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PubMed1994

An integrated approach to the interpretation of cardiopulmonary exercise testing.

This article demonstrates how the impressive amount of information obtained during cardiopulmonary exercise testing can be reasonably managed and meaningfully applied in the clinical decision-making process. An integrative approach is highlighted that emphasizes patterns of abnormalities and limitations to exercise so that reliance on single measurements is reduced. Illustrative case studies demonstrate the integrative method to the interpretation of cardiopulmonary exercise testing that may be used routinely in clinical practice.

Adult↗
PubMed1993

Predictive value of manual ECG-monitored exercise test before abdominal aortic or peripheral vascular surgery.

The value of manual ECG-monitored exercise test was studied in 58 patients (39 men and 19 women) with intermittent claudication scheduled for abdominal or peripheral vascular surgery. There was a high incidence of well-known risk factors (hypercholesterolemia, smoking, and hypertension) in men and women. History of coronary artery disease (CAD) was present in 29.3% of the patients. No correlation was found between patients with single or multiple stenoses in lower extremity arteries (angiography) and CAD. Ischemic response (ECG) to manual exercise testing was positive in 14 patients (24.1%), of whom 2 (14.3%) had major cardiovascular postoperative complications. Both died of acute myocardial infarction within fourteen days. They had slow recovery (thirty to sixty minutes) of the ST segment (0.3-0.6 mV). The authors conclude that manual exercise testing might reveal serious CAD in patients with severe occlusive peripheral arterial disease of the lower extremities. In cases with slow recovery of ischemic response to exercise, coronary bypass or angioplasty could be advantageous before major vascular surgery.

Adult↗
PubMed1988

Does beta adrenergic blockade influence the prognostic implications of post-myocardial infarction exercise testing?

The influence of beta blockade on the ability of ST depression, during pre-discharge exercise testing, to predict coronary anatomy and subsequent complications was studied in 300 consecutive post-infarct patients, 125 of whom underwent cardiac catheterisation. At the time of exercise 62 patients were taking a beta blocker. The exercise test had a higher sensitivity in predicting multivessel disease in patients who were not taking beta blockers than in patients who were (95% v 76%). beta Blockade did not, however, influence the ability of the test to identify patients at risk of subsequent cardiac events (sensitivity 84% and 85% respectively). These results suggest that it is not necessary to stop treatment with beta blockers before predischarge exercise testing of patients who have had an acute myocardial infarction.

Adrenergic beta-Antagonists↗
PubMed2000

Is rest or exercise hypertension a cause of a false-positive exercise test?

STUDY OBJECTIVES: To determine if a history of hypertension or an exaggerated rise in exercise systolic BP is associated with a false-positive exercise ECG. DESIGN, SETTING, AND PATIENTS: Retrospective analysis of the associations between exercise-induced ST-segment depression and a history of hypertension, exercise systolic BP, and several other clinical and exercise test variables. Among 20,097 patients referred for exercise tomographic thallium imaging in a nuclear cardiology laboratory at a tertiary care center, 1,873 patients met inclusion criteria for this study, which included no history of myocardial infarction or coronary artery revascularization, a normal resting ECG, and normal exercise thallium images. RESULTS: False-positive ST-segment depression occurred in 20% of the population. A history of hypertension was actually associated with a lower likelihood of ST-segment depression (odds ratio, 0.70; 95% confidence interval [CI], 0.55 to 0.89; p = 0. 004). A higher peak exercise systolic BP was associated with a higher likelihood of ST-segment depression (odds ratio, 1.08 for each 10-mm Hg increase in systolic BP; 95% CI, 1.03 to 1.14; p < 0. 001). However, the association between peak exercise systolic BP and ST-segment depression was so weak that this measurement could not be predictive in the individual patient (R(2) = 0.2%). For every 20-mm Hg increase in peak exercise systolic BP, the percentage of patients with ST-segment depression increased by only 3%. CONCLUSIONS: In patients with normal resting ECGs, we conclude the following: (1) a history of hypertension is not a cause of a false-positive exercise test, and (2) higher exercise systolic BP is a significant but weak predictor of ST-segment depression.

Blood Pressure↗
PubMed1982

[Comparison of 24-hour long-term electrocardiogram and exercise testing in the detection of ventricular arrhythmias (author's transl)].

The incidence of ventricular arrhythmias was investigated in 100 patients with a mean age of 53 years with symptom-limited maximal bicycle exercise testing and 24-hour long-term electrocardiogram. 47% of the patients developed ventricular ectopic beats under exercise and 78% in the long-term electrocardiogram. Repetitive forms such as couplets and ventricular tachycardias were found to be three times as frequent with monitoring than with exercise. Therefore it may be concluded that 24-hour monitoring was superior to exercise testing in the detection of incidence and severity of ventricular ectopies. In contrast, there was no significant difference between the two method when comparing exercise testing with the first hour of monitoring. Therefore it may be concluded that exercise testing exposes the grades of ectopic activity occurring during the first hour of the monitoring session. Two-thirds of patients without arrhythmias under exercise had no or insignificant ventricular arrhythmias under monitoring, whereas two-thirds of patients with exercise-induced arrhythmias had advanced grade ventricular ectopic activity with monitoring.

Adult↗
PubMed1984

Exercise test for growth hormone deficiency.

An exercise test measuring energy expenditure was performed on a bicycle ergometer by 98 patients in the outpatient clinic. Results concordant with the final diagnosis were obtained in 89% of the 75 children referred because of short stature and in 65% of the 23 children with associated chronic disorders.

Adolescent↗
PubMed2005

Comparison of stroke volume estimation for non-steady-state and steady-state graded exercise testing.

The stroke volume (SV) during exercise is an important index of the heart's functional capacity. A new method has been developed for the non-invasive estimation of exercise SV (SVex). It requires the determination of the slope for the oxygen uptake versus heart rate relationship in the steady state of graded exercise testing (GXT). The product of the slope and a constant (reciprocal of an assumed value of the arterial oxygen content) equals an estimated value for SVex. It was validated in a previous study using invasive measurements while subjects were performing steady-state GXT. However, currently the most commonly used GXT protocols are non-steady state, e.g. protocols with 1-min increment durations. We tested the hypothesis that SVex is the same for steady-state and non-steady-state GXT. A total of 30 subjects (15 males and 15 females) served as subjects for the study. Each subject performed two GXTs on different days with different increment durations - 1 and 4 min. Ventilation and gas exchange were measured with the Vacumed metabolic cart. For the male subjects, the mean (SD) SVex values for the 1- and 4-min GXTs were 155.4 (39.5) and 134.6 (27.5) ml, respectively. The corresponding values for the female subjects were 151.6 (37.6) and 134.3 (36.4) ml. Paired t-test analysis demonstrated that for both genders the mean SVex for the 1-min GXT was significantly larger than the 4-min GXT mean value (P<0.05). Hence, the commonly used 1-min GXT does not yield the same values for SVex as the steady-state GXT.

Adult↗
PubMed1983

The role of exercise testing soon after acute myocardial infarction.

Exercise testing is a readily available form of evaluation following acute myocardial infarction, especially in the early stages of recovery. Care is necessary to exclude bad-risk patients, but 70% of patients can be included. Either a treadmill or bicycle ergometer can be used. The important prognostic variables are left ventricular function indexes, and ventricular arrhythmias.

Arrhythmias, Cardiac↗
PubMed1988

Physical working capacity determined by different types of bicycle exercise tests.

Forty-three pairs and 10 triplets of bicycle exercise tests were performed. Seven different workload incremental procedures were used. Triplets and nine pairs of tests were performed by healthy subjects (n = 19) and 34 pairs of tests by patients (n = 19) 3 and 15 months after coronary by-pass operation. From each test result a hypothetical maximal workload sustainable for 6 min (Wmax6') was calculated. The two and three Wmax6' values obtained for each pair and each triplet of tests, respectively, were compared. The ratios between the corresponding Wmax6' values were 1.00 +/- 0.01 (mean +/- SE) for healthy subjects and 0.96 +/- 0.03 for patients. It is concluded that working capacities determined by bicycle exercise tests with different workload incremental procedures can be compared via the Wmax6'.

Adult↗
PubMed2000

Effect of creatine supplementation on muscle metabolic response to a maximal treadmill exercise test in Standardbred horses.

The aim of the present study was to investigate the effect of creatine (Cr) supplementation on muscle metabolic response in connection with a maximal treadmill exercise test, known to cause a marked anaerobic metabolic response and adenine nucleotide degradation. First, 6 Standardbred trotters performed a standardised maximal exercise test until fatigue (baseline test). The test used was an inclined incremental treadmill test in which the speed was increased by 1 m/s, starting at 7 m/s, every 60 s until the horse could no longer keep pace with the treadmill. After this baseline test, the horses were separated into 2 equal groups. One half received a dose of 25 g creatine monohydrate twice daily, and the other group were given the same dose of lactose (placebo). The supplementation period was 6.5 days, after which the maximal treadmill exercise test was performed again. A washout period of 14 days was allowed before treatments were switched between groups and a new supplementation period started. After this second supplementation period a new maximal exercise test was performed. After supplementation with creatine or placebo, horses were stopped after performing the same number of speed steps and duration of exercise as they had in the baseline test. Blood samples for analysis of plasma lactate, creatine (Cr), creatinine, hypoxanthine, xanthine and uric acid concentrations were collected at rest, during each speed step and during recovery. The total blood volume (TBV) was also determined. Muscle biopsies for analysis of muscle metabolites (adenosine triphosphate [ATP], adenosine diphosphate [ADP], adenosine monophosphate [AMP], inosine monophosphate [IMP], creatine phosphate [CP], lactate [La] and glycogen) were taken at rest, immediately post exercise and after 15 min recovery. The results showed no significant increase in plasma Cr or muscle total creatine concentration (TCr) after supplementation with Cr. At the end of exercise ATP and CP concentrations had decreased and IMP and lactate concentrations increased in muscle in all groups. Plasma lactate concentration increased during exercise and recovery and plasma uric acid concentration increased during recovery in all groups. No influence could be found in TBV after supplementation with creatine. These results show that creatine supplementation in the dosage used in this study had no influence on muscle metabolic response or TBV.

Animals↗
PubMed1979

Antianginal efficiency of nifedipine with and without a beta-blocker, studied with exercise test. A double-blind, randomized subacute study.

Twenty-one patients, mean age 60.3 years, with stable angina pectoris earlier treated with beta-blockers, were investigated with standardized exercise tests to evaluate the action of nifedipine alone and in combination with a beta-blocker. The first exercise test was performed 3 weeks after treatment with the patient's usual beta-blocker. Following this, the patients were tested twice after a double-blind cross-over 3-week trial with nifedipine and placebo. The patients were subsequently treated for 3 weeks with nifedipine 10 mg 3 times daily or placebo and then performed an exercise test. During the 4th period of 3 weeks the patients took a combination of nifedipine, 10 mg 3 times daily, and their usual beta-blocker and then performed the final exercise test. Nifedipine alone raised the heart rate by 5 beats/min at rest and diminished the systolic blood pressure at rest by 17 mm Hg. During exercise at comparable load the heart rate did not change significantly, but the systolic blood pressure decreased with 22 mm Hg. The exercise tolerance expressed as total work increased on a average by 20%, range-14 - + 194%. Nifedipine in combination with a beta-blocker gave a further decrease in the systolic blood pressure, totally 37 mm Hg at comparable load. The exercise tolerance increased more, totally by an average of 41%. There was a significant correlation between basal values for systolic blood pressure registered during the placebo period at rest and the percentage change in total work. The atrioventricular conduction time did not change significantly compared to placebo during treatment with nifedipine or the combination nifedipine + beta-blocker. No serious side-effects were observed during the study.

Aged↗
PubMed2001

Early recovery of oxygen kinetics after submaximal exercise test predicts functional capacity in patients with chronic heart failure.

BACKGROUND: Oxygen (O2) uptake at peak exercise (VO2 peak) is an objective measurement of functional capacity in patients with chronic heart failure (CHF). The significance of recovery O2 kinetics parameters in predicting exercise capacity, and the parameters of submaximal exercise testing have not been thoroughly examined. METHODS AND RESULTS: Thirty-six patients (mean age = 48+/-14 years) with CHF and New York Heart Association functional class I, II, or III, and eight healthy volunteers (mean age = 39+/-13 years) were studied with maximal and submaximal cardiopulmonary exercise testing (CPET). The first degree slope of O2 uptake decay during early recovery from maximal (VO2/t-slope), and submaximal exercise (VO2/t-slope)(sub), were calculated, along with VO2 half-time (T(1/2)VO2). Patients with CHF had a longer recovery of O2 uptake after exercise than healthy volunteers, expressed by a lower VO2/t-slope (0.616+/-0.317 vs. 0.956+/-0.347 l min(-1) min(-1), P=0.029) and greater T(1/2)VO2 (1.28+/-0.30 vs. 1.05+/-0.15 min, P = 0.005). VO2/t-slope correlated with the VO2 peak (r = 0.84, P<0.001), anaerobic threshold (r = 0.79, P<0.001), and T(1/2)VO2, a previously established estimate of recovery O2 kinetics (r = -0.59, P<0.001). (VO2/t-slope)(sub) was highly correlated with VO2/t-slope after maximal exercise (r=0.87, P<0.001), with the VO2 peak (r=0.87, P<0.001) and with T(1/2)VO2 after maximal exercise (r=-0.62, P<0.001). VO2/t-slope after maximal and submaximal exercise was reduced in patients with severe exercise intolerance (F=9.3, P<0.001 and F=12.8, P<0.001, respectively). CONCLUSIONS: Early recovery O2 kinetics parameters after maximal and submaximal exercise correlate closely with established indices of exercise capacity in patients with CHF and in healthy volunteers. These findings support the use of early recovery O2 kinetics after submaximal exercise testing as an index of functional capacity in patients with CHF.

Adult↗
PubMed2004

[Long-term orthostatic and bicycle ergometry exercise tests in differential diagnosis of syncopal conditions of unclear origin].

AIM: To study efficiency of bicycle exercise test and long-term orthostatic test in differential diagnosis of syncopes. MATERIAL AND METHODS: The study included 113 patients suffering from recurrent syncopes of unclear origin. Twelve healthy volunteers were selected for assessment of the tests specificity. All the patients and controls were examined by means of long-term orthostatic test (LTOT) and bicycle exercise test (BET). RESULTS: Specificity of both tests was 100%. In LTOT syncopes were observed in 52 (46%) cases, including vasovagal syncopes (51 patients), epileptic seizure (1 patient). BET induced vasovagal syncopes in 54 (48%) patients. The results of both tests by inducing syncopes coincided in 30 (26%) cases. In 24 (21%) patients syncopes occurred only in BET while LTOT appeared uninformative. In 21 (18.6%) cases syncopes occurred only in LTOT while BET produced a negative result. 38 (34%) patients had syncopes neither in LTOT nor BET. Both tests induced syncopes in 75 (66%) patients. No complications were observed. CONCLUSION: LTOT and BET are safe and complementary methods in differential diagnosis of syncopes.

Adolescent↗
PubMed1999

Effect of cholesterol lowering treatment on positive exercise tests in patients with hypercholesterolaemia and normal coronary angiograms.

AIM: To assess the impact of cholesterol lowering on positive exercise stress tests in hypercholesterolaemic patients with normal coronary angiograms. METHODS: 43 non-diabetic patients aged 43-61 years, with total serum cholesterol concentrations of more than 7.75 mmol/l, positive exercise tests, and normal coronary angiograms, were started on the American Heart Association step 1 diet. After 12 weeks these patients were randomly assigned to treatment for another 16 weeks with the diet alone (diet group, n = 20) or with the diet plus lovastatin or simvastatin (statin group, n = 23). After this 28 week run in period, statins were withdrawn and lipid profile tests and exercise tests were done and repeated 20 weeks later. RESULTS: At week 28, the statin group but not the diet group had significant reductions from baseline (week 12) in plasma total cholesterol (p < 0.0001), low density lipoprotein (p < 0.0001), and triglyceride (p < 0.0001). The number of patients with positive exercise tests decreased from 23 to three in the statin group and from 20 to 15 in the diet group (p = 0.01). After the final 20 weeks without statins, lipid profiles returned to baseline levels in all 17 patients remaining in the statin group, and exercise tests were again positive in 15 of these patients. CONCLUSIONS: In hypercholesterolaemic patients with normal coronary arteries, cholesterol lowering treatment reduces myocardial ischaemia, as shown by the beneficial effects on exercise testing.

Adult↗
PubMed1981

Incidence and prognostic implications of severe ventricular arrhythmias during maximal exercise testing.

Among 7,500 consecutive maximal exercise tests (MET), we have observed 6 cases of ventricular fibrillation (VF) and 40 cases of ventricular tachycardia (VT); 13 patients had a sustained VT and 27 patients had a single short run of VT. No patient died immediately but 11 patients died during the follow-up. The prognosis was determined by the underlying disease (most often coronary artery disease) and the type of arrhythmia. The 5-year survival rate was 84% in patients with a short run of VT and only 43% in patients with VF or sustained VT.

Arrhythmias, Cardiac↗
PubMed1987

Exercise testing three days after onset of acute myocardial infarction.

To determine the feasibility and predictive value of early exercise testing 72 hours after acute myocardial infarction, 109 consecutive patients who received reperfusion therapy were prospectively evaluated. In the group studied, in 87 (80%) the course was uncomplicated 3 days after admission, as defined by a lack of congestive heart failure, arrhythmias and angina, and 53 patients (49%) performed heart rate-limited (140 beats/min) treadmill exercise. These patients exercised for 7.9 +/- 3.4 minutes, achieving a heart rate of 129 +/- 11 beats/min and a systolic blood pressure of 151 +/- 27 mm Hg. The exercise test was not accompanied by any protracted ischemia, infarction or significant arrhythmias. Accompanying tomographic thallium-201 scintigraphy demonstrated a reversible perfusion defect in 14 patients (26%), no evidence for ischemia in 36 patients (69%) and an equivocal result in 3 patients (6%). Of the 14 patients with a positive exercise-thallium test result, 4 had an adverse clinical outcome of either reinfarction, postinfarction angina or ventricular tachycardia during hospital days 4 to 10; an adverse in-hospital outcome was not seen in the 40 patients with a negative exercise-thallium test result (p = 0.009). Thus, early exercise testing after acute myocardial infarction is safe in selected patients with an uncomplicated course and the test is predictive of in-hospital clinical outcomes.

Adult↗
PubMedDate not supplied

Effects of anxiety and depression on 5-year mortality in 5,057 patients referred for exercise testing.

OBJECTIVE: Beyond acute myocardial infarction, little is known about the effect of depression, and especially anxiety, on prognosis in cardiology patients. The present study aims to examine the effect of anxiety and depression on 5-year mortality in patients referred for exercise testing. METHODS: A total of 5,057 patients referred for routine exercise testing completed the Hospital Anxiety and Depression Scale (HADS) before undergoing the exercise test. Survival data were obtained from 5,017 (99.2%) of those patients after 5.7 +/- 0.8 years. HADS scores and cardiological baseline data were used to predict mortality. RESULTS: In univariate analyses, HADS depression was not a significant predictor; high anxiety was associated with improved survival. Logistic regression revealed nine independent objective predictors from which we computed a composite somatic risk index. When controlling for this physical risk index, anxiety and depression had independent, opposite effects; that is, anxiety was associated with a lower mortality and depression with a higher mortality. CONCLUSION: Anxiety and depression scores have different predictive effects on mortality in patients referred for exercise testing. These effects are independent of a highly effective physical risk index, suggesting that psychological screening of cardiology patients might improve risk stratification.

Aged↗
PubMedDate not supplied

[Post-infarction recurrent myocardial ischemia. Characterization with Holter ECG and exercise test].

In order to characterize postinfarction ischemia, 68 patients were studied by 24 hours Holter-monitoring and exercise testing. Twenty-four (35%) patients in Holter-monitoring and 26 (38%) in exercise testing had transient ischemic episodes. A significant coefficient of agreement was found between both tests. Nineteen (79%) of the patients had only silent ischemic episodes in Holter monitoring, and 87% of all episodes were asymptomatic. Twenty-two (87%) of the patients during positive exercise testing had silent ischemia. Eleven (46%) patients had transient ischemia at low and also at high heart-rates. Ten (37%) patients had ischemic episodes at lower charges than 100 watts, and all of them had more than 60 min of total ischemic burden in Holter-monitoring. A significant correlation was found between total ischemic burden and maximum ST segment shifts. The number of ischemic episodes were significantly higher during morning hours. A significantly higher rate of ventricular extrasystoles was found in recurrent ischemic patients, however, no difference was found in complex arrhythmias. After 1 year follow-up, 3 residual ischemic patients have died. The morbidity-calculated relative-risk is 13.9 times higher in patients with recurrent ischemia.

Adult↗