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PubMed1984

Directional variability in the R wave response during serial exercise testing in patients with coronary artery disease.

The reproducibility of the direction of R wave amplitude response to exercise was analyzed in patients with coronary artery disease. Forty-three serial exercise tests were performed by 10 patients with exertional angina pectoris and documented coronary artery disease (CAD). Seventeen tests (37%) resulted in no change or an increase in R wave amplitude (abnormal response). Twenty-six tests (63%) resulted in a decrease in R wave amplitude. The direction of the R wave amplitude response was variable in at least one exercise test in 7 of 10 patients with CAD, all of whom had reproducible ischemic ST segment responses during serial testing. The inconsistent R wave response in these patients was unrelated to heart rate, workload, or duration of exercise. Because of the variability in the directional R wave response during serial exercise testing in CAD patients, we conclude that the R wave response during exercise is unreliable for the detection of CAD or ischemia-related myocardial dysfunction.

Adult↗
PubMed2004

Prognostic impact of different regional referral practices for interventional investigation and coronary treatment after exercise testing: a population-based 5-year follow-up study.

OBJECTIVE: To examine the association among different centres' referral practices for coronary angiography (CAG) after exercise testing, with 1- and 5-year outcomes. DESIGN: Observational population-based cohort study. SETTING: All 10 hospitals and six private practising consultants in Aarhus and Ringkjoebing counties (900 000 inhabitants), Denmark. SUBJECTS: All patients who in 1996 had an abnormal bicycle exercise test (n = 736). MEASUREMENTS: Referral for CAG, coronary intervention, cardiovascular and all-cause mortality, and myocardial infarction (MI). RESULTS: As an immediate consequence of the exercise test, 60.7% of subjects were referred for CAG. Based on the centres' fraction of patients referred for CAG, three categories of centres were defined: low (<33%), intermediate (33-66%) and high (>66%). A low compared with a high referral fraction was associated with a similar 5-year mortality and MI ratio [all-cause/cardiovascular mortality rate ratio (RR) = 1.33, 95% confidence interval (CI): 0.45-3.92/RR = 0.62, 95% CI: 0.25-1.57; and MI RR = 0.92, 95% CI: 0.45-1.86]. The same was found for an intermediate compared with a high fraction (all-cause/cardiovascular mortality RR = 0.92, 95% CI: 0.49-1.72/RR = 0.74, 95% CI: 0.42-1.33; and MI RR = 1.07, 95% CI: 0.68-1.70). Estimates were about the same after 1 year of follow-up with no major differences among centres in mortality or MI. CONCLUSIONS: Centres' different referral practices for interventional investigation and treatment were not associated significantly with short-term or long-term mortality or MI among patients with an abnormal exercise test.

Comorbidity↗
PubMed1976

Exercise tests before and after heart valve replacement.

A simple progressive exercise test was performed before and after operation on five subjects undergoing mitral valve replacement and on five subjects undergoing aortic valve replacement. The responses of heart rate and ventilation were related to work rate )kilopond metres/min). The patients were also assessed clinically by the New York Heart Association grading and radiologically before each exercise test. The clinical grading was shown to be a poor guide to observed exercise tolerance, as the improvement noted in symptoms was not matched by the objective measurement of working capacity. Only two patients had normal exercise tolerance after surgery, although six of the ten patients claimed that they had no exertional dyspnoea after operation. The changes in simple ventilatory function tests before and after operation were generally small. We suggest that measurements of exercise tolerance before and after operation should be an essential part of heart valve replacement surgery.

Adult↗
PubMed2004

Different effects of exercise tests on the antioxidant enzyme activities in lymphocytes and neutrophils.

We have determined the effects of maximal and submaximal cycloergometer tests on the antioxidant enzyme defences of neutrophils and lymphocytes. We also compared the neutrophil and lymphocyte basal enzyme antioxidant activities. A total of 17 well-trained amateur athletes, runners, and cyclists participated in this study. Two tests were performed on an electromagnetic reduction cycloergometer: the maximal exercise test, and the submaximal prolonged exercise test. Blood samples were taken before and after the tests. Basal enzyme activity of superoxide dismutase was higher in lymphocytes but neutrophils presented higher activities of catalase and glutathione peroxidase. The maximal test increased the circulating number of lymphocytes and the activities of catalase and glutathione peroxidase. No changes were observed in lymphocyte number or in lymphocyte antioxidant enzyme activities after the submaximal test. The circulating number of neutrophils increased significantly after the submaximal test. Maximal and submaximal tests decreased the activities of neutrophil glutathione dependent antioxidant enzymes (glutathione peroxidase and glutathione reductase), but no changes were observed in catalase or superoxide dismutase activities after either test. Neither the maximal nor submaximal test produced increases in serum activities of lactate dehydrogenase and creatine kinase (CK).

Adult↗
PubMed1994

[Cardiopulmonary exercise test in the evaluation of healthy elderly men].

PURPOSE: To study methodological aspects and results of cardiopulmonary exercise tests in elderly. METHODS: Twenty-five men (mean age 65 +/- 5 years) performed a cardiopulmonary exercise test using a bicycle ergometer and a progressive continuous work load increase protocol was employed. A computadorized system (2001 CAD/Net System-MGC), which includes a gas analyser and a pneumotacograph, was used for on line monitoring of oxygen and carbon dioxide expired fraction and also of pulmonary flow. RESULTS: We observed the following values of oxygen uptake, pulmonary ventilation and respiratory gas exchange: rest=4 +/- 1 ml/kg-1/min-1, 11 +/- 2 l/min-1 and 0.80 +/- 0,1, respectively: anaerobic threshold=12 +/- 3 ml/kg-1/min-1, 29 +/- 6 l/min-1 and 0.90 +/- 0.1, respectively: respiratory compensation point=18 +/- 4ml/kg-1/min-1, 47 +/- 1 l/min-1 and 1.07 +/- 0.1, respectively, and peak of exercise = 13 +/- 5 ml/kg-1/min-1, 76 +/- 18 l/min-1 and 1.21 +/- 0.2, respectively. The anaerobic threshold and the respiratory compensation point were achieved at 53 +/- 11 and 77 +/- 9% of peak oxygen uptake respectively. The elderly shown slightly increased values of the relation volume dead/tidal volume at rest with a slightly smaller decrease of its values during exercise in comparison to data obtained from young healthy untrained subjects. The heart rate prescription for exercise based on the heart rate reserve was higher than that based on the cardiorespiratory and metabolic responses (113-126bpm vs 96-114bpm). CONCLUSION: The cardiorespiratory and metabolic responses pattern in the elderly is quite heterogeneous. The heart rate prescription for exercise based on conventional stress tests seems to overestimate cardiorespiratory and metabolic capacity in healthy elderly men. The determination of anaerobic threshold and respiratory compensation point from cardiopulmonary exercise test data optimize exercise prescription for healthy elderly men.

Aged↗
PubMed2005

Pulmonary exercise testing predicts prognosis in patients with chronic obstructive pulmonary disease.

OBJECTIVE: In patients with chronic obstructive pulmonary disease (COPD), patient age and initial value of forced expiratory volume in 1 second (FEV1) have been considered the most accurate predictors of mortality among the parameters obtained from pulmonary exercise tests. However, few studies have examined the predictive variables of prognosis among exercise parameters in COPD. We therefore attempted to identify the best index for predicting long-term survival in patients with COPD among the cardiopulmonary variables obtained during exercise testing. PATIENTS AND METHODS: Fifty-eight patients with COPD (50 men and 8 women) without hypoxemia at rest or other serious complications performed resting pulmonary function tests followed by a symptom-limited ramp exercise test on a cycle ergometer with breath-by-breath gas analysis and arterial blood gas sampling. RESULTS: After 3,570+/-1,373 days follow-up (mean+/-SD), 21 died because of deaths by respiratory failure. The overall survival rates calculated by the Kaplan-Meier method were 92.9% and 75.8% at 5 years and 10 years, respectively. In univariate Cox hazards analysis, age, FEV1, VC, RV/TLC, VEmax, VO2max, VCO2max, PaO2max, PacO2max, and PaO2 at rest were found to be significant prognostic indices of survival. However, multivariate analysis revealed only FEV1, PaO2max, and age as independent predictors of mortality. In severe COPD patients (FEV1 <50% predicted, n=35), PaO2max and age also correlated with prognosis, whereas FEV1 did not. CONCLUSION: Pulmonary exercise testing is useful in predicting prognosis in patients with COPD.

Aged↗
PubMed2002

Blood pressure response to heart rate during exercise test and risk of future hypertension.

Previous works have shown that exaggerated blood pressure response to exercise is a valid risk marker for future hypertension, yet the use of an exercise test as a means of early prediction of hypertension still requires methodological development and confirmation. The purpose of this study was to determine abnormal ranges of blood pressure responses in relation to heart rate increase during exercise and to examine the clinical utility of exercise blood pressure measurement in evaluating individual risk for developing hypertension. We examined exercise test data from a population-based sample of 1033 nonmedicated normotensive men (mean age, 42.9+/-8.5 years; range, 20 to 59 years). Percentile curves of systolic and diastolic blood pressure responses to relative heart rate increments during submaximal exercise were constructed using a third-order polynomial model with multiple regression analysis. Of the original study sample, a cohort of 726 subjects was followed for hypertensive outcome for an average period of 4.7 years. Progression to hypertension, defined as a blood pressure of > or =140/90 mm Hg or the initiation of antihypertensive therapy, was found in 114 subjects (15.4%). Kaplan-Meier survival estimates showed that the cumulative incidence of hypertension increased progressively with higher percentiles of systolic and diastolic blood pressure response (both, P<0.01). A Cox proportional survival analysis revealed a significantly increased risk for developing hypertension associated with exaggerated blood pressure response to exercise after multivariable adjustments for traditional risk factors (relative risk, 3.8; 95% confidence interval, 2.3 to 6.1). These results suggest that an exaggerated blood pressure response to heart rate during exercise is predictive of future hypertension independent of other important risk factors and lend further support to the concept that blood pressure measurement during exercise test is a valuable means of identifying normotensive individuals at high risk for developing hypertension.

Adolescent↗
PubMed2002

[Evaluation of the appropriateness of prescribing exercise tests].

BACKGROUND: We evaluated the appropriateness of the indications to exercise testing for ambulatory patients performed during 4 weeks in 21 laboratories in Tuscany and Umbria, Italy. METHODS: We collected the following data: the appropriateness of the prescription (according to the guidelines of the Italian Federation of Cardiology), the prescribing physician (cardiologist vs non-cardiologist), the synthetic result (normal vs abnormal) and the clinical utility (useful vs useless) of each exam. RESULTS: We evaluated 1158 prescriptions (population: 822 males, 336 females; mean age 60 years, range 16-82 years). Prescriptions were of class I (appropriate) in 38.9%, of class II (of doubtful appropriateness) in 52.5% and of class III (inappropriate) in 8.6% of the cases. In 14.2% of the cases the exam was abnormal: it was abnormal in 35.5% of class I, in 26.6% of class II and in 23% of class III exams (p < 0.05). The exam was useful in 51.6% of the cases; it was useful in 62.4% of class I, in 50.2% of class II and in 13% of class III exams (p < 0.05). Cardiologists required 596/1158 tests (51.5%). Their indications were included in class I in 45.6%, in class II in 49.7% and in class III in 4.7% of the cases vs 31.7, 55.5 e 12.8% of non-cardiologists' prescriptions (p < 0.05). The test was abnormal in 35.7% of cardiologist vs 23.5% of non-cardiologist-prescribed examinations (odds ratio 1.81, 95% confidence interval 1.4-2.34; p < 0.05); the test was useful in 64.4% of cardiologist vs 38.2% of non-cardiologist-prescribed exams (odds ratio 2.92, 95% confidence interval 2.3-3.71; p < 0.05). CONCLUSIONS: In Tuscany and Umbria, Italy, less than half of exercise testing procedures are appropriate; appropriately-prescribed exams are more often abnormal and useful; cardiologist-prescribed exams are significantly more appropriate, abnormal and useful.

Adolescent↗
PubMed2001

[Assessment of corrected orthogonal ECG system of McFee-Parungao leads in bicycle exercise test in patients with myocardial ischemia].

AIM: To assess orthogonal ECG system McFee-Parungao in exercise test performed by patients with ischemic heart disease (IHD). MATERIAL AND METHODS: The trial included 103 patients: 41 patients with IHD, 23 patients with IHD combined with arterial hypertension and 39 control patients free of IHD. All the patients performed bicycle exercise with ECG registration in the corrected orthogonal system of leads modified according to McFee-Parungao. In 11 patients ECG was registered in two systems--orthogonal and standard 12-lead. Sensitivity and specificity in IHD were assessed. RESULTS: Parameters of the bicycle exercise test registered by ECG in the corrected orthogonal system indicated that sensitivity and specificity of this system in IHD patients are not inferior to sensitivity and specificity of the standard 12-lead ECG system. CONCLUSION: The system of orthogonal leads McFee-Parungao is recommended for use in the practice of bicycle exercise tests in IHD patients.

Adult↗
PubMed1994

The role of cardiopulmonary exercise testing in lung and heart-lung transplantation.

Cardiopulmonary exercise testing in recipients of lung and heart-lung transplants demonstrates significant restoration of exercise tolerance to individuals severely disabled by their underlying cardiopulmonary disease. Recipients can perform moderate levels of activity compatible with a normal lifestyle. Considerable exercise limitation, however, remains in most recipients as measured by maximum oxygen uptake and work rate, despite substantial improvement and often normalization in resting cardiopulmonary function. The amount of exercise limitation observed in recipients of single-lung, bilateral-lung, and heart-lung transplants is interestingly similar, and the pattern of limitation is somewhat stereotyped. Ventilatory abnormalities are never limiting. Gas exchange abnormalities are sometimes seen (especially in single-lung transplant recipients) but generally are not limiting. Cardiac dysfunction is sometimes seen (particularly in heart-lung transplant recipients) but also does not appear to be limiting. Peripheral factors limiting exercise (which may include abnormalities in the peripheral circulation and peripheral neuromuscular structure and function) are almost universally seen and are probably the primary determinant of exercise limitation in these patients. At present, the relative contributions of various peripheral factors to exercise limitation are unclear. Further study may help elucidate these issues.

Disability Evaluation↗
PubMed1999

The exercise test in Andersen syndrome.

BACKGROUND: Andersen syndrome is a rare form of periodic paralysis (PP) associated with dysmorphic features and potentially fatal cardiac dysrhythmias. To date, no electrodiagnostic abnormalities have been reported that can be used to confirm the presence of PP in this condition. OBJECTIVES: To determine if the exercise test could be used to confirm the diagnosis of PP in Andersen syndrome. To evaluate the exercise test as a means to assess neuromuscular status during treatment. METHODS: We performed the exercise test on 2 patients with Andersen syndrome. In 1 patient, we used a modified version of the test to document responsiveness to treatment with tocainide. RESULTS: Studies in both patients demonstrated a progressive decline in the compound muscle action potential amplitude after exercise that was characteristic of the phenomenon seen in other forms of PP. In 1 patient, improvement in interattack strength and a reduction in the number of attacks of weakness correlated with improvement in the test results. CONCLUSIONS: Our cases demonstrate that the exercise test can confirm the diagnosis of PP in Andersen syndrome. A modified version of exercise testing may also be considered as an objective method for documenting treatment responses in PP.

Abnormalities, Multiple↗
PubMed2006

Usefulness of early exercise testing and clinical risk score for prognostic evaluation in chest pain units without preexisting evidence of myocardial ischemia.

We investigated whether the result of early exercise testing yields prognostic information in addition to that afforded by a clinical risk score in patients who present with chest pain in the emergency department. The study group consisted of 340 patients without preexisting evidence of myocardial ischemia. A clinical risk score was calculated. Primary (mortality or myocardial infarction) and secondary (mortality, myocardial infarction, or rehospitalization due to unstable angina) end points at 1 year were defined. Patients with a positive exercise test result underwent invasive management. Frequencies of primary (7.4% vs 2.1%, p = 0.06) and secondary (9.3% vs 2.8%, p = 0.04) end points and risk score (1.6 +/- 1.0 vs 1.0 +/- 0.9 points, p = 0.0001) were higher in patients with a positive exercise test result. However, in multivariate analysis, clinical risk score was the only independent predictor for the primary (hazard ratio 2.0, 95% confidence interval 1.2 to 3.2, p = 0.004) and secondary (hazard ratio 1.9, 95% confidence interval 1.2 to 2.9, p = 0.003) end points. In conclusion, if a policy of invasive management is implemented for patients with positive exercise test results, the clinical risk score constitutes the main prognostic predictor of 1-year outcome.

Aged↗
PubMedDate not supplied

[Exercise test: abnormal ST segments restricted to recovery phase].

PURPOSE: To determine the incidence of atherosclerotic coronary artery disease (CAD) and or myocardial ischemia in patients (pt) with abnormal ST segments restrict to recovery phase (RRAST) of exercise testing (ET). MATERIAL AND METHOD: Retrospective study in 19 non consecutive pt with RRAST, related to coronary arteriography or exercise planar scyntillography (18 men, 58 +/- 9 years, 18 asymptomatic). RESULTS: RRAST corresponded to ST segment depression from 1 to 4 mm, with T inversion during early recovery (2 pt); late (14 pt) or both (4 pt). It was documented CAD (14 pt and 9) with artery-by-pass surgery); hypertensive myocardiopathy with normal coronary (3 pt), and mitral prolapse valve (1 pt). In 13 pt with coronary arteriography or exercise scyntillography, within the first 6 months from exercise testing, myocardial ischemia was confirmed in 8 pt in 3 pt, successive exercise testing showed RRAST reproductive in 2 cases. CONCLUSION: The authors report the high incidence of CAD and or transitory hypoperfusion during myocardial scyntillography in symptomatic men with middle age with RRAST during exercise testing.

Adult↗
PubMed2002

Particulate air pollution and risk of ST-segment depression during repeated submaximal exercise tests among subjects with coronary heart disease: the Exposure and Risk Assessment for Fine and Ultrafine Particles in Ambient Air (ULTRA) study.

BACKGROUND: Daily variations in ambient particulate air pollution have been associated with cardiovascular mortality and morbidity. We therefore assessed the associations between levels of the 3 main modes of urban aerosol distribution and the occurrence of ST-segment depressions during repeated exercise tests. METHODS AND RESULTS: Repeated biweekly submaximal exercise tests were performed during 6 months among adult subjects with stable coronary heart disease in Helsinki, Finland. Seventy-two exercise-induced ST-segment depressions >0.1 mV occurred during 342 exercise tests among 45 subjects. Simultaneously, particle mass <2.5 microm (PM2.5) and the number concentrations of ultrafine particles (particle diameter 10 to 100 nm [NC(0.01-0.1)]) and accumulation mode particles (100 to 1000 nm [NC(0.1-1)]) were monitored at a central site. Levels of particulate air pollution 2 days before the clinic visit were significantly associated with increased risk of ST-segment depression during exercise test. The association was most consistent for measures of particles reflecting accumulation mode particles (odds ratio 3.29; 95% CI, 1.57 to 6.92 for NC(0.1-1) and 2.84; 95% CI, 1.42 to 5.66 for PM2.5), but ultrafine particles also had an effect (odds ratio 3.14; 95% CI, 1.56 to 6.32), which was independent of PM2.5. Also, gaseous pollutants NO2 and CO were associated with an increased risk for ST-segment depressions. No consistent association was observed for coarse particles. The associations tended to be stronger among subjects who did not use beta-blockers. CONCLUSIONS: The present results suggest that the effect of particulate air pollution on cardiovascular morbidity is at least partly mediated through increased susceptibility to myocardial ischemia.

Adult↗
PubMed1980

Maximal 12-lead exercise testing for prediction of severity of coronary artery disease.

Ninety-three patients with chest pain underwent both maximal 12-lead treadmill testing and coronary arteriography to ascertain whether exercise testing might predict multivessel coronary disease. Twenty-eight patients had normal coronary arteries, 20 single vessel disease (greater than 70% reduction in luminal diameter), 18 double and 22 triple vessel disease. Five patients had left main coronary disease. All 45 patients with double, triple or left main disease had positive 12-lead exercise tests whilst only 15/20 (75%) with single vessel disease had positive tests. Sensitivity of the 12-lead electrocardiogram during maximum stress testing was 92%, with 15% false negatives. The predictive value of a positive test was 100% (no false positives) and 85% for a negative test. Significant predictors of severe triple vessel and left main coronary disease were the sum of ST segment depression (xi ST), the number of ECG leads which developed ST segment depression, the stage at which ST depression developed and the ST segment recovery time. There was a significant correlation between the anatomical location of coronary artery stenoses and the area of ischaemia indicated by the exercise electrocardiogram.

Adult↗
PubMed2003

Subclassifying chronic fatigue syndrome through exercise testing.

PURPOSE: The purpose of this study was to examine physiological responses of persons with chronic fatigue syndrome (CFS) to a graded exercise test. METHODS: Cardiopulmonary exercise tests were performed on 189 patients diagnosed with CFS. Based on values for peak oxygen consumption, patients were assigned to one of four impairment categories (none, mild, moderate, and severe), using American Medical Association (AMA) guidelines. A one-way MANOVA was used to determine differences between impairment categories for the dependent variables of age, body mass index, percentage of predicted [OV0312]O(2), resting and peak heart rates, resting and peak systolic blood pressure, respiratory quotient (RQ), and rating of perceived exertion. RESULTS: Significant differences were found between each impairment level for percentage of predicted [OV0312]O(2) and peak heart rate. Peak systolic blood pressure values for the "moderate," and "severe" groups differed significantly from each other and both other groups. The more impaired groups had lower values. The no impairment group had a significantly higher peak RQ than each of the other impairment levels (all P < 0.001). Peak [OV0312]O(2) values were less than predicted for all groups. Compared with the males, the women achieved actual values for peak [OV0312]O(2) that were closer to their predicted values. CONCLUSION: Despite a common diagnosis, the functional capacity of CFS patients varies greatly. Stratifying patients by function allows for a more meaningful interpretation of the responses to exercise and may enable differential diagnosis between subsets of CFS patients.

Adult↗
PubMed1975

[Evaluation of the results of myocardial revascularization surgery by exercise tests under electrocardiographic control. Correlations with control coronography].

A myocardial revascularisation procedure was carried out on 68 patients with obstructive atheroma of the coronary arteries associated with severe angina pectoris. In 58 cases a total of 97 vein grafts were used, and in 10 cases the internal mammary artery was anastomosed to the anterior descending artery (using a vein graft in 5 of them). Before operation the patients had selective coronary arteriography, and a maximal exercise test using a bicycle ergometer. Three months postoperatively the patency of the coronary by-pass was checked, and a further exercise test completed. In the exercise test the criteria were the appearance of angina pectoris, improved performance (measured by the duration of exercise, the maximal power, and the heart rate at the end of exercise), and improved ECG findings. These criteria were correlated by the patency of the graft or grafts as noted at arteriography. There was no pain on exercise in 55 patients (81 per cent), the performance improved in 37 (54 per cent), and the ECG findings improved in 50 (72 per cent). At angiography, 34 patients (50 per cent) had a completely patent by-pass (group I), 31 patients (45.5 per cent) had at least one patent graft (group II), and 3 patients (4.4 per cent) had no patent graft (group III). Group I corresponds to 31 good or very good results and to 3 states on non improvement; group II contains 22 good results and 9 states of non improvement; group III corresponds to 3 states of non improvement. Exercise demonstrates the results of myocardial revascularisation surgery; the correlations between these results and those of graft patency justify its use in surveillance of coronary patients who have been operated. Exercise tests show that the best results are obtained in patients with severe functional disturbances and whose ventricular cinetics have remained sufficient.

Adult↗