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PubMed1990

Superiority of dipyridamole over exercise testing when exercise thallium imaging is limited by angina.

The extent of jeopardized myocardium can be underestimated on stress thallium myocardial perfusion images when exercise tolerance is limited by angina pectoris. A patient's tolerance for pain can influence the degree of myocardial ischemia observed on myocardial perfusion images during effort angina. A case is reported of a patient with angina pectoris showing mild ischemia limited to one myocardial segment on exercise thallium images, but severe and extensive reversible perfusion defects during dipyridamole-thallium imaging, and a 70% stenosis of the left main coronary artery on coronary angiography.

Angina Pectoris↗
PubMed1996

Forearm blood flow by Doppler ultrasound during test and exercise: tests of day-to-day repeatability.

The between-day repeatability of simultaneous measures of brachial artery diameter (D) (echo Doppler) and mean blood velocity (MBV) (pulsed Doppler) was tested during rest and exercise. On 3 separate days, six volunteers performed one trial of 1-min rest followed by a step increase in dynamic handgrip exercise for 4 min which required the lifting and lowering of a 4.4-kg weight (approximately 8-12% MVC) in a 1s/2s (work/rest) cadence. Measures for MBV and D were collected continuously on a beat-by-beat basis during the transition from rest to end exercise. The mean rest values over one min, and single data points at 30, 60, 120, and 240 s of exercise were extracted from the time series data. At all exercise time points, MBV was greater than rest (P < 0.05), but these levels were not different across test days. Arterial D at all exercise time points ranged from 3.8 +/- 0.1 mm to 4.1 +/- 0.1 mm (mean +/- SEM) and did not differ from rest (3.9 +/- 0.1 mm) (P > 0.05), nor did D differ between days. The mean between-day coefficient of variation for D was 4.08 +/- 0.7% at rest and ranged from 2.90 +/- 0.4% to 3.96 +/- 0.5% during exercise. The coefficient of variation for MBV was 13.2 +/- 2.6% at rest and reached 20.2 +/- 3.1% during the final min of exercise; the exercise variability was reduced to 14.9 +/- 2.4% by averaging MBV over 3 s (the duration of a contraction/relaxation duty cycle) (P < 0.05) with no further advantage of averaging over ten 60-s sample periods. The data indicate that, for the six subjects tested, Doppler ultrasound measures of arterial MBV and diameter during both rest and exercise were reproducible across different test days and can be used as a reliable, noninvasive means of testing hypotheses pertaining to blood flow control.

Adult↗
PubMedDate not supplied

[Positive exercise test and normal exercise myocardial perfusion SPECT. Clinical significance].

OBJECTIVE: To establish, in our area, the clinical significance of a normal exercise myocardial perfusion study, in patients with an ischemic response of the exercise test. MATERIAL AND METHODS: A retrospective study was carried out in our Service for the last four years. We studied 45 patients (41 women and 4 men) with an ischemic response of the exercise test and normal myocardial perfusion SPECT, during a mean follow-up of 13,2 months. We considered the final clinical diagnosis according to clinical evolution, therapy outcome and coronary angiography results. RESULTS: The presence of positive exercise test and normal SPECT was predominant in women (93.3%). In 35 patients (77.8%), the final diagnosis was chest pain of probable non-coronary origin (not secondary to coronary artery disease): 18 patients were diagnosed of hypertensive cardiomyopathy, 3 of valvulopathy, 2 of vasospastic angina, 1 of hypertrophic obstructive cardiomyopathy, 1 of microvascular angina, 1 of angina due to arrhythmia, and 9 patients diagnosed of atypical chest pain due to functional or non-cardiac origin. In 10 patients (22.2%), the final diagnosis was chest pain of probable coronary origin. We did not observe any major cardiac events (cardiac death and nonfatal myocardial infarction) during the follow-up period. CONCLUSIONS: Patients with chest pain, positive exercise test and normal SPECT have an excellent prognosis within an intermediate follow-up period. 77.8% of patients were diagnosed of chest pain of non-coronary origin. The most common cause of non-coronary chest pain was hypertensive cardiomyopathy (51.4%), followed by functional or non-cardiac chest pain (28.6%).

Aged↗
PubMed2001

Clinical exercise testing.

Clinical exercise testing is increasingly being utilized in clinical practice because of the valuable, often unique information that it provides in patient diagnosis and management. This is also due to a growing awareness that resting cardiopulmonary measurements provide an unreliable estimate of functional capacity. A continuum of exercise testing modalities for functional evaluation from "low tech" to "high tech" will be discussed. These include the six minute walk test, shuttle walk test, exercise induced bronchoconstriction test, cardiac stress test, and cardiopulmonary exercise testing. The main focus of this article will be cardiopulmonary exercise testing including indications, important measurements, salient methodological considerations, and interpretation.

Exercise Test↗
PubMedDate not supplied

A comparison of treadmill and arm-leg ergometry exercise testing for assessing exercise capacity in patients with peripheral arterial disease.

PURPOSE: To compare the results of treadmill exercise testing (TM) to arm-leg ergometry testing (AL) in patients with peripheral arterial disease (PAD). METHODS: Twelve men and 8 women with PAD (mean age, 62 +/- 10 years) completed a treadmill test and an arm-leg ergometer exercise test. Oxygen uptake, heart rate, rate-pressure product (x10(-3)), ratings of claudication and perceived exertion, and power were measured. RESULTS: Peak oxygen uptake, heart rate, and rate-pressure product were similar between TM and AL. Exercise duration was longer and the peak power higher on the AL than on the TM. Claudication pain > or =3/4 was the reason for test termination in all subjects during TM test and in 13 subjects during AL. Nine patients discontinued due to severe claudication on both tests, but the pain occurred later in AL than TM. CONCLUSIONS: Although peak oxygen uptake was similar between the 2 exercise tests, patients with PAD exercised longer and to a higher peak power during the AL. These data suggest that the AL test may be used to evaluate peak exercise capacity in patients with PAD. The AL may also provide an alternate method for detecting PAD and coronary heart disease.

Aged↗
PubMed2002

Functional evaluation in patients with chronic obstructive pulmonary disease: pulmonary function test versus cardiopulmonary exercise test.

The pulmonary function test (PFT) alone may be inadequate for predicting work-related exercise capacity in patients who file workers' compensation claims for respiratory limitation and compensation. Two hundred sixteen ambulatory patients with chronic obstructive pulmonary disease (forced expiratory volume in 1 second = 54.1 +/- 16.8% predicted) were administered the PFT and cardiopulmonary exercise test, and the results were analyzed by categorical statistical comparison, based on standard medical impairment classifications. Sixty-five patients (30.1%) were similarly classified by the two methods. Of the remaining patients, 132 (61.1%) were found to be less impaired according to the cardiopulmonary exercise test than according to the PFT, and 19 (8.8%) were more impaired according to the PFT. The results favor the use of the cardiopulmonary exercise test for the routine evaluation of respiratory impairment in patients with chronic obstructive pulmonary disease, particularly for patients with mild or moderate impairment revealed by the PFT. The large discrepancy between the two procedures emphasizes the need for a novel approach.

Aged↗
PubMed1976

[Comparative diagnostic value of the isoproterenol test and the exercise test in detection of coronary insufficiency].

It appears that a constant-speed infusion of isoproterinol is as reliable and sensitive a method of detecting coronary insufficiency as the exercise test. It is indicated when: - the exercise test is impossible or not submaximal; - there is disagreement between the clinical findings, which are suggestive, and ergometry, which is negative; - there is pure angina of effort arising spontaneously.

Adult↗
PubMed1987

Exercise test variables of a population with maximal bicycle exercise test.

The aim of the study was to establish reference values for appraising the circulatory response of men and women to age-predicted maximal heart rate (220-age) exercise testing. The data of exercise testing have been analysed in 942 subjects (608 men and 334 women). Under exercise testing the mean maximal heart rate was 177/min in both sexes. Increase in heart rate per minute of exercise was 5.59 +/- 1.93 in men, 9.00 +/- 4.94 in women. At the peak of exercise test, systolic blood pressure was considerably higher in men than in women (188.96 +/- 27.98 vs. 171.66 +/- 28.46 mmHg; p much less than 0.0001). The average working capacity was 1.7 W/kg among men and 1.31 W/kg among women. The duration of exercise testing time was significantly longer in men than in women (918.6 + 269.4 vs. 578.4 +/- 193.2 s; p less than 0.0001). Reference values for testing time are given according to sex and age with due consideration of body weight and height.

Adult↗
PubMed2006

Understanding the basics of cardiopulmonary exercise testing.

Cardiopulmonary exercise testing adds important additional information to that provided by the standard exercise test. In particular, cardiopulmonary exercise testing provides precise determination of aerobic capacity, the causes of dyspnea with exertion, and prognosis in patients with systolic heart failure. This review provides basic, practical information about cardiopulmonary exercise testing for the clinician.

Disability Evaluation↗
PubMed1994

The safety of exercise testing.

Although exercise testing is a safe activity for the vast majority of individuals being tested, complications during or soon after testing do occur, and safety is an extremely important consideration. In reviewing published rates of complications, it appears that complication rates around 5 per 10,000 tests and death rates around 0.5 per 10,000 tests might be expected. The rate of complications and deaths in our clinic is much lower than these published rates, but our population is, in general, a healthier population than those reported on in other studies. It is instructive to review the details of exercise tests in which complications have occurred, although sometimes it is impossible to predict that an untoward occurrence is imminent. Exercise testing soon after myocardial infarction or angioplasty can generally be conducted safely by knowledgeable professionals, although submaximal testing is recommended under these circumstances. Following accepted contraindications to testing and accepted indications for terminating an exercise test is still very important to ensure the safety of testing. If one desires to step outside these recognized guidelines, the anticipated benefits of testing must clearly outweigh the inherent risks. Any testing facility must have appropriate safety equipment, including a defibrillator, and personnel must be regularly drilled in responding to emergencies. In reviewing our experience at the Cooper Clinic, practical suggestions have been offered that should make exercise testing, which is already a very safe activity, even safer.

Angioplasty, Balloon, Coronary↗
PubMed2002

Exercise capacity and mortality among men referred for exercise testing.

BACKGROUND: Exercise capacity is known to be an important prognostic factor in patients with cardiovascular disease, but it is uncertain whether it predicts mortality equally well among healthy persons. There is also uncertainty regarding the predictive power of exercise capacity relative to other clinical and exercise-test variables. METHODS: We studied a total of 6213 consecutive men referred for treadmill exercise testing for clinical reasons during a mean (+/-SD) of 6.2+/-3.7 years of follow-up. Subjects were classified into two groups: 3679 had an abnormal exercise-test result or a history of cardiovascular disease, or both, and 2534 had a normal exercise-test result and no history of cardiovascular disease. Overall mortality was the end point. RESULTS: There were a total of 1256 deaths during the follow-up period, resulting in an average annual mortality of 2.6 percent. Men who died were older than those who survived and had a lower maximal heart rate, lower maximal systolic and diastolic blood pressure, and lower exercise capacity. After adjustment for age, the peak exercise capacity measured in metabolic equivalents (MET) was the strongest predictor of the risk of death among both normal subjects and those with cardiovascular disease. Absolute peak exercise capacity was a stronger predictor of the risk of death than the percentage of the age-predicted value achieved, and there was no interaction between the use or nonuse of beta-blockade and the predictive power of exercise capacity. Each 1-MET increase in exercise capacity conferred a 12 percent improvement in survival. CONCLUSIONS: Exercise capacity is a more powerful predictor of mortality among men than other established risk factors for cardiovascular disease.

Adrenergic beta-Antagonists↗
PubMed1999

[Evaluation of visceral impairments by exercise testing: practice and problems in recently-developed exercise testing in disabled patients and an introduction of a newly-developed instrument for monitoring cardiopulmonary and postural parameters].

OBJECTIVE: Exercise testing plays a major role in evaluation of visceral impairments in disabled patients. We introduced recently-developed exercise testing and a newly-developed instrument for monitoring cardiopulmonary and postural parameters. We also evaluated the effects of cardiac phase II rehabilitation, pulmonary rehabilitation, and lung volume reduction surgery (LVRS) in patients with cardiopulmonary diseases. METHODS: 1) The ratio of ischemic heart disease in stroke patients was assessed by exercise testing. 2) The physical status of the patients with myocardial infarction (MI) was assessed before and just after our hospitalized cardiac phase II rehabilitation program, and at a 6-month follow-up by cardiopulmonary exercise testing. 3) The physical status of the patient with idiopathic interstitial pneumonia was assessed before and after pulmonary rehabilitation by a six-minute walking test. 4) The physical status of the patients with pulmonary emphysema (PE) was assessed before and 3 months after LVRS. 5) We introduced a newly-developed instrument for monitoring cardiopulmonary and postural parameters (MCPP). RESULTS AND CONCLUSIONS: The ratio of ischemic heart disease (IHD) in stroke patients was 18%. Our hospitalized phase II cardiac rehabilitation program improved the management of cardiac risk factors and the physical status in patients with MI. The physical status of the patient with idiopathic interstitial pneumonia was markedly improved after pulmonary rehabilitation, and she did not need to undergo lung transplantation. The physical status and lung function of PE was significantly improved 3 months after LVRS. MCPP was made and used in the field of rehabilitation medicine. MCPP shows the picture and cardiopulmonary and postural parameters at the same time on a monitor, and is a very useful tool to evaluate the activities of daily living of the patients undergoing rehabilitation. MCPP may provide useful information to develop more efficient strategies for rehabilitation planning and patients' education.

Exercise Test↗