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PubMed1981

[Examination of the effect of aorto-coronary revascularisation by means of exercise tests (author's transl)].

The purpose of this study was to determine the value of exercise tests in the examination of the effect of aorto-coronary revascularisation. 48 patients (mean age 52 +/- 6 years) were examined 5.0 +/- 1.9 months before and 4.9 +/- 3.0 months after coronary revascularisation by means of coronary and left ventricular angiography. Left ventricular function at rest was unchanged. 122 grafts were constructed, the patency rate was 86%. Preoperatively two exercise tests with a bicycle ergometer were performed, some days before angiography and some days before operation, respectively. A third test was performed postoperatively (again some days before angiography). During exercise at identical work load, heart rate and systolic blood pressure did not change significantly pre- and postoperatively. At the second preoperative examination, pulmonary artery pressure (31.6 +/- 11.3 mm Hg) was significantly lower than at the first examination (36.3 +/- 10.8 mm Hg). Postoperatively there was a further decrease of mean pulmonary artery pressure (27.6 +/- 6.5 mm Hg). At the highest work load, mean pulmonary artery pressure was significantly lower at the second preoperative and at the postoperative examination (34.4 +/- 11.6 and 31.3 +/- 8.1 mm Hg versus 39.6 +/- 9.8 mm Hg). The explanation of the preoperative reduction of pulmonary artery pressure is not clear. The pressure decrease must be considered in the examination of the effect of aorto-coronary revascularisation by means of exercise tests.

Coronary Angiography↗
PubMed1999

[Can the exercise test with nitroglycerin be useful for differentiation of patients with and without changes in coronary arteries--syndrome X?].

UNLABELLED: The aim of this study was to compare the results of ECG exercise test performed before and after oral administration of nitroglycerine (NTG) in patients with coronary artery disease (CAD), and patients with typical chest pain without any changes in coronary arteriography--syndrome X. We examined 98 patients with typical chest pain, positive result of ECG exercise test, then accordingly to results of coronary arteries assessed with coronary arteriography, patients (pts.) were divided into two groups: group 1--35 pts. without any changes in coronary arteriography--syndrome X, and group 2--48 pts. with significant stenosis present in one or more coronary vessels. Each patient underwent two ECG exercise tests: first without any medication and second performed average 30 minutes after first test, and 5 min after oral administration of 1 table of nitroglycerine. During both tests the following parameters were evaluated: test duration, presence of chest pain, max. ST-T changes, heart rate (HR), and systolic blood pressure (SBP). RESULTS: In group 1 after NTG time of test duration had shortened from 5.9 +/- 0.4 min to 5.7 +/- 0.6 min. We also observed an increase in max. ST-T complex depression (2.2 +/- 0.5 mm vs 2.4 +/- 0.4 mm) but these differences were not statistically significant. In CAD group, duration of test after NTG was longer (6.2 +/- 1 vs 7.4 +/- 1.2), and normalization of max. ST-T complex depressions (2.7 +/- 0.5 vs 2.0 +/- 0.3 mm) was observed p < 0.01. CONCLUSION: Our study suggests that ECG exercise test with NTG may be useful in differentiation of patients with syndrome X and patients with typical coronary artery disease.

Adult↗
PubMedDate not supplied

Value of exercise testing in assessing clinical state and prognosis in hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is a genetic disease of the sarcomeric contractile proteins. A majority of patients with HCM are limited in terms of functional capacity, and a minority of these patients die suddenly. The main aims of management are symptom alleviation and prevention of sudden cardiac death. In patients with HCM, cardiopulmonary exercise testing provides a much more accurate index of functional capacity than New York Heart Association classification status, and it is useful in assessing symptoms after various therapeutic strategies have been implemented. Exercise testing is also valuable in identifying patients with HCM who are at high risk of sudden cardiac death and is an integral part of the algorithm in risk stratification and delivery of prophylactic therapy. Also, cardiopulmonary exercise testing plays an important role in differentiating HCM from other conditions associated with left ventricular hypertrophy, such as physiologic athlete's heart. Therefore, during the last few years, cardiopulmonary exercise testing has provided insights into the diagnosis, determinants, and mechanisms of exercise limitation in HCM. This understanding aids physicians in targeting therapy and developing new treatment modalities.

Cardiomyopathy, Hypertrophic↗
PubMed1986

The value of standardized exercise testing in the noninvasive evaluation of mitral stenosis.

The determination of functional impairment is an important portion of the evaluation of patients with mitral stenosis and frequently is instrumental in the determination to proceed with invasive testing. To test the hypothesis that patients with slowly evolving disability from mitral stenosis frequently do not recognize the degree of their limitations and to determine the utility of formal exercise testing, 24 consecutive patients with pure or predominant mitral stenosis were evaluated for NYHA functional category (NYHA class) by historical determination of functional impairment, echocardiographic mitral valve area (echo MVA), exercise duration, estimated maximum oxygen consumption, and functional aerobic impairment during a symptom-limited Bruce protocol exercise test and multiple catheterization-derived parameters. The data revealed no difference in exercise duration or mitral valve area between NYHA classes, but demonstrated an excellent correlation between exercise duration and severity of mitral valve stenosis determined at cardiac catheterization (cath MVA). This relationship was similar to that of echo MVA to cath MVA and exceeded that of exercise time to any other parameter measured during catheterization. Estimation of maximum oxygen consumption or functional aerobic impairment did not improve the exercise duration to valve area relationship. The data presented thus demonstrate that Bruce protocol exercise testing is a valuable adjunct to other noninvasive tests in the initial evaluation of selected patients with mitral stenosis. By virtue of being easily repeated at low risk, exercise testing may also be useful in long term follow-up of medically treated mitral stenosis patients.

Adult↗
PubMed1979

Significance of the negative exercise test in evaluation of patients with chest pain.

Fifty-three patients with chest pain and a negative exercise test at greater than 85% predicted maximal heart rate underwent coronary arteriography. Twenty-one patients (40%) had significant luminal narrowing in one or two vessels. No patient had left main disease. Pathologic electrocardiographic Q waves were present in only coronary heart disease patients (p less than 0.001). There was no difference (p greater than 0.05) in prevalence of T wave abnormalities, chest pain or ventricular beats during exercise in patients with or without coronary disease. Analysis of sex distribution revealed that typical angina pectoris was uncommon in the women (p less than 0.001) and all twenty-one coronary patients were men (p less than 0.001). We conclude that in patients with chest pain and a negative exercise test, three vessel or left main coronary artery disease is unlikely. Also, women with atypical chest pain and a negative exercise test are unlikely to have a fixed coronary obstruction.

Adult↗
PubMedDate not supplied

Exercise testing in children with primary pulmonary hypertension.

Cardiopulmonary exercise testing is a useful noninvasive tool to assess physiological changes associated with exercise. Developing noninvasive methods to assess the severity of cardiopulmonary disorders, as well as the response to therapeutic interventions, is useful in conditions, such as primary pulmonary hypertension, in which invasive procedures carry significant risks. The 6-minute walk test is a simple measure of exercise endurance. Exercise studies that measure both hemodynamic and ventilatory responses provide additional information regarding the interaction of the circulatory and pulmonary systems. Subtle changes in exercise capacity may suggest deterioration prior to clinical manifestations. This may lead to an earlier reevaluation, including repeat cardiac catheterization, and subsequently changes in medical and/or surgical therapy.

Child↗
PubMed1997

[Diagnostic value of exercise testing in the diagnosis of silent myocardial ischemia in elderly patients with systolic hypertension].

PURPOSE: To evaluate the diagnosis value of exercise testing for silent myocardial ischemia in systolic hypertension of the elderly. METHODS: We compared 110 patients with systolic hypertension (group A) with 104 patients without hypertension (group B). They were submitted to an exercise test according to the Bruce protocol, between January/91 to December/94. Exercise was discontinued if target heart rate was achieved, or fatigue, dyspnea, severe arrhythmia, hypotension or significant ST segment depression > or = 2 mm/0.2 mV developed. RESULTS: Exercise testing showed ischemic ST depression in 22 (20%) of the elderly patients with hypertension systolic and 12 (11.5%) of control elderly patients. The exercise time was shorter in the hypertensives 7.1 +/- 2.9 min vs 8.8 +/- 2.5 min. The ST depression was greater in the hypertensives than the control group: 2.5 +/- 0.8 min vs 1.9 +/- 0.4 min. Also the duration or ischemic ST depression was longer in the hypertensive patients than the control group 5.4 +/- 2.8 min vs 3.4 +/- 1.9 min. CONCLUSION: Elderly hypertensive patients with systolic hypertension have more silent myocardial ischemia than elderly without hypertension. Among the elderly hypertensive patients there was a prevalence of silent ischemia that was 1.7 times higher than in the normotensive elderlies (20% vs 11.5% P < 0.003).

Aged↗
PubMed1979

Exercise testing in Sweden: a survey of procedures.

This report surveys the techniques of exercise testing of patients in twenty out of twenty-four (83%) Clinical Physiological Departments in Sweden. The study shows that bicycle ergometry is the predominant technique used. In the vast majority of hospitals, the standards of practice employed are high and adequate safety precautions are observed. However, criteria for exclusion from and interruption of exercise testing differ from one hospital to another. Limit values for heart rate, breathing frequency and blood pressure are by no means standardized. The criteria for distinguishing between normal and pathological electrocardiographic response vary. We conclude that in order to reduce complication rates and prevent accidents there is a need for further evaluations of the optimal use of exercise stress testing.

Blood Pressure↗
PubMed1980

History, exercise test, and prognosis of chest pain.

Three hundred and eighteen patients were followed up for periods up to seven years (mean, 37.5 months) after an initial assessment of their history followed by a symptom-limited exercise test. Twenty-four of the subjects (7.6%) died, eight within one month of being seen within the unit. The major determinant of mortality was the presence and severity of effort angina. Thus, the survival rates of patients with severe angina, mild angina, and atypical pain were 86.8%, 97.6%, and 99.5% at one month and 73%, 82%, and 93% at five years respectively. The occurrence of angina or ST-segment depression, reduced working capacity, and peak heart rate on exercise testing were all associated with an increased risk of premature mortality. However, the exercise testing abnormalities were closely correlated with the presence and severity of angina by history, except in patients with atypical histories. The major contribution of exercise tests is to the patients with atypical, but possibly eschaemic, chest pains.

Angina Pectoris↗
PubMed1987

Value of exercise testing in determining the risk classification and the response to coronary artery bypass grafting in three-vessel coronary artery disease: a report from the Coronary Artery Surgery Study (CASS) registry.

To determine whether exercise testing can identify higher risk patients with 3-vessel coronary artery disease (CAD) whose survival might be prolonged by coronary artery bypass grafting (CABG), the results of CABG were compared with those of medical therapy in 1,249 nonrandomized patients with 3-vessel CAD from the Coronary Artery Surgery Study (CASS) registry who underwent exercise testing. Analysis of 28 variables by Cox's regression model for survival revealed an independent effect of the left ventricular (LV) score, the final exercise stage, and treatment received on survival. Seven-year survival rates between medical and surgical therapy were compared among subsets of patients according to the LV function and the results of exercise testing. Among patients with normal LV function, those with at least 1 mm of ischemic ST-segment depression or low exercise capacity had better 7-year survival if treated by surgical rather than medical therapy (p less than 0.05). Survival was not different between the medical and surgical groups in patients without ischemic ST depression or with good exercise capacity. Among patients with impaired LV function, surgery improved survival in most subsets of patients with the exception of patients with a preserved exercise capacity. These results support the use of exercise testing in the risk stratification of patients with 3-vessel CAD.

Clinical Trials as Topic↗
PubMed1984

[Exercise testing in patients with the sick sinus syndrome].

Heart rate response to exercise was compared in three groups of subjects; 22 patients (mean age 63.7 years) with sick sinus syndrome and no other significant heart disease (Group I); 10 subjects of the same age with stable, asymptomatic sinus bradycardia at rest (Group II); 29 age-matched controls (Group III). All subjects underwent maximal, symptom-limited exercise testing and the maximal heart rate (HR max), the ratio between HR max and the theoretical maximal heart rate (HR%), exercise capacity (EC) and the ratio between heart rate % and exercise capacity (HR%/EC) % of the three groups were compared. Maximal heart rate, heart rate % and (HR%/EC) % in Group I patients were significantly lower than in Group III subjects (119.1 +/- 24.0 vs 139.0 +/- 18.2; 76.0 +/- 13.9 vs 87.9 +/- 10.8 and 83.0 +/- 19.3 vs 97.5 +/- 15.1 respectively); (HR%/EC) % was significantly lower in Group I patients compared to Group II subjects (83.0 +/- 19.3 vs 101.5 +/- 28.6). Heart rate response was the same in Group I and Group II patients and exercise capacity did not differ in the three groups. Maximal heart rate, heart rate % and (HR%/EC) % were similar in Group II and Group III subjects. The association of (HR%/EC) % less than or equal to 85% with either HR max less than or equal to 110/min or HR% less than or equal to 70% at the end of maximal exercise testing may be suggestive of sick sinus syndrome. The reduced heart rate response during exercise may be helpful in assessing sick sinus syndrome in patients with no other signs of heart disease.

Adult↗
PubMed1977

New criteria to enhance the predictability of coronary artery disease by exercise testing in asymptomatic subjects.

Thirty-seven subjects (10 asymptomatic and 27 symptomatic) who had undergone maximal treadmill exercise tests and coronary arteriography were selected to determine whether the predictive value of ST-segment depression as a marker of coronary artery disease (CAD) in asymptomatic subjects could be enhanced. All subjects had greater than or equal to 2 mm ST-segment depression during testing. Three of the ten asymptomatic subjects had significant CAD (predictive accuracy 30%) and all had greater than or equal to 2 mm ST depression in the one-minute recovery tracing. ST-segment depression resolved by one minute in all seven subjects without CAD. All 27 symptomatic subjects had CAD (predictive accuracy 100%) and 26 of 27 had greater than or equal to 1 mm (21/24 greater than or equal to 2 mm) ST depression in the one-minute recovery tracing. The age, maximum heart rate and exercise tolerance did not differ significantly between the symptomatic and asymptomatic subjects. Thus the predictive accuracy for CAD in asymptomatic subjects is not enhanced by increasing the degree of ST depression required for a positive exercise test. The predictive value may be enhanced if ST depression persists for greater than or equal to 2 minutes into recovery. These data suggest that by using new criteria accurate identification of asymptomatic patients with CAD by exercise testing may be practical.

Adult↗
PubMed1987

Usefulness of low-level exercise testing early after acute myocardial infarction in patients taking beta-blocking agents.

The value of low-level exercise testing early after acute myocardial infarction (AMI) in 207 patients taking beta-blocking drugs was evaluated in a multicenter study of prognosis after AMI. After stratifying patients according to the absence of significant rales upon admission or pulmonary congestion on the admitting chest x-ray, the results of the exercise test (ability to complete the 9-minute protocol) permitted a large cohort (108 patients, 52% of exercising patients) with no deaths from cardiac causes in the year after AMI to be identified. The results suggest that even in patients taking beta-blocking agents, low-level exercise testing together with clinical stratification has value in identifying a large group of patients with a good prognosis after AMI.

Adrenergic beta-Antagonists↗
PubMed1991

[Accelerated exercise test for the evaluation of transesophageal cardiac pacing].

The diagnostic potentialities of the unique procedure of transesophageal cardiac pacing (TECP) exercise test were examined. The accelerated one-stage TECP test was started just at a rate equal to the heart rate submaximal for a patient's age, and continued up to 1 min. The test was considered to be positive with horizontal or obliquely descending ST segment depression greater than or equal to 2 mm. The procedure was used to examine 116 patients: 75 with coronary heart disease and 41 with neurocirculatory dystonia. A high (93 versus 84%) diagnostic sensitivity was displayed by the proposed modified exercise test versus the graded test. Noteworthy, it is possible to substantially reduce the duration of exercise test (1 min versus 5-7 min of the graded test). The accelerated TECP test is safe for patients, easy-to-use and fails to cause any complications.

Adult↗
PubMed2006

Test-retest reliability for two indices of ventilatory efficiency measured during cardiopulmonary exercise testing in healthy men and women.

The level of ventilation (VE)) at a given carbon dioxide output (CO2) determines ventilatory efficiency. During cardiopulmonary exercise testing (CPET), ventilatory efficiency can be measured as the slope of the (VE) versus VCO2 relationship or the lowest VE/VCO2. We evaluated the test-retest reliability of these two ventilatory efficiency indices in 29 healthy subjects (14 males). Each subject performed duplicate cycle ergometer tests on different days. Ventilation and the gas fractions for oxygen and CO2 were measured with a Vacumed metabolic cart. Linear regression analysis of the VE versus VCO2 slope for the duplicate tests in the males, females, and both sexes combined yielded correlation coefficients of 0.822, 0.942, and 0.910, respectively. The corresponding correlation coefficients for the lowest VE/VCO2 were 0.745, 0.929, and 0.884. A comparison of the test-retest correlation coefficients between the two ventilatory efficiency measures for the men, women, and both sexes combined revealed that they were not significantly different and, for a given index, there were no sex differences. The bias (mean of difference scores between tests) and 95% limits of agreement for the VE versus VCO2 slope in the males, females, and both sexes combined were -0.05 +/- 2.41, -0.57 +/- 1.92, and -0.32 +/- 2.20, respectively. The bias and 95% limits of agreement for the lowest VE/VCO2 were very similar with values of 0.06 +/- 2.45, -0.22 +/- 2.03, and -0.10 +/- 2.27. We conclude that the test-retest reliability for the VE versus VCO2 slope and the lowest VE/VCO2 is the same and that there is no sex difference in reliability for either index of ventilatory efficiency.

Carbon Dioxide↗
PubMed1983

Prognostic value of ventricular arrhythmias associated with treadmill exercise testing in patients studied with cardiac catheterization for suspected ischemic heart disease.

The prognostic information provided by ventricular arrhythmias associated with treadmill exercise testing was evaluated in 1,293 consecutive nonsurgically treated patients undergoing an exercise test within 6 weeks of cardiac catheterization. The 236 patients with simple ventricular arrhythmias (at least one premature ventricular complex, but without paired complexes or ventricular tachycardia) had a higher prevalence of significant coronary artery disease (57 versus 44%), three vessel disease (31 versus 17%) and abnormal left ventricular function (43 versus 24%) than did patients without ventricular arrhythmias. Patients with paired complexes or ventricular tachycardia had an even higher prevalence of significant coronary artery disease (75%), three vessel disease (39%) and abnormal left ventricular function (54%). In the 620 patients with significant coronary artery disease, patients with paired complexes or ventricular tachycardia had a lower 3 year survival rate (75%) than did patients with simple ventricular arrhythmias (83%) and patients with no ventricular arrhythmias (90%). Ventricular arrhythmias were found to add independent prognostic information to the noninvasive evaluation, including history, physical examination, chest roentgenogram, electrocardiogram and other exercise test variables (p = 0.03). Ventricular arrhythmias made no independent contribution once the cardiac catheterization data were known. In patients without significant coronary artery disease, no relation between ventricular arrhythmias and survival was found.

Arrhythmias, Cardiac↗
PubMed1998

Assessment of functional results after percutaneous transluminal coronary angioplasty by cardiopulmonary exercise test.

Twenty-nine patients with documented coronary artery disease underwent cardiopulmonary exercise tests before and following a percutaneous transluminal coronary angioplasty (PTCA). The patients medication regimen and exercise protocols remained the same in both cases. Following PTCA, significant improvement (p < 0.001-0.0001) was noted in oxygen consumption (1,526.8 +/- 470.0 vs. 1,686.2 +/- 390 ml/min), oxygen pulse (12.40 +/- 2.73 vs. 13.44 +/- 2.9 ml/beat), oxygen pulse score (7.62 +/- 1.29 vs. 8.85 +/- 1.26 points) and in the ventilatory anaerobic threshold (993.1 +/- 177.6 vs. 1,089.8 +/- 150.9 ml/min) but not (p > 0.05) in maximal heart rate (128.7 +/- 16.9 vs. 132.0 +/- 17.2 beats/min). Thus, a cardiopulmonary exercise test is an effective method to assess functional results following PTCA.

Adult↗
PubMed1989

[Early exercise test after myocardial infarction. Our experience-- results of the examinations of 102 patients].

The paper presented results of early exercise tests performed after myocardial infarction in 102 patients. Examinations were performed on the average, 22 days after the onset of myocardial infarction symptoms. In 52 patients a positive results of the exercise test was stated: lowering of ST-T segment (n = 25), ventricular arrhythmias (n = 16), ST-T segment elevation (n = 15), angina pain (n = 5), and a fall of systolic arterial pressure (n = 4). Two of above mentioned symptoms were observed in some patients. Exercise test was limited by a pulse rate (70% of predictive, maximal pulse rate and) or the work load (up to 125 Watts). No significant complications were observed.

Adult↗