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PubMed1979

Cardiovascular responses to repeated treadmill exercise testing soon after myocardial infarction.

To determine the response to repeated treadmill exercise testing soon after uncomplicated myocardial infarction, 24 males (mean age 54 +/- 6 years) performed two symptom-limited tests several days apart 3, 7 and 11 weeks after the acute event. Significant within-week differences were noted for peak exercise tolerance (mets) and peak heart rate at 7 weeks (p less than 0.05). Significant within-week differences in these variables were not noted for other weeks or for systolic blood pressure or heart rate-systolic blood pressure product for any of the three test periods. No significant within-week differences were noted for any variable recorded at a submaximal work load of 4 mets. The frequency of exercise-induced ischemic ST-segment depression, angina pectoris and premature ventricular complexes did not change from visit to visit and was highly reproducible (p less than 0.01). All test variables measured at peak exercise increased significantly between 3 and 11 weeks after infarction. We conclude that cardiovascular responses to symptom-limited exercise testing are highly reproducible in the 3 months after uncomplicated myocardial infarction. Changes in the response to treadmill exercise tests performed several weeks apart reflect alterations in cardiovascular performance.

Aged↗
PubMed2004

Long-term prognostic value of dobutamine stress echocardiography compared with myocardial perfusion scanning in patients unable to perform exercise tests.

PURPOSE: To compare the long-term prognostic value of dobutamine stress echocardiography and dobutamine stress single photon emission computed tomography (SPECT) in patients unable to perform an exercise test. METHODS: We assessed the prognostic value of dobutamine stress technetium 99m ((99m)Tc)-sestamibi SPECT and dobutamine stress echocardiography in 301 patients who were unable to perform exercise tests. Outcomes during a mean (+/- SD) follow-up of 7.3 +/- 2.8 years were overall death, cardiac death, nonfatal myocardial infarction, and late (>60 days) coronary revascularization. RESULTS: Abnormal myocardial perfusion was detected in 66% of patients (n = 198), while 60% (n = 182) had an abnormal stress echocardiogram; agreement was 82% (kappa = 0.62). During the follow-up period, 100 deaths (33%) occurred, of which 43% were due to cardiac causes. Nonfatal myocardial infarction occurred in 23 patients (8%), and 29 (10%) underwent late revascularization. With stress SPECT, annual event rates were 0.7% for cardiac death and 3.6% for all cardiac events after a normal scan, and 2.6% for cardiac death and 6.5% for all cardiac events after an abnormal scan (P <0.0001). For stress echocardiography, annual event rates were 0.6% for cardiac death and 3.3% for all cardiac events after a normal test, and 2.8% for cardiac death and 6.9% for all cardiac events after an abnormal test (P <0.0001). CONCLUSION: Dobutamine stress (99m)Tc-sestamibi SPECT and dobutamine stress echocardiography provide comparable long-term prognostic information in addition to that afforded by clinical data.

Aged↗
PubMed2002

Heart rate recovery after treadmill exercise testing and risk of cardiovascular disease events (The Framingham Heart Study).

A delayed heart rate (HR) recovery after graded exercise testing has been associated with increased all-cause mortality in clinic-based samples. No prior study has examined the association of HR recovery after exercise with the incidence of coronary heart disease (CHD) and cardiovascular disease (CVD) events. We evaluated 2,967 Framingham study subjects (1,400 men, mean age 43 years) who were free of CVD and underwent a treadmill exercise test (Bruce protocol) at a routine examination. We examined the relations of HR recovery indexes (decrease in HR from peak exercise) to the incidence of a first CHD or CVD event and all-cause mortality, adjusting for established CVD risk factors. During follow-up (mean 15 years), 214 subjects experienced a CHD event (156 men), 312 developed a CVD event (207 men), and 167 died (105 men). In multivariable models, continuous HR recovery indexes were not associated with the incidence of CHD or CVD events, or with all-cause mortality. However, in models evaluating quintile-based cut points, the top quintile of HR recovery (greatest decline in HR) at 1-minute after exercise was associated with a lower risk of CHD (hazards ratio vs bottom 4 quintiles 0.54, 95% confidence interval [CI], 0.32 to 0.93) and CVD (hazards ratio 0.61, 95% CI 0.41 to 0.93), but not all-cause mortality (hazards ratio 0.99, 95% CI 0.60 to 1.62). In our community-based sample, HR recovery indexes were not associated with all-cause mortality. A very rapid HR recovery immediately after exercise was associated with lower risk of CHD and CVD events. These findings should be confirmed in other settings.

Adult↗
PubMed1992

[Comparison of ST depression and various exercise test indices in the diagnosis of coronary stenosis].

UNLABELLED: Various modifications and refinements have been proposed to improve the diagnostic accuracy of standard ST-segment criteria for identifying coronary artery disease using exercise testing. To ascertain if the treadmill exercise score (TES), the ST integral, or the ST/HR index are significantly better markers for coronary disease the standard ST analysis, measured visually or by computer, a retrospective study of 173 male patients was performed. Exclusions were clinical or electrocardiographic evidence of prior myocardial infarction, left ventricular hypertrophy, left bundle branch block, or resting ST segment depression on their baseline electrocardiogram, digitalis, previous revascularization procedure or any significant valvular or congenital heart disease. Ninety-six patients (55.5%) had at least one epicardial coronary stenosis (more than 70% diameter stenosis). Cutpoints were chosen for each method, that maximized their best combination of sensitivity and specificity. There were no statistically significant differences between any of the five methods (TES, ST integral, ST/HR index, standard and computer ST analysis) for identifying any coronary disease. CONCLUSION: careful visual or ST-segment analysis continues to be the simplest as well most effective marker for coronary disease during exercise testing.

Coronary Disease↗
PubMed2000

Maximal exercise testing in late gestation: fetal responses.

OBJECTIVE: To determine the fetal response to and safety of maximal maternal exercise in the third trimester. METHODS: Twenty-three active women with uncomplicated pregnancies (singleton gestations) underwent maximal exercise testing in late gestation using a progressive maximal cycle ergometer protocol. Fetal heart rate (FHR) responses were monitored and classified using National Institute of Child Health and Human Development guidelines. Statistical analyses involved use of the Student t test, repeated measures analysis of variance with Tukey-Kramer multiple comparisons posttest, and the chi(2) test. RESULTS: There was an increase in baseline FHR in the 20-minute posttest period compared with the 20-minute pretest period. There were significantly fewer accelerations in the second posttest 10-minute segment compared with the second pretest 10-minute segment. Variability was reduced in both posttest periods compared with the first 10-minute pretest period. Time to reactivity increased after testing. Mild tachycardia was noted in two tracings and bradycardia occurred in a fetus with previously undiagnosed growth restriction. There were no abnormal neonatal outcomes. CONCLUSION: Maximal exercise testing in late gestation led to minimal changes in FHR. Fetal bradycardiac responses were not seen in appropriate for gestational age fetuses, suggesting that brief maximal maternal exertion for research or diagnostic purposes is safe in this group.

Adult↗
PubMed2003

Relation between oscillatory ventilation at rest before cardiopulmonary exercise testing and prognosis in patients with left ventricular dysfunction.

BACKGROUND: Although nocturnal Cheyne-Stokes respiration alternating between hyperpnea and hypopnea has been considered a sign of severe heart failure, the clinical status of cardiac patients who exhibit oscillatory ventilation during wakefulness has not been clarified. This study was carried out to determine the relation between oscillatory ventilation during wakefulness and exercise capacity in patients with chronic heart disease. We also evaluated retrospectively whether the presence of oscillatory ventilation influences the long-term prognosis in these patients. METHODS: A total of 164 patients with left ventricular dysfunction performed a symptom-limited incremental exercise test. Respiratory gas exchange was measured on a breath-by-breath basis throughout the test. Oscillatory ventilation was defined when clear ventilatory oscillation of at least two consecutive cycles was identified at rest before exercise testing and the difference between the peak and nadir of oscillating ventilation was > 30% of the mean value of ventilation. RESULTS: Oscillatory ventilation was noted in 45 of 164 cardiac patients (27%), and the magnitude (mean +/- SD) of oscillation in these patients was 45.5 +/- 16.9%. Patients with oscillatory ventilation had significantly lower left ventricular ejection fraction than those without it (40.7 +/- 12.7% vs 44.9 +/- 11.6%, p < 0.05). However, parameters of exercise capacity such as the peak oxygen uptake (O(2)), the slope of the increase in O(2) relative to the increase in work rate (DeltaO(2)/DeltaWR), and the ratio of the increase in ventilation to the increase in carbon dioxide output (DeltaE/DeltaCO(2)) were not significantly different between the two groups. The mortality rate during 1,797 +/- 599 days of follow-up did not differ between the groups (p = 0.65). CONCLUSIONS: Oscillatory ventilation present at rest before cardiopulmonary exercise testing is not significantly related to the peak O(2), DeltaO(2)/DeltaWR, DeltaE/DeltaCO(2), or prognosis in patients with left ventricular dysfunction.

Adult↗
PubMed1987

Enhanced efficacy of computerized exercise test by multivariate analysis for the diagnosis of coronary artery disease. A study of 558 men without previous myocardial infarction.

Multivariate analysis has been proposed to enhance diagnostic accuracy of the exercise test in coronary artery disease. To quantify the improvement given by multivariate analysis in comparison with ST segment depression alone during exercise test, 558 men without previous myocardial infarction were studied retrospectively. All the patients underwent a symptom-limited Bruce protocol with computer-averaged recordings in V5, aVF, V2. Coronary angiography was performed within the following 90 days. Prevalence of coronary artery disease (diameter narrowing of 50% or greater) was 0.56. Among 12 clinical and exercise parameters studied by stepwise multivariate analysis, five were found to reach the maximal accuracy: (1) exercise duration, (2) history of typical angina, (3) typical angina during the test, (4) age, (5) maximal heart rate. In comparison with ST depression, multivariate analysis significantly improves accuracy (74.6 vs. 66.8%, P less than 0.01) by increasing sensitivity (0.68 vs. 0.59, P less than 0.05) without affecting specificity (0.83 vs. 0.76, NS). Thus, in a group of men without infarction and a low prevalence of coronary artery disease, multivariate analysis with five easily collected variables is more accurate than ST segment depression alone during exercise. In addition, ST depression did not appear as discriminant as exercise duration for diagnostic purposes. This finding emphasises the importance of performing a symptom-limited exercise test.

Adult↗
PubMed2001

The physiology behind exercise testing.

Despite significant advances in related technologies, the exercise test remains a useful clinical tool. It can define the limits of performance in an athlete or the functional capabilities of the patient with heart disease. Although virtually all of the body's physiologic and metabolic systems interact in a coordinated fashion to perform a single bout of exhaustive exercise, a major burden falls on the cardiopulmonary system. A good understanding of the basic physiologic responses to acute exercise can assist the clinician in applying the information gained from the test. These responses are influenced by state of health and fitness, age, gender, type of exercise, exercise position, and the environment. This article provides an overview of the physiologic responses to acute exercise, and discusses the many factors that influence these responses.

Cardiovascular Diseases↗
PubMed2005

[Usefulness of lung and right ventricular thallium-201 uptake during single photon emission computed tomography in exercise testing of patients with coronary artery disease].

OBJECTIVES: Increased pulmonary or right ventricular 201Tl uptake during the exercise test has been used as a marker of multivessel coronary artery disease. The most useful method for assessing the severity of coronary artery disease was evaluated among conventional evaluation of single photon emission computed tomography (SPECT), measurement of lung to heart uptake ratio (L/H), and right ventricular to left ventricular uptake ratio (RV/LV) on 201Tl images during exercise testing. METHODS: Regions-of-interest (4 X 4 pixels) were placed at the lung and the heart, and L/H was defined as mean lung uptake/mean heart uptake. Correspondingly, regions-of-interest (4 X 4 pixels) were placed at the RV and the LV, and RV/LV was defined as maximum RV uptake /maximum LV uptake. L/H and RV/LV on the initial image were analyzed in 216 patients(angiographically normal coronary arteries: 89, single-vessel disease: 82, multivessel disease: 45). The diagnostic value was evaluated using the receiver operating characteristic curve. RESULTS: All methods showed significantly higher values in patients with multivessel disease than in patients with no coronary artery disease or single-vessel disease. L/H was significantly higher in patients with prior myocardial infarction and RV/LV was significantly higher in patients without infarction. The sensitivity of only conventional SPECT evaluation for multivessel coronary artery disease was low (sensitivity 53%, specificity 94%). However, addition of evaluation of L/H and RV/LV to SPECT improved the sensitivity for multivessel coronary artery disease (sensitivity 93%, specificity 49%). CONCLUSIONS: The diagnostic sensitivity for multivessel coronary artery disease was improved by adding L/H and RV/LV to conventional evaluation of exercise 201Tl SPECT. L/H and RV/LV during exercise 201Tl imaging may provide additional information regarding the severity of coronary artery disease.

Aged↗
PubMed1981

Serial exercise testing after coronary artery bypass surgery.

To determine the duration of functional benefit from coronary bypass surgery, 111 patients with angina pectoris were serially evaluated by standard exercise testing prior to and for up to 4 years after surgery. Exercise testing 6 to 18 months after surgery showed greater heart rate-blood pressure product at peak work load, improved work capacity, and less symptomatic and electrocardiographic evidence of ischemia than was demonstrated preoperatively. Twenty patients were tested 37 to 48 months postoperatively and showed improved exercise performance in comparison with preoperative results, but the frequency of positive tests during this period no longer differed. Thus, improved exercise performance appears to persist for at least 4 years after coronary bypass surgery.

Angina Pectoris↗
PubMed2001

[Changes in QT dispersion during the exercise test in women with syndrome X].

UNLABELLED: The aim of the present study was to examine the effect of exercise test on QT dispersion (dQT) and to compare the result in women with syndrome X with women with coronary artery disease and normal subjects. We examined 53 women in mean age 54.2 +/- 9.2 who were divided into groups: 20 women with one-vessel coronary artery disease (group I), 19 women with syndrome X (group II) and 14 healthy control women (group III). All subjects underwent a modified Bruce protocol exercise test and QT intervals were measured manually at rest and peak exercise. The value of dQT was calculated as a difference between the longest and the shortest measured value in each of the 12 ECG leads. Corrected QT (dQTc) dispersion was measured after the QT interval was corrected with Bazett's formula. There were no significant differences in rest values of dQT between groups but rest dQTc was significantly greater in group I and II then in group III. We observed significant increase in dQT and dQTc on peak exercise in group I and II when compared with group III. CONCLUSION: At rest dQTc is significantly greater in women with syndrome X and coronary artery diseases in comparison with control subjects. The exercise caused increase in the value of dQT and dQTc both in women with syndrome X and coronary artery disease. The value of dQT and dQTc makes impossible to differentiate between women with syndrome X and women with coronary artery disease.

Coronary Disease↗
PubMed2002

[Prognostic value of exercise tests performed 3 months after coronary artery grafting in evaluation cardiac events. 6 years follow-up].

Prognostic value of exercise test in evaluation of cardiac events were examined in 326 pts after coronary artery bypass grafting (CABG). During 6 years follow up 18 (5.5%) cardiac deaths and 23 (7.1%) myocardial infarctions were observed. Chest pains persisted in 116 pts (35.6%) and 37 (11.3%) pts needed hospital treatment. Coronary and bypass angiography were performed in 25 pts (7.7%) followed by PTCA in 8 pts (2.5%) and CABG in 5 (1.5%) pts. Exercise duration and maximal work capacity in exercise tests were significantly lower in pts with cardiac events. Reasons of exercise termination: ST segment depression, heart rate and blood pressure values were not different in pts with and without cardiac events and didn't have prognostic value. Patients with cardiac events had significantly reduced left ventricle function. The value of ejection fraction influenced significantly relative risk of cardiac death (p < 0.05).

Adult↗
PubMed1988

A simple exercise test in assessment of asthma.

Exercise-induced asthma (EIA) is a manifestation of the bronchial hyper-responsiveness of asthmatic patients. Laboratory methods for measuring EIA are now well standardised. We compared a stepping test with a standard treadmill exercise test to determine whether the sensitivity of the latter could be maintained with the simplified test. We used heart rate as a measure of exercise intensity and changes in forced expiratory volume in 1 second (FEV1) to record bronchial responsiveness. In 32 adolescent asthmatic patients we demonstrated a fall in FEV1 of 10% or more in 27 following the treadmill test and in 25 following the stepping test. There was a strong correlation between the maximum falls of FEV1 following the two exercise challenges (r = 0.92 p less than 0.0001). There was poor agreement between the patient's history of EIA and the demonstration of a 10% fall of FEV1 after exercise in 11 patients. Notably all six patients who claimed no association of exercise with their asthma symptoms clearly demonstrated a fall in FEV1 of 10% or more following the treadmill challenge. We conclude that a simplified exercise test can be both objective and sensitive in detecting EIA and therefore useful in the assessment of the asthmatic patient and the effect of therapy.

Adolescent↗
PubMed1984

Safety of maximal exercise testing in patients at high risk for ventricular arrhythmia.

While maximal exercise testing is useful for detection of arrhythmias and assessment of antiarrhythmic drug efficacy, few reports have documented the safety of this procedure in patients with malignant ventricular arrhythmias. We reviewed the complications of symptom-limited exercise in 263 patients with such arrhythmias who underwent a total of 1377 maximal treadmill tests. Seventy-four percent of the population studied had a history of ventricular fibrillation or hemodynamically compromising ventricular tachycardia and the remainder had experienced ventricular tachycardia in the setting of either recent myocardial infarction or poor left ventricular function. A complication was defined as the occurrence of arrhythmia during exercise testing--ventricular fibrillation, ventricular tachycardia, or bradycardia--that mandated immediate medical treatment (cardioversion, use of intravenous drugs, or closed-chest compression). Complications were noted in 24 patients (9.1%) during 32 tests (2.3%), whereas 239 patients (90.9%) were free of complication during 1345 tests (97.7%). There were no deaths, myocardial infarctions, or lasting morbid events. Clinical descriptors associated with complications included male sex, presence of coronary artery disease, and a history of exertional arrhythmia (p less than .05). Clinical variables previously considered to confer increased risk during exercise, such as poor left ventricular function, high-grade ventricular arrhythmias (Lown grade 4A or 4B) before or during exercise, exertional hypotension, and ST depression, were not predictive of complications (p greater than .05). Occurrence of a complication was also unaffected by the use of antiarrhythmic drugs at the time of exercise (chi square = 0.19, p greater than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2003

Fatal cardiac rupture during stress exercise testing: case series and review of the literature.

Mortality rates of exercise testing are low and cardiac rupture and sudden death are rare. Three cases of fatal cardiac rupture that occurred during exercise stress testing are reported. Once thought to be a fatal complication, there are increasing reports of ante-mortem diagnosis and survival. Cardiac rupture is a stuttering process with recognizable clinical symptoms that allow early recognition and treatment. Certain clinical, biochemical, ECG and hemodynamic markers may allow identification of patients likely to sustain rupture. Strategies for diagnosis, resuscitation, and definitive intervention are reviewed.

Aged↗
PubMed1985

Predictive value of early maximal exercise test and thallium scintigraphy after successful percutaneous transluminal coronary angioplasty.

Restenosis of the dilated vessel after percutaneous transluminal coronary angioplasty can be detected by non-invasive procedures but their ability to predict later restenosis soon after a successful angioplasty as well as recurrence of angina has not been assessed. A maximal exercise test and myocardial thallium perfusion scintigraphy were, therefore, performed in 91 asymptomatic patients a median of 5 weeks after they had undergone a technically successful angioplasty. Primary success of the procedure was confirmed by the decrease in percentage diameter stenosis from 64(12)% to 30(13)% as measured from the coronary angiograms and in the trans-stenotic pressure gradient (normalised for mean aortic pressure) from 0.61(0.16) to 0.17(0.09). A clinical follow up examination (8.6(4.9) months later) was carried out in all patients and a late coronary angiogram obtained in 77. The thallium perfusion scintigram showing the presence or absence of a reversible defect was highly predictive for restenosis whereas the exercise test was not. The positive predictive value of an abnormal scintigram was 82% compared with 60% for the exercise test (ST segment depression/or angina or both at peak workload). Angina or a new myocardial infarction occurred in 60% of patients with abnormal and in 21% of patients with normal scintigrams.

Adult↗
PubMed1988

Graded exercise testing for diagnosis of coronary artery disease in elderly patients.

We tested the clinical utility and predictive value of graded exercise testing in the diagnosis of coronary artery disease in 153 patients aged 65 years or more. Based on changes of the ST segment from baseline, the test was considered positive with 1 mm of depression lasting 0.08 seconds, negative with no changes despite 85% of predicted maximal heart rate, probably positive with 1 mm of depression at rest becoming 2 mm with exercise, probably negative with no changes at maximal heart rate (within 10 beats per minute of 85% of predicted maximal), and uninterpretable with baseline electrocardiographic changes (eg, digitalis effect, left bundle branch block, left ventricular hypertrophy, etc). A test was considered inadequate when the exercise tolerance was less than or equal to 5 METs (metabolic equivalent of the task) and/or maximal heart rate was less than 100 beats per minute. The 153 patients had 163 tests. Only 33 (20%) were considered inadequate or uninterpretable, and there were no complications requiring medical intervention. Of 82 patients who had coronary angiography, 52 (63%) had 50% stenosis of at least one major epicardial artery; 44 of these patients had positive results of exercise testing. Nine patients with negative exercise tests had negative angiograms. There were eight false-negative and seven false-positive results. These results revealed a sensitivity of 85%, a specificity of 56%, and a predictive value of 86% for a positive test.

Aged↗