cent at 200/s. Q waves with small beat-to-beat variation were usually well preserved after averaging while more variable QRS details often decreased in width or amplitude. The averaging program performed adequately on most kinds of arrhythmia. Averaging should not be used on pacemaker ECGs. Caution must be exercised in the presence of very frequent ventricular extrasystoles.

Arrhythmias, Cardiac↗
PubMed1985

Diurnal variation in symptom-limited exercise test responses six weeks after myocardial infarction.

Diurnal variation of exercise test responses occurring during symptom-limited treadmill exercise testing was investigated in 45 patients six weeks after myocardial infarction. Each patient was exercised using a Naughton protocol before 8 a.m. and after 6 p.m. on the same day. No complications arose. There was no significant diurnal variation of any of the analysed exercise induced ischaemic abnormalities (angina pectoris or ST segment shift) or of the mean maximal exercise durations and achieved workloads. Mean maximal heart rates and heart rate-systolic blood pressure double products were similar in both tests. ST segment depression occurred in 21 patients and was totally consistent in both tests. An abnormal blood pressure response occurred in 14 patients in the morning test and in 18 patients in the evening test but this discordance did not reach statistical significance. Similarly there was no significant diurnal variation in exercise induced ventricular arrhythmias, although only three of the 11 patients in whom they occurred had this abnormality on both tests. We conclude that in this group of patients, no significant diurnal variation was observed in either exercise induced ischaemic abnormalities or in exercise haemodynamics during symptom-limited exercise tests performed six weeks after myocardial infarction. These data increase the confidence in clinical management decisions based on the results of this test.

Adult↗
PubMed1999

Maximal exercise testing for the selection of heart transplantation candidates: limitation of peak oxygen consumption.

BACKGROUND: Peak exercise oxygen consumption (peak VO2), which is considered an indicator of prognosis in advanced heart failure, is currently being used as a major criterion in many centers for the selection of candidates for heart transplantation. Available studies suggest that patients with peak VO2 < 14 mL/min/kg have improved survival and significant functional benefit with transplantation. Since patients may terminate symptom-limited exercise tests for a variety of reasons, peak VO2 does not necessarily reflect maximal VO2, leading to the possibility of inappropriate selection for transplantation. Therefore, we investigated the proportion of transplant candidates referred for exercise testing considered to have achieved maximal results from studies. METHODS: Fifty-five patients with heart failure, aged 51+/-9 years, (mean +/- SD) underwent maximum symptom-limited exercise tests on a cycle ergometer utilizing a Jones stage 1 incremental protocol. Tests were considered maximal if subjects achieved peak heart rate (HR) > 85% predicted ("cardiocirculatory limitation") or peak minute ventilation (VE) > 85% predicted ("ventilatory limitation"), and achieved an anaerobic threshold (AT) by noninvasive measures. RESULTS: Seven tests were terminated because of chest pain, ST-segment abnormalities, or ventricular arrhythmias. Of the remaining 48 studies, the reasons for stopping exercise were leg fatigue in 52%, dyspnea in 16%, and both symptoms in 23%. Sixteen of the 48 patients (33%) had peak VO2 < 14 mL/min/kg. In 8 of these 16 patients, both peak HR and VE were < 85% predicted. Of these eight without apparent HR or ventilatory limitation, none had oxygen desaturation below 90% or fall in BP, two were in atrial fibrillation, and only three had evidence that an AT was achieved. CONCLUSIONS: Among the patients with peak VO2 < 14 mL/min/kg, there were no objective signs of a cardiocirculatory or a respiratory limitation to exercise in half of them, and 31% did not achieve an AT either, thus not meeting any criteria to support evidence of maximal exercise. Exercise tests without objective evidence of cardiocirculatory or ventilatory limitation may not represent maximal performance. Consequently, peak VO2 may misclassify an appreciable proportion of candidates if the test results are submaximal. CLINICAL IMPLICATIONS: Clinical exercise studies indicating low peak VO2 must be interpreted in the context of whether a defined objective exercise limitation is evident to avoid biasing the selection of heart transplant candidates.

Adult↗
PubMed1984

Clinical value of exercise testing in elderly patients.

Between 1978 and 1983, 1391 exercise tests were performed by 1083 males and 308 females over 64 years of age. This represents 17% of the total number of 8213 exercise tests. A history of myocardial infarction was present in 53% of the males and 30% of the females, while 12% of patients had previous heart surgery. Exercise was performed on a bicycle ergometer with stepwise workload increments of 10 or 20 W min-1. In 10% of patients the physician stopped the test because of serious arrhythmias or abnormal blood pressure response. The test was terminated because of fatigue (40%), angina (12%), dyspnea (18%) or tired legs and claudicatio (18%). Peak workload averaged 115 W in males and 85 W in females, which corresponds to 120% of the predicted normal values. Heart rate increased on average to 130 beats min-1 and systolic blood pressure increased to 180 mmHg. ECG changes compatible with myocardial ischaemia were observed in 42% of patients. Although elderly patients constitute a small fraction of the population referred for exercise testing, these findings indicate that the clinical value of the test when performed is similar to that in younger patients. The observation that most patients achieved higher than 'normal' maximum workloads may be due to unreliability of the reference values.

Aged↗
PubMed2004

Exercise testing of healthy men in a new perspective: from diagnosis to prognosis.

AIM: It has recently been suggested that exercise testing may be more valuable prognostically than it is diagnostically in apparently healthy subjects. We wanted to compare the accuracy of CHD risk assessment based on classical risk factors with an assessment also based on multiple exercise test parameters. METHODS AND RESULTS: In 1972-75, 2014 apparently healthy men aged 40-60 had a symptom limited exercise test during a cardiovascular survey. Three hundred died from CHD during 26 years of follow-up. Compared to Cox regression models solely including classical risk factors (CRF), models also including multiple exercise test parameters (CRF+X) were clearly superior (P < 0.0001). Risk scores were computed based on the models. CRF and CRF+X risk scores often differed markedly; CRF+X scores were generally most reliable in both the high and low risk range. In smokers with cholesterol >6.5 mmol/l (n = 470), the CRF and CRF+X models identified 67 vs. 110 men at the highest CHD risk level according to European guidelines (34.2% vs. 38.2% CHD mortality). Three in five CRF+X-identified smokers with cholesterol >6.5 mmol/l had CHD mortality similar to the mean of all 2014 men. CONCLUSION: Integration of multiple exercise test parameters and conventional risk factors improved CHD risk assessment substantially--especially in smokers with high cholesterol.

Adult↗
PubMed1984

Repeat treadmill exercise testing: variability of results in patients with angina pectoris.

To assess the reproducibility and individual variability of ECG treadmill exercise test results, we evaluated 23 patients with coronary artery disease and stable exertional angina by means of two control exercise tests performed on different days within a 1 week period. In addition, each control test was followed on the same day by a single dose of placebo or active agent determined in a randomized double-blind manner and the exercise test was repeated. When the mean exercise test results from the control tests on days 1 and 2 were compared, there was a significant increase in exercise duration to angina (7.4 +/- 3.2 to 9.0 +/- 3.3 minutes, p less than 0.05), ST segment depression (7.8 +/- 3.9 to 9.6 +/- 3.6 minutes, p less than 0.01), and maximal exercise (9.7 +/- 3.7 to 11.0 +/- 4.1 minutes, p less than 0.01). In addition, when the mean exercise results on the control test were compared to those on the postplacebo test on the same day, similar increases in exercise duration were observed at each end point (p less than 0.01). Individual differences of more than 2 minutes in exercise duration between the two control tests and between the control and postplacebo tests in time to angina, ST segment depression, and maximal exercise were frequent (26% to 33% of patients). However, the mean rate-pressure products on the two control tests performed on days 1 and 2 and on the control and postplacebo tests performed on the same day did not differ at angina, ST segment depression, and maximal exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Predictive importance of clinical findings and a predischarge exercise test in patients with suspected unstable coronary artery disease.

The prognostic information of clinical variables and a predischarge exercise test was studied in 400 patients (282 men, 118 women) admitted to the coronary care unit with suspected unstable coronary artery disease, that is, recurring chest pain of new onset, increasing anginal pain in formerly stable angina pectoris or suspected nontransmural acute myocardial infarction. Forty-nine coronary events occurred in the 276 men who performed the exercise test during the following year, whereas only 5 coronary events occurred among the 118 women. The only variable of prognostic importance in women was nontransmural myocardial infarction. In men, the clinical variables increasing age, duration of angina, ST- or T-segment changes on the rest electrocardiogram and increasing angina or nontransmural myocardial infarction as inclusion criteria were associated with increased occurrence of coronary artery bypass surgery, transmural myocardial infarction or cardiac death. Findings of ST-segment depression, limiting chest pain or low rate-pressure product during the exercise test were of greater value than any clinical variable in prediction of coronary artery bypass surgery, transmural myocardial infarction or cardiac death. Within all clinical subgroups of men, the results of the exercise test had an additive predictive value for future coronary events. Combinations of clinical data and exercise test results enabled the best identification of patients with high or low risk for coronary events.

Adult↗