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PubMed1998

[Significance of electrocardiographic projection of ST-segment depression during exercise test in the prediction of the location of regional myocardial ischemia].

There is still some controversy whether ST segment depression during exercise testing might predict the location of myocardial ischemia. From a population of 1196 patients who underwent myocardial 99mTc-tetrofosmin exercise SPECT scintigraphy, 22 consecutive patients (20 males and 2 females, mean age 54 +/- 10 years) with no previous myocardial infarction, positive exercise testing (> or = 1 mm ST segment depression) performed in pharmacologic wash-out and angiographically documented isolated single vessel coronary artery disease (> or = 70% diameter stenosis in a main coronary artery) were selected. None of the patients showed > or = 1 mm ST segment depression exclusively in inferior leads (II-III-aVF). Eight patients (36%) showed > or = 1 mm ST segment depression exclusively in precordial leads (Group 1). The remaining 14 patients (64%) showed > or = 1 mm ST segment depression in both inferior and precordial leads (Group 2). No differences between groups were observed regarding peak exercise test parameters such as heart rate (124 +/- 28 vs 135 +/- 21 b/min, NS), rate-pressure product (22592 +/- 5323 vs 23118 +/- 4197 mmHg x b/min, NS) and exercise time (14.5 +/- 3.9 vs 15.1 +/- 2.9 min, NS) and the number of stress-induced reversible and partially reversible defects (3.3 +/- 3.4 vs 4.6 +/- 2.8, NS). All reversible and partially reversible defects were seen in the related coronary artery stenosis region. Among Group 1, 5 patient (62.5%) showed a > or = 70% stenosis of left descending coronary artery, 1 patient (12.5%) of left circumflex and 2 patients (25%) of right coronary artery. Similarly, among Group 2, 9 patients (64.3%) showed a significant stenosis of left descending coronary artery, 1 patient (7.1%) of left circumflex and 4 patients (28.6%) of right coronary artery. Thus, we were not able to show a relation between exercise ST segment depression and the location of myocardial ischemia as assessed by myocardial 99mTc-tetrofosmin SPECT scintigraphy in a population of patients selected on the basis of single coronary artery disease.

Adult↗
PubMed1995

The diagnostic and prognostic importance of ambulatory ST recording compared to a predischarge exercise test after an episode of unstable angina or non-Q wave myocardial infarction.

The diagnostic and prognostic value of ambulatory ST recordings after admission to the CCU and before discharge was compared to a symptom-limited predischarge exercise test in 170 men with unstable angina pectoris or non-Q wave myocardial infarction. ST depression in recordings before discharge identified a small group of patients (18%) out of whom 23% had a myocardial infarction within 3 months compared to 7% in those without this finding. The exercise test gave more diagnostic information, with ST depression found in 52% including 70% of those with ST depression at Holter monitoring. After 3 months, 13% of patients with ST depression at exercise test had a myocardial infarction compared to 5% in the other patients. ST depression at exercise also indicated an increased risk of myocardial and future severe angina over a longer time period. Thus ST recordings are recommended before discharge in all patients after an episode of unstable coronary artery disease as it identifies the patients with the most severe prognosis who might benefit from early revascularization. In those without ST depression at Holter a predischarge exercise test will give further information regarding the long-term risk for angina and coronary events.

Administration, Oral↗
PubMed1994

[Changes in levels of noradrenaline and adrenaline in blood after exercise testing and transesophageal atrial pacing in patients with ischemic heart disease].

13 patients with ischaemic heart disease and 8 healthy subjects underwent exercise testing and transesophageal atrial pacing. Alternations in plasma noradrenaline, adrenaline as well as systolic and diastolic blood pressure were determined. Mean plasma noradrenaline significantly increased after exercise effort in both groups of patients and it significantly correlated with the increase in systolic blood pressure. The essential increase in mean plasma noradrenaline was found after atrial pacing but the degree of increment was significantly higher after the exercise testing in both groups. The plasma adrenaline level showed a significant increase only during exercise in the ischaemic group. Considering to a more noticeable adrenergic response it can be concluded that exercise test is a more helpful method in diagnosis of ischaemic heart disease than transesophageal atrial pacing.

Adult↗
PubMed2002

Comparison of cardiovascular responses to isometric (static) and isotonic (dynamic) exercise tests in chronic atrial fibrillation.

The aim of the present study was to evaluate the tolerance to various exercises by determining the cardiovascular response to static and dynamic exercises in patients with nonvalvular atrial fibrillation. Fifty patients (mean age: 63.6 +/- 10.3 years; male: 25, female: 25) with chronic (more than one year) nonvalvular atrial fibrillation were included in the study. All patients underwent exercise tests, adjusted appropriately according to their symptoms, as dynamic exercise on a Marquette Case 15 device according to a modified Bruce protocol. Heart rate, and systolic and diastolic arterial pressures were measured at rest and at all stages of the exercise; and the heart rate-pressure products were evaluated. A handgrip test was also conducted as static exercise. The measurements were made before, at the 1st, 2nd and 3rd minutes, and in the recovery periods of the exercise. The percent values of the changes of the 1st, 2nd and 3rd minute measurements in relation to the initial values for both exercises were compared. In addition, the maximal responses to the exercise tests and the post exercise values were also compared. For statistical evaluations, the paired Student-t test was used. Heart rate and pressure-heart rate product values obtained at 1, 2, and 3 minutes during the treadmill exercise test were significantly high compared to the handgrip values (P < 0.0001). The arterial systolic and diastolic pressure values in the 1st minute were also significantly higher during the handgrip test (P = 0.0100 and P = 0.0320, respectively). The values of diastolic arterial pressure at the 2nd minute during the handgrip test, and systolic arterial pressure at the 3rd minute during the treadmill test were found to be statistically significant (P = 0.0240, P = 0.0340, respectively). The mean exercise time and MET value during the treadmill exercise test were 7.18 +/- 2.65 minutes and 5.32 +/- 1.38 mL.kg(-1) x dk(-1). respectively. During the recovery period, the 5th minute, heart rate and pressure-heart rate product values were significantly high after the treadmill test (P < 0.0001). In this study, we revealed that the heart rate response to static exercise was lower and the patients tolerated the static exercise better. Therefore, we decided that the short duration of static exercise is not harmful for the noncomplicated chronic atrial fibrillation cases.

Aged↗
PubMed1986

Role of exercise testing in relationship to coronary artery bypass surgery and percutaneous transluminal coronary angioplasty.

Most patients who are considered candidates for coronary angioplasty should have objective evidence of myocardial ischemia confirmed before the procedure, if clinically possible. In patients with progressive unstable angina, for whom exercise testing is inappropriate, the location of transient resting ECG changes should be looked for on the 12-lead ECG. In clinically stable patients with 1-vessel coronary disease, a pre-PTCA exercise test without radionuclides would suffice for most patients. In the initial months after PTCA, persistence or the return of an ischemic response similar to that observed before the procedure would indicate restenosis. Disease progression in other vessels during the year after the PTCA procedure would be uncommon compared to the incidence of restenosis. In all other stable patients, exercise ECG should be combined with thallium-201 scintigraphy to provide a more useful evaluation of angioplasty results. If only a single vessel is dilated, the importance of the remaining coronary disease may be demonstrated and may influence the clinical decision as to whether further intervention is needed. Dilatation of occluded vessels is occasionally attempted in patients with multivessel coronary disease. The incidence of restenosis is slightly greater (40%) in the months after PTCA than in a stenotic nonoccluded vessel. Multilesion dilatation can also be associated with restenosis at more than one site, and the use of thallium scintigraphy may be helpful in assessing which region of the myocardium is ischemic. As dilatation is performed more frequently in patients with multivessel disease, coronary angiography will remain the 'gold standard' to answer questions about recurrence or progression of the disease, and against which to compare results of noninvasive tests. All exercise tests should be performed without cardioactive medication if possible, and the test should be a sign- or symptom-limited test. The elective exercise test in an asymptomatic individual after PTCA should be performed between 1 and 2 weeks to serve as a baseline for future follow-up. In patients who develop restenosis, symptomatic status will often suggest a PTCA failure. In asymptomatic patients or those with atypical symptoms, the exercise thallium study will often be useful.

Angioplasty, Balloon↗
PubMed2006

Increase in systolic blood pressure during exercise testing after heart transplantation: correlation with the clinical condition and ventricular function assessed by dobutamine stress echocardiography.

OBJECTIVE: Patients who underwent heart transplantation (HTX) experience a reduction in the elevation that is usual in systolic blood pressure during exercise testing. Of unknown origin, this phenomenon varies in frequency and intensity. The aim of this study was to analyze the relationship between systolic blood pressure increase (delta SBP) and clinical aspects, as well as variables measured during exercise testing (ET) and dobutamine stress echocardiography (DSE) in patients in the late post-transplantation course. METHODS: Forty-five men, mean age 49.04 +/- 10.19, underwent clinical assessment, ET and DSE 40.91 +/- 27.46 months after heart transplantation. Left ventricular wall motion score index and ejection fraction were assessed. Delta SBP < 35 mmHg during ET was considered abnormal (SBC,1995). RESULTS: No significant correlation was found between delta SBP and post-transplantation time, graft ischemic time, history of rejection, diltiazem dosage, oxygen uptake, ejection fraction, and wall motion score index (WMSI). Delta SBP was normal in 17 patients (Group I) and abnormal in 28 (Group II). Patients of both groups did not differ significantly in regard to clinical features and ET and DSE results. CONCLUSION: Unlike other populations, no correlation was found between delta SBP during exercise testing and clinical condition or left ventricular function in heart transplant patients. Pathophysiological factors associated with delta SBP reduction during exercise testing remain unknown.

Blood Pressure↗
PubMed1996

Psychological determinants of anginal pain perception during exercise testing of stable patients after recovery from acute myocardial infarction or unstable angina pectoris.

The objective of this study was to test the hypothesis that psychological factors are determinants of anginal symptoms during positive exercise tests. The sample consisted of clinically stable patients who were enrolled in the Multicenter Study of Myocardial Ischemia 1 to 6 months after admission to a coronary care unit. Among 186 post-myocardial infarction patients, 151 developed ischemia (i.e., a stress-induced myocardial perfusion defect) without symptoms (silent ischemia) and 35 developed angina with ischemia (symptomatic ischemia) during a thallium exercise test; among 39 patients who had been hospitalized for unstable angina, 24 developed silent ischemia and 15 developed symptomatic ischemia. Two sets of psychometric tests were administered: set 1, factors that influence awareness of physical symptoms, and set 2, factors associated with biases toward or against reporting perceived symptoms. Two hundred eleven patients produced complete data in each set. Analysis of set 1 factor scores revealed significant effects of symptom status (p = 0.006) and index event (p = 0.02), but no interaction. No effects were found in set 2. Patients who are clinically stable after recovery from an acute coronary event and who experience angina during exercise testing are more aware of physical symptoms in general than are comparable patients with silent ischemia. Psychological biases toward or against reporting perceived symptoms do not differentiate these groups. Thus, it appears that silent ischemia is probably "silent" in the sense of being truly asymptomatic rather than of stoic endurance or denial of perceived symptoms.

Aged↗
PubMed2002

Exercise testing induces fatal thromboembolism from mechanical mitral valve.

Thromboembolism is still one of the most important complications of prosthetic heart valves. Embolism to a major coronary branch is rare, but acute proximal occlusions can be fatal, even when the coronary arteries are otherwise normal and intervention is rapid. We report a fatal complication of an exercise test in a patient who had a St. Jude bileaflet mitral valve. After an exercise test, a 42-year-old woman with a mechanical prosthetic valve had a severe hemodynamic collapse with acute ST segment changes. Coronary angiography showed a totally occluded left main coronary artery with TIMI grade 0 to 1 flow. Rapid injection of contrast material and the passage of a floppy guidewire through the thrombus restored a TIMI grade 3 flow. Angiography showed no coronary atherosclerostic involvement. Despite successful coronary reperfusion, intra-aortic balloon counterpulsation, and intensive medication, the patient died. This case demonstrates that exercise testing should be applied with great caution in patients with prosthetic valves, and only after a careful evaluation of valve function. We recommend transesophageal echocardiography prior to exercise testing in these patients.

Adult↗
PubMedDate not supplied

Treadmill exercise testing in asymptomatic chronic smokers to detect latent coronary heart disease.

The treadmill exercise test has been performed in 50 chronic smokers and 50 non-smokers (93 males and 7 females) who were not having any clinical or electrocardiographic manifestation of ischemic heart disease. The test was positive in 18% chronic smokers and 4% in non-smokers, the chances of positivity of stress test was 4-5 times greater in chronic smokers than in non-smokers. The duration of smoking and number of/cigarettes/bidis smoked per day were directly proportional to the incidence of a positive stress test. There was no significant difference in the incidence of a positive exercise test amongst purely cigarette smokers (17.64%), purely bidi smoker, (16.16%), and in both bidi and cigarette smokers (20%). The study, therefore, suggests that chronic heavy smoking is more frequently associated with asymptomatic ischemic heart disease, as compared to non-smokers and stress testing of persons with coronary risk factors important for detection of latent IHD.

Adult↗
PubMed1980

The value of combining noninvasive techniques in exercise testing.

A 3-stage cycle ergometer exercise test which combines the noninvasive measurement of systolic time intervals (STI's), stroke volume (SV), mean systolic ejection rate (MSER) and blood pressure was administered to 2 groups of middle-aged men. Group 1 included 15 healthy men. Group 2 consisted of 20 men with coronary artery disease (CAD), confirmed by a proven myocardial infarction. The groups were matched for age, weight and height. Over the range of heart rates (HR's) encountered (70--173 beats min-1) the STI's described an inversely linear relationship with HT. At all exercise HR's, group 2 displayed higher values for total electromechanical systole (QS2), left ventricular ejection time (LVET) and the pre-ejection period (PEP), and lower values for SV and MSER. Statistical comparison of all variables at a common HR of 100 beats min-1 indicated that QS2 and MSER best discriminated between the groups. It was concluded that this test is sufficiently sensitive to detect differences in cardiac performance in groups of subjects, but not for the diagnosis of CAD in individual patients.

Adult↗
PubMed2004

[Exercise testing and 24 hours Holter monitoring in the detection of complex ventricular arrhythmias in different stages of chronic Chagas' heart disease].

To detect complex ventricular arrhythmias in different stages of chronic chagasic cardiopathy, the results of exercise testing to 24 hours Holter monitoring have been compared. We evaluated a group of 71 patients, half women, aged 51+/-10.3, with no others associated diseases. These patients were separated in 4 groups according to degree of cardiac involvement. Statistical data can be found elsewhere in the study. In group IA, Holter monitoring detected 4.3% of complex ventricular arrhythmias, group IB 25%, group II 55% and group III 90%. We found no difference between Holter and exercise testing in the detection of complex ventricular arrhythmias in groups II and III (p = ns). In groups IA and IB we found 100% concordance, concerning the no detection of complex ventricular arrhythmias by exercise testing seen by two independent examiners. In group II there was a 70% concordance (kappa = 0.368, p = 0.003) and 90% in group III (kappa = 0.78, p = 0.002). Different results were found, concerning the presence of complex ventricular arrhythmias, among patients in the initial and advanced stages of chronic chagasic cardiopathy. In groups II and III we found no difference between the two methods in the detection of complex ventricular arrhythmias. It seems reasonable to recommend either Holter on exercise testing in groups IA and IB if progression of disease is noticed.

Adult↗
PubMed2006

Effects of treadmill exercise test on oxidative/antioxidative parameters and DNA damage.

OBJECTIVE: We investigated the acute effects of treadmill exercise test (TET) on total peroxide, total antioxidant capacity (TAC), oxidative stress index (OSI) and DNA damage levels in voluntary and untrained healthy subjects. METHODS: A total of 113 untrained healthy subjects were included in the study. All subjects maintained a similar diet and physical activity for a week before the test. Blood samples were obtained before and after TET. Total peroxide, TAC, vitamin C and DNA damage were measured. The DNA damage was analyzed by using the Comet assay and OSI was calculated using total peroxide and TAC values. RESULTS: Treadmill exercise test leads to the increase of total peroxide (12 +/- 3 micromol H2O2/L to 14 +/- 3 micromol H2O2/L, p<0.001), OSI (0.72 +/- 0.18 AU to 0.81 +/- 0.22 AU, p<0.001), and to the decrease of TAC (1.78 +/- 0.16 mmol Trolox Eq./L to 1.72 +/- 0.15 mmol Trolox Eq./L, p<0.001) and vitamin C levels (98 +/- 4.2 micromol/L to 95 +/- 3.4 micromol/L, p<0.001). There was not significant difference in DNA damage. CONCLUSION: Our findings demonstrate that TET increases oxidants, decreases TAC and vitamin C namely, the balance shift towards oxidative side, but this stress is not enough to produce DNA damage.

Antioxidants↗
PubMed2002

A nonischemic forearm exercise test for McArdle disease.

Ischemic forearm exercise invariably causes muscle cramps and pain in patients with glycolytic defects. We investigated an alternative diagnostic exercise test that may be better tolerated. Nine patients with McArdle disease, one with the partial glycolytic defect phosphoglycerate mutase deficiency, and nine matched, healthy subjects performed the classic ischemic forearm protocol and an identical protocol without ischemia. Blood was sampled in the median cubital vein of the exercised arm. Plasma lactate level increased similarly in healthy subjects during ischemic (Delta5.1 +/- 0.7mmol L(-1)) and non-ischemic (Delta4.4 +/- 0.3) tests and decreased similarly in McArdle patients (Delta-0.10 +/- 0.02 vs Delta-0.40 +/- 0.10mmol L(-1)). Postexercise peak lactate to ammonia ratios clearly separated patients and healthy controls in ischemic (McArdle, 4 +/- 2 [range, 1-12]; partial glycolytic defect phosphoglycerate mutase deficiency, 6; healthy, 33 +/- 4 [range, 17-56]) and non-ischemic (McArdle, 5 +/- 1 [range, 1-10]; partial glycolytic defect phosphoglycerate mutase deficiency, 5; healthy, 42 +/- 3 [range, 35-56]) protocols. Similar differences in lactate to ammonia ratio between patients and healthy subjects were observed in two other work protocols using intermittent handgrip contraction at 50% and static handgrip exercise at 30% of maximal voluntary contraction force. All patients developed pain and cramps during the ischemic test, and four had to abort the test prematurely. No patient experienced cramps in the non-ischemic test, and all completed the test. The findings indicate that the diagnostic ischemic forearm test for glycolytic disorders should be replaced by an aerobic forearm test.

Adult↗
PubMed2004

Effects of air ventilation during stationary exercise testing.

The impact of air ventilation on performance and physiological responses during stationary exercise in the laboratory was studied. Fourteen well-trained cyclists performed three exercise tests on a cycle ergometer, each separated by a 1-week interval. The first test was a graded test to determine the power output corresponding with the 4-mmol l(-1) lactate level. Tests 2 and 3 were 30-min constant-load tests at a power output corresponding with this 4-mmol l(-1) lactate threshold. One constant-load test was performed in the absence (NAV), whilst the other was performed in the presence (AV) of air ventilation (3 m s(-1)). During the constant-load tests, heart rate, tympanic temperature, blood lactate concentration and oxygen uptake (VO2) were measured at 10-min intervals and at the end of the test. Differences between the two test conditions were evaluated using paired t-tests. During NAV, 12 subjects interrupted the test due to premature exhaustion (exercise duration <30 min), versus only seven in AV ( P<0.05). At the end of the test tympanic temperature was 35.9 (0.2) degrees C in AV and was higher in NAV [36.7 (0.2) degrees C, P<0.05]. Exercise heart rate increased at a faster rate during NAV [+2.2 (0.3) beats min(-1)] than during AV [+1.5 (0.2) beats min(-1), P<0.05]. Blood lactate concentration and VO2 were similar between conditions. Air ventilation is essential to prevent an upward shift in the lactate:heart rate as well as the power output:heart rate relationship during laboratory exercise testing and indoor exercise training.

Adaptation, Physiological↗
PubMedDate not supplied

Cardiac rehabilitation without exercise tests for post-myocardial infarction and post-bypass surgery patients.

PURPOSE: To compare the progress of patients who were exercise tested before or during cardiac rehabilitation versus those patients who were not tested. METHODS: Eighty-eight (88) post-myocardial infarction patients and 141 post-bypass surgery patients had a symptom-limited exercise test before or during 12 weeks of cardiac rehabilitation. Another 125 post-myocardial infarction and 146 post-surgery patients were not tested. RESULTS: Caloric expenditure during class increased for the entire group (P < 0.001) from week 1 to week 12. Body weight decreased for the entire group as a result of cardiac rehabilitation (P < 0.001). Tricep skinfolds decreased for the entire group (P < 0.001) while subscapular skinfolds did not change (P = 0.28). The percent change from week 1 to week 12 for both groups was similar for all variables. No problems occurred during cardiac rehabilitation that required emergency medical management. CONCLUSIONS: Patients completing a 12-week cardiac rehabilitation program can be safely progressed in terms of their exercise capacity without an entry exercise test. This is desirable in a managed-care setting for reducing costs while maintaining effective patient care. Such factors as staff training and experience, institutional philosophy, patient referral patterns, and facility location must be considered before adopting a no-test policy.

Body Composition↗
PubMed1988

[The clinical significance of ECG exercise testing at hospital discharge of patients with acute myocardial infarction].

330 patients were admitted to the intensive care unit of our hospital from January 1985 to December 1986. 141 of the 150 patients aged below 65 years underwent symptom-limited maximal exercise testing on a bicycle ergometer before discharge. No severe complications were noted. 61 of those tested showed a pathological reaction such as angina pectoris, ST-segment depression or ventricular ectopic activity (couplets, ventricular tachycardia). Coronary angiography was performed in 33 patients (23.4%). The outcome of this examination led to coronary bypass surgery in 15 cases and to PTCA in 2. For 9 of these 17 patients exercise testing soon after myocardial infarction was the essential investigation that led to angiography and surgery. Symptom-limited exercise testing before discharge is a safe method of distinguishing patients at risk, requiring further investigations for possible coronary bypass surgery, from those that do not need additional work-up. We conclude that every post-myocardial infarction patient should be exercise-tested before leaving hospital.

Adult↗
PubMed2006

The value of cardiopulmonary exercise testing and brain natriuretic peptide plasma levels in predicting the prognosis of patients with chronic heart failure.

BACKGROUND: A peak VO2 above 14 ml/min/kg at cardiopulmonary exercise testing and brain natriuretic peptide (BNP) levels is used to estimate survival in patients with chronic heart failure (CHF). Limited data, however, exist comparing the prognostic value of both markers simultaneously in patients with mild to moderate CHF. METHODS: We prospectively studied 85 consecutive patients (59+/-13 years, 63 men) with CHF (mean LVEF 26+/-6%). All patients underwent cardiopulmonary exercise testing with determination of peak VO2 and measurement of plasma BNP at rest. The incidence of cardiac decompensation and cardiac death was recorded in the follow-up. RESULTS: During a mean follow-up of 427+/-150 days, four deaths and ten cardiac decompensations occurred. Kaplan-Meier estimates of freedom from clinical events differed significantly for patients above and below the median BNP of 292 pg/ml and also for patients above and below a peak VO2 of 14 ml/min/kg (p<0.05 each). BNP and peak VO2 (area under the ROC 0.75 vs. 0.72) showed a comparable discrimination of CHF patients with adverse cardiac events. The prognostic information of BNP was at least as powerful as that derived from peak VO2. A BNP above 324 pg/ml was associated with a risk ratio of 8.8 for adverse cardiac events. CONCLUSIONS: In patients with mild to moderate CHF, BNP measurements appear to be an alternative to peak VO2 determined by cardiopulmonary exercise testing for the assessment of prognosis in CHF. BNP may facilitate the ambulatory management of patients with mild to moderate CHF since it is less expensive, less time-consuming, and free of procedural risk compared to exercise testing.

Journal Article↗
PubMed2003

Coronary artery stent thrombosis associated with exercise testing.

Chest pain following coronary artery stenting is common, yet finding the cause can be difficult. Exercise testing has long been used in the assessment of chest pain, but its usefulness in patients who have recently undergone coronary artery stenting is in doubt. A case of exercise testing appearing to precipitate acute stent thrombosis in a patient several weeks post-coronary artery stenting is reported and compared to a similar case in the literature. The role of exercise testing in the assessment of chest pain early after coronary artery stenting is then reviewed.

Journal Article↗