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PubMed1992

Intermittent anterior divisional block and far advanced right bundle branch block induced by vasospasm during exercise testing.

A patient is reported in whom exercise induced reversible ischemic left anterior fascicular block and far advanced right bundle branch block. Master's two step exercise test for pre-operative check-up revealed significant ST elevation in leads V1-5, negative U waves in leads V3-5 and fascicular blocks with retrosternal anginal chest pain. Long acting nitrate and nicorandil relieved the fascicular blocks.

Aged↗
PubMed1995

Marked PR interval prolongation simulating ST-segment elevation during exercise testing. A case report.

ST-segment elevation during exercise testing is usually indicative of severe proximal coronary artery disease. In this report, the authors describe a patient who underwent exercise stress testing and developed apparent ST elevation in the inferolateral leads. However, noninvasive imaging studies revealed no evidence of myocardial ischemia or other recognized causes of this exercise electrocardiographic (ECG) finding. Analysis of the ECG tracings showed that ST elevation was produced by marked prolongation of the PR interval, super-imposing the P wave on the J-junction of the preceding QRS-ST-segment complex. The authors suggest that marked PR prolongation during exercise may mimic ST elevation, and this possibility should be considered in patients with this exercise ECG finding in whom cardiac evaluation is negative.

Aged↗
PubMed1997

Physiological parameters during the initial stages of cardiopulmonary exercise testing in patients with chronic heart failure. Their value in the assessment of clinical severity and prognosis.

AIMS: To analyse the relationship between initial exercise parameters and peak oxygen consumption and prognosis in 96 patients with congestive heart failure. METHODS AND RESULTS: Comparison of responses during the initial 6 min of cardiopulmonary exercise testing (Naughton modified protocol) in patients stratified to the Weber classification, and analysis of their predictive value with respect to peak oxygen uptake and prognosis. All patients had a left ventricular ejection fraction < 0.45 and a valid cardiopulmonary exercise test, during which they remained in sinus rhythm. Significant differences in several parameters were seen in the initial stages, including oxygen pulse (P < 0.04) and ventilation equivalent for oxygen (P < 0.004). These parameters remained as independent predictors of peak oxygen uptake in the algorithm derived from baseline and initial stage variables. In a multivariate Cox proportional hazards model, the predicted peak oxygen uptake (P < 0.003) was an independent predictor of mortality. CONCLUSION: In patients with congestive heart failure, the initial 6 min parameters of a cardiopulmonary exercise test have additional value in the assessment of clinical severity and prognosis. This may be of clinical relevance since a limited incremental exercise protocol may be more objective than more traditional 6 min walking tests and less demanding.

Aged↗
PubMed2003

[The role of exercise testing in the management of systemic sarcoidosis].

INTRODUCTION: Patients suffering from sarcoidosis sometimes report dyspnoea of effort. The restrictive or obstructive ventilatory problems contribute to this disability, but the systemic manifestations of sarcoidosis should be considered as other possible causes of the dyspnoea. CASE REPORT: We report a case of systemic sarcoidosis in a 29 year old man from the Ivory Coast. The disorder presented in December 1999 with generalised symptoms and grade II dyspnoea (Sadoul). Investigations confirmed pulmonary, mediastinal, hepatic, lachrymal and salivary involvement. Lung function tests at rest showed a combined restrictive and obstructive ventilatory defect. The initial exercise test showed evidence of severe limitation of aerobic metabolism with impaired oxygen uptake without limitation of ventilation. The absence of cardiac involvement, confirmed by echocardiography and myocardial isotope scanning, suggested that the dyspnoea was, at least in part, secondary to a "peripheral" muscular abnormality. After 3 months treatment with oral corticosteroids, the clinical and physiological parameters improved. Exercise testing confirmed an improvement in maximum work rate and oxygen uptake. The relative stability of the functional measurements and the subsequent development of myalgia prompted a biopsy of the quadriceps that showed granulomata within the muscle tissue, confirming a sarcoid myopathy. A combination of steroids and methotrexate allowed the patient to increase his exercise capacity without any major change in the resting lung function tests. CONCLUSIONS: This case report underlines the role of exercise testing in determining the cause of dyspnoea. In this patient it contributed to the diagnosis of sarcoid myopathy and lead to modification of his treatment.

Adult↗
PubMed2003

Sport specific performance diagnosis in rowing: an incremental graded exercise test in coxless pairs.

The aim of the present study was to develop and validate an incremental graded exercise test performed in the rowing boat(coxless pair) in order to give specific performance evaluation data. Furthermore, an attempt was made to transfer these data to training recommendations. Thirty-four female rowers of national and international level performed a 4 x 6 min incremental graded exercise test GXT(boat) in coxless pairs on a lake (6 km, no wind, no waves). The boat velocity on the water (V; measured by a speedometer PACE COACH) was increased continuously from 3.55 m x s-I to 4.03 m x s-1. The individual anaerobic threshold(IAT) was determined by means of the lactate (LA) kinetics during and after exercise. Within 28 days all subjects performed arowing ergometry test GXT(ergo); Gjessing rowing ergometer: 40 watts increments every 3 min) as well as 70 min of constant endurance training in the boat in moderate velocity (ET; n- 10 pairs because of changing weather conditions). Results for V/LAIHR at IAT are: GXT(boat): 3.84+/- 0.10 m x s-1/2.44 +/- 0.66 mmol x 1-1/172 + 11 min(-1); GXT(ergo): 206+/-10 watts/2.53 +0.40 mmol x 1-171 +/- 10 min-' (means+/-SD). The Spearman rank order test showed significant correlations for HR (p < 0.001) and the mean performances of the coxless pairs (p < 0.05). A'5 % lower V during ET lead to a 10% lower HR and a 30% lower LA compared to the values at IAT. In conclusion, both a performance specific evaluation and velocity oriented control of training are possible by means of a 4 x 6 min incremental graded exercise test in coxlesspairs. However, this test on the water requires almost perfect weather conditions. The HR recommendations based on GXT (ergo) were confirmed during GXT(boat).

Adult↗
PubMed1986

Early exercise testing after coronary care for suspected unstable coronary artery disease--safety and diagnostic value.

The safety of and the diagnostic information provided by a predischarge exercise test performed 2-7 days after admission to the coronary care unit (CCU) was evaluated in 400 patients less than 65 years of age with suspected unstable coronary artery disease, i.e. probable or definite non-transmural myocardial infarction, progressive angina pectoris or recurring chest pain of recent onset ('new chest pain'). No serious complications occurred. Signs of ischaemia during exercise tests were more common in older than in younger men and more often found in subjects with than without pathological findings in resting ECGs in the CCU. Above 45 years of age, more than half of the men with progressive angina or non-transmural MI had SI depression greater than or equal to 2 mm and/or limiting chest pain, whereas men less than 45 years of age had a 10-25% incidence of corresponding findings in the test. In women above 55 years with progressive angina or non-transmural MI, 30-35% had ST depression and/or limiting chest pain at the test while 20-30% of women below 55 years of age had similar findings at the test. Beta-adrenoceptor blockade was used by half of the patients but did not seem to conceal signs of severe ischaemia. Thus a predischarge exercise test can be performed safely in patients with suspected unstable coronary artery disease in order to support or reduce the suspicion of severe disease.

Adrenergic beta-Antagonists↗
PubMed1992

Antianginal effects of amlodipine at a single dose on exertional angina patients using treadmill exercise testing--a randomized crossover study in comparison with placebo.

With eight cases of stable exertional angina as subjects, the antianginal action and sustained effects of single 10 mg oral doses of new calcium antagonists amlodipine were assessed by treadmill exercise tests in randomized crossover trials with respect to a placebo. Exercise tests were conducted before as well as 4, 8, and 24 hours after administration, and plasma amlodipine concentration was investigated at the same times. The maximal exercise time was 299 +/- 43 seconds before as compared with 346 +/- 49 seconds 4 hours after administration and 368 +/- 50 seconds 8 hours after administration, a significant prolongation in each case (p < 0.01). Moreover, the exercise time elapsed until 1 mm of ST-segment depression, as well as the ST-segment depression measured at the same time, were both significantly improved as compared with the placebo results. The plasma amlodipine concentration reached a peak 8 hours after administration and displayed an effective level even 24 hours after administration. The value of delta PRP measured at the same time during the exercise test was also significantly reduced as compared with the placebo results, even 24 hours after administration of amlodipine. These findings supported the conclusion that single 10-mg doses of amlodipine provide stable antianginal action over a 24-hour period.

Administration, Oral↗
PubMed1992

Exercise testing? Not at all.

The traditional approach to the ambulatory patient with suspected or definite coronary disease is to evaluate the clinical features, to perform non-invasive tests for myocardial ischaemia, and to proceed, if necessary, to coronary angiography and coronary revascularisation. However, when the results of the exercise tests are discordant with the clinical classifications they are usually misleading as diagnostic tools. When the exercise test is used to assist prognostication, the information provided overlaps with that available to the clinician and only the presence of ST segment depression is an independent prognosticator. The amount of ST segment shift has been found to be an inferior prognosticator to the severity of disease seen on a coronary angiogram and the latter allows for appropriate decisions to be made regarding coronary angioplasty or bypass surgery. A more appropriate use of exercise testing is as a gate for coronary angiography if there is real doubt or the nature of the chest pain or as an aid in therapeutic decisions if the coronary angiography interpretation is difficult.

Angina Pectoris↗
PubMed1994

Screening for childhood asthma using an exercise test.

BACKGROUND: Screening for asthma in children in the community could have advantages at a time when prevalence rates of the condition and associated hospital admission rates are rising. AIM: The aim of this study was to assess the usefulness of a standard exercise test as a marker of asthma or potential asthma in children, and to examine the relationship between asthma and other respiratory tract illnesses. METHOD: In 1985 a cross-sectional research study was undertaken in 10 primary schools in West Glamorgan; the children were followed up over six years until 1991. The exercise test involved measuring peak expiratory flow rate before and after the children ran as fast as they could for six minutes. A control group of children with a negative exercise test result were compared with those not known to have asthma who had a positive result (fall in peak expiratory flow rate of 15% or greater), using clinical data. Similar clinical comparisons were undertaken between the children known to have asthma and a control group. RESULTS: Of 864 children not known to have asthma, 60 had a positive exercise result. Of 92 children known to have asthma, 33 had a positive test result and seven were unable to finish the test because of bronchospasm, a sensitivity of 43% and a specificity of 93%. Follow up of 55 of the 60 children not known to have asthma but who had an abnormal response to the test showed that 32 had developed clinically recognizable asthma six years later. There was a significantly higher prevalence of atopic and respiratory illnesses (otitis media, hay fever and eczema) in the group of children with bronchial hyperreactivity demonstrated on exercise than in those without bronchial hyperreactivity. CONCLUSION: This research shows that bronchial hyperreactivity demonstrated by an exercise test can be a marker for childhood asthma. The study has also identified other respiratory tract illnesses which appear to belong to the same spectrum as asthma.

Asthma↗
PubMed1982

Comparison of prolonged exercise tests at the individual anaerobic threshold and the fixed anaerobic threshold of 4 mmol.l(-1) lactate.

Prolonged physical exercise tests (50 min) at the threshold of 4 mmol . l-1 lactate (ATc) and at the individual anaerobic threshold (IAT) were applied in 19 rowing athletes. In each of the rowers (n = 19) work loads corresponding to the IAT did not result in a gradual lactase accumulation or exhaustion within 50 min of exercise. Means of lactate concentration and heart rate at the end of exercise were 4.0 +/- 1.6 mmol . l-1 and 182 +/- 13.0 beats . min-1, respectively. In 15 of 19 rowers, the IAT corresponded to lower work loads than the ATc. In these cases, prolonged exercise tests at the ATc showed gradual increases in lactate concentrations to a mean of 9.6 +/- 1.2 mmol . l-1, associated with exhaustion at a mean working time of 14.4 +/- 6.3 min and a mean heart rate of 192 +/- 10.4 beats . min-1. In four rowers, the IAT was found at identical (n = 3) or higher (n = 1) work loads than the ATc. In these cases, after an initial increase no further rise in lactate concentrations in blood was observed, and exhaustion did not occur during the prolonged exercise tests. These findings support the conclusion derived from the lactate kinetics model that the IAT defines the work load at the maximal lactate steady state.

Adolescent↗
PubMed1997

Submaximal early exercise test compared to clinical findings for evaluation of short- and long-term prognosis after the first myocardial infarction. Result from the MONICA Projects in Augsburg and Toulouse.

Clinical and ergometric data were derived from 1098 consecutive exercise tests in patients with a first acute myocardial infarction between 1974-1983. In 1992 a follow-up was performed in order to analyse the importance of a submaximal early exercise test, in combination with clinical data, for the prediction of short- and long-term prognosis of cardiovascular death. The relative value of 20 clinical variables, including medical history, markers of infarction size, medication etc., and 28 variables at exercise test were studied. Univariate, multivariate and survival analysis, for estimation of prognosis and independent prediction of cardiovascular death was used. Independent clinical risk factors for cardiovascular death were (1) Within 1 year: relative heart volume (ml.m-2 body surface area) on chest X-ray. (2) Long-term mortality: maximum heart rate and relative heart volume, diabetes, age and digitalis medication. Independent exercise risk factors were: (1) Within 1 year: heart rate, ventricular arrhythmia and ST depression > or = 1 mm before exercise, diastolic blood pressure at maximum exercise and target heart rate. (2) Long-term mortality: angina pectoris and/or ST depression > or = 1 mm at maximum exercise. In subgroups of patients with clinical risk factors, mortality risk increased if there were signs of angina pectoris and/or ST depression > or = 1 mm during exercise. The risk increased 100% in diabetics, 91% with age > 70 years, 58% with relative heart volume > or = 500 ml.m-2 body surface area, 42% with heart rate > or = 100 at admission, and 34% with digitalis medication. No increase was found in the subgroup of patients without clinical risk factors. Thus, submaximal early exercise stress testing provides important information for short- and long-term prognosis in patients after the first acute myocardial infarction compared to clinical evaluation alone.

Adult↗
PubMed2001

Non-invasive cardiac output evaluation during a maximal progressive exercise test, using a new impedance cardiograph device.

One of the greatest challenges in exercise physiology is to develop a valid, reliable, non-invasive and affordable measurement of cardiac output (CO). The purpose of this study was to evaluate the reproducibility and accuracy of a new impedance cardiograph device, the Physio Flow, during a 1-min step incremental exercise test from rest to maximal peak effort. A group of 12 subjects was evaluated to determine the reproducibility of the method as follows: (1) each subject performed two comparable tests while their CO was measured by impedance cardiography using the new device (COImp1, COImp2), and (2) in a subgroup of 7 subjects CO was also determined by the direct Fick method (COFick) during the second test. The mean difference between the values obtained by impedance (i.e. COImp1-COImp2) was -0.009 l.min-1 (95% confidence interval: -4.2 l.min-1, 4.2 l.min-1), and CO ranged from 3.55 l.min-1 to 26.75 l.min-1 (n = 146). When expressed as a percentage, the difference (COImp1-COImp2) did not vary with increasing CO. The correlation coefficient between the values of COImp and COFick obtained during the second exercise test was r = 0.94 (P < 0.01, n = 50). The mean difference expressed as percentage was -2.78% (95% confidence interval: -27.44%, 21.78%). We conclude that COImp provides a clinically acceptable evaluation of CO in healthy subjects during an incremental exercise.

Adult↗
PubMed2004

[The importance of exercise testing for the functional assessment of lung resectional candidates].

UNLABELLED: Although there are a lot of physiologic tests to evaluate the preoperative cardio-pulmonary reserve in the patients who candidate lung resection, there is no a single gold standard test to suggest the postoperative pulmonary complications. In this study, we researched the importance of the exercise testing in the evaluation preoperative cardio-pulmonary reserve. We analyzed a series of 26 consecutive patients with a resectable lung disease [26 male patients, mean age 51.5 +/- 15.8 (13-78 years), 22 non-small cell lung carcinoma (NSCLC), 2 bronchectasis, 1 hydatid cyst, 1 empyema]. Patients were evaluated by pulmonary function testing (PFT), diffusing capacity of lung for carbonmonoxide (DLCO), and symptom-limited exercise testing. After the functional examination, 26 patients underwent pulmonary resections with standard thoracotomy: 4 segmental or wedge resection, 11 lobectomies, 5 pneumonectomies, and 1 cystotomia. The mean stay in the ICU was 2.6 days (+/- 3.5), the mean hospital stay was 11.9 days (+/- 8.0). Postoperative complications (within 30 days) occurred in 9 (34.6%) patients of whom one died (overall mortality rate was 3.8%). There was no relationship between the presence of complication and physiologic tests (PFT, DLCO). The patients were divided three groups according to peak oxygen consumption (VO(2)/kg peak) (mL/kg/min) (< 10, 10-20, > 20 mL/kg/min). There was no significantly difference among these groups and complication rates (p= 0.056), but the complication rate was higher in the group of VO(2)/kg peak < 10 mL/kg/min (75%). On the other hand, there was a significantly relationship between the presence of only pulmonary complication and VO2/kg peak (p= 0.034). CONCLUSION: We think that the preoperative functional evaluation in the patients with lung resection candidate is prominent to reduce the postoperative mortality and morbidity and especially cardiopulmonary exercise testing has an important role to suggest the postoperative pulmonary complications as a major complication.

Adolescent↗
PubMed2006

Safety of exercise testing in the chest pain unit: 31-mm ST elevation in variant angina.

We discuss a patient who presented with symptoms classic for variant angina with dramatic 31-mm ST elevation secondary to exercise testing in the chest pain unit, in whom neither myocardial infarction nor severe arrhythmia resulted. Although exercise testing is deemed generally safe, it has not been studied for safety per se in patients with variant angina. Further studies are needed to determine if the magnitude of ST elevation during exercise testing carries prognostic significance.

Angina Pectoris↗
PubMed1989

Noninvasive predictors of cardiac events after myocardial infarction. Complementary value of exercise testing and signal-averaged electrocardiography.

Signal-averaged electrocardiography, resting radionuclide ventriculography and Holter monitoring were performed prior to hospital discharge, to assess their value in predicting recurrent cardiac events in 210 survivors of acute myocardial infarction. In addition, 153 of these patients also underwent exercise radionuclide ventriculographic assessment. During median follow-up of 14 months (6-24 months), there were 16 cardiac deaths, 15 patients had recurrent infarction and 7 patients represented with symptomatic ventricular tachycardia. Cox regression analysis identified independent predictors of 'ischemic events' (death or re-infarction) as a previous history of infarction (p = 0.01), Killip class III-IV (p = 0.03) and an abnormal exercise radionuclide study (p = 0.04); and predictors of 'arrhythmic events' (sustained ventricular tachycardia or sudden death) as an abnormal signal-averaged electrocardiograph (p = 0.01) and left ventricular ejection fraction less than 40% (p = 0.03). Patients with an abnormal signal-averaged electrocardiograph and reduced left ventricular ejection fraction had a 34% incidence of arrhythmic events during the first 6 months compared with a 4% incidence among patients without late potentials. In those patients who underwent exercise testing and signal averaging, 85% of total cardiac events and all cardiac deaths were predicted by an abnormality of either noninvasive test. In addition, exercise testing and signal-averaged ECG were independent predictors of outcome. Hence, using a combination of noninvasive tests, patients can be stratified according to the risk of recurrent life-threatening cardiac events after myocardial infarction; such patients may be suitable for intensive investigation and considered for trials involving active intervention.

Electrocardiography↗
PubMed1992

Comparison of isoproterenol and exercise tests in asymptomatic subjects with Wolff-Parkinson-White syndrome.

In order to evaluate the effects of increases of sympathetic tone in ventricular response during atrial fibrillation and in the relationship between the accessory pathway effective refractory period (ERP) and ventricular rate during atrial fibrillation, 20 male subjects, aged 19 +/- 6 years, were studied electrophysiologically in basal conditions, after isoproterenol infusion (2-4 micrograms/min) and during submaximal bicycle exercise test, at a constant workload equal to that which increases the sinus rate to the same extent (140 beats/min) induced by isoproterenol infusion. Accessory pathway ERP was evaluated at the same driven rate (150 beats/min) in both instances. In the control study as during both tests atrial fibrillation paroxysms were induced by burst stimulation. In control conditions the rate increase from 100 to 150 beats/min induced a reduction of accessory pathway ERP from 266 +/- 27 msec to 244 +/- 22 msec (P less than 0.005). At the same driven rate of 150 beats/min, isoproterenol infusion and exercise test induced a more marked shortening of accessory pathway ERP to 211 +/- 28 msec (P less than 0.005) and to 214 +/- 29 msec (P less than 0.005), respectively. Atrial fibrillation paroxysms lasting more than 10 seconds were induced in 20/20 cases in the control study, in 15/20 during isoproterenol infusion and in 13/19 cases during exercise test. The shortest cycle length during atrial fibrillation was reduced from a basal value of 253 +/- 72 msec to 204 +/- 27 msec (P less than 0.05) during isoproterenol infusion and to 236 +/- 32 msec (NS) during exercise test.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

[Evaluation of arterial blood pressure and heart rate during exercise tests in patients with essential hypertension in different stages of hypertension].

This article analyses the changes of arterial blood pressure and heart rate (HR) in 120 patients with essential hypertension during two successive exercise tests. Before and during the tests, the patients did not take any hypertensive drugs. The obtained measuring results at exercise tests and restitution were the basis for the calculating regression equations. Then the results were analyzed statistically (p < 0.05) and clinically (drop or increase of arterial systolic blood pressure value (SAP) or/and diastolic (DAP) by 5 mmHg, and HR by 5 beats per minute). The HR response was comparable in both test for all tested groups both in exercise and restitution periods. For the additional sex division the HR value in all subgroups women was lower in the second test and satisfies the condition of statistic and clinical significance. In the second test SAP was lower only in the group of mild pressure and in the group without organ changes (stage I WHO) during exercise. At restitution periods the SAP values were lower in all the tested groups with the exception of the group with borderline hypertension. DAP was lower in the second test in all the tested groups both in exercise test and in the restitution period. It is also shown that the quantity of DAP difference in the second test is the greater, the higher value of DAP at restitution is.

Adult↗
PubMed1990

Exercise testing for assessment of the significance of ST segment depression observed during episodes of paroxysmal supraventricular tachycardia.

Sixteen patients who had manifested ST segment depression during episodes of paroxysmal supraventricular tachycardia (PSVT) were studied with exercise testing in order to detect coronary artery disease and myocardial ischaemia. No ST segment depression was observed during exercise testing in 15 out of the 16 patients tested. Paroxysms of supraventricular tachycardia associated with ST segment depression occurred during exercise testing in three cases. The ST segment depression was immediately apparent, remained constant throughout the supraventricular tachycardia and was almost instantly abolished following conversion to sinus rhythm. Patients with heart rates greater than 250 beats min-1 during PSVT had marked ST segment depression associated with the tachycardia. These results suggest that coronary artery disease and myocardial ischaemia are not involved in the genesis of ST segment depression during PSVT. Tachycardia per se may be the cause of ST segment depression by altering the slope of phase 2 of the ventricular action potential. Retrograde atrial activation may also induce ST segment shifts in some of the cases.

Adolescent↗