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PubMed1990

[Exercise test in exercise-induced asthma in children: study of delayed response].

In this study we perform the exercise broncho-provocation test according to a protocol and involving 27 children with allergic asthma to study the prevalence and distinctive traits of the late response in exercise-induced asthma (EIA). At the conclusion of the study, 20 patients (74%) were diagnosed of EIA through some of the tests employed (ergometric bicycle, free run). In the cases where both tests were negative, we reproduced in a controlled manner the exercise reported as asthmogenic on the basis of anamnesis; no positivity was observed for the test in any case. Prevalence of late asthmatic response was 40% (8/20); mean beginning time to this response was 4-6 hours, lasting less than 1 hour and with a mean intensity rate of 26.8% (measured as the percentage of PEFR drop according to the preexercise basal value). The results are discussed, comparing them with those of other authors and with the allergen provocation response pattern; in addition the methods used and therapeutic implications in view of the results are dealt with.

Asthma, Exercise-Induced↗
PubMed2006

Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation Part III: Interpretation of cardiopulmonary exercise testing in chronic heart failure and future applications.

Optimal use of cardiopulmonary exercise testing (CPET) in clinical practice and chronic heart failure (CHF) requires appropriate data presentation and a flexible interpretative strategy. The greatest potential impact on the decision-making process may rest not on the value of any individual measurement, although some are obviously more important than others, but rather on their integrative use. Such an integrative approach relies on interrelationship, trending phenomena and patterns of key gas exchange variable responses. An multiparametric approach will be discussed in different clinical applications, for exercise prescription and monitoring, functional evaluation of drug therapy or cardiac resynchronisation therapy efficacy, and risk stratification. The role of CPET in the daily clinical decision-making process will be underscored. Future indications of CPET will be addressed, suggesting and promoting an extended candidacy either to all CHF patients, including those at high risk or most vulnerable, such as female, elderly patients, and patients with implantable cardioverter defibrillator or in every clinical setting where objective definition of exercise capacity provides implications for medical, surgical, and social decision making.

Exercise Test↗
PubMed1997

[The exercise test with atropine].

BACKGROUND: Exercise testing remains the most accessible and widely used technique for the detection of coronary artery disease (CAD) and for the assessment of its severity. Clinical usefulness of the simple exercise test is limited by poor sensitivity and imperfect specificity. Many patients referred for diagnostic stress testing cannot achieve an adequate increase in heart rate due to lack of motivation, poor physical condition, or medications. Atropine increases the heart rate and therefore myocardial oxygen consumption, and might improve the diagnostic accuracy of exercise testing, either reducing the number of non-diagnostic examinations, or increasing the positivity of the test in patients with non severe coronary disease. METHODS: One-hundred-seventy-two consecutive patients (144 males and 28 females, age 58 +/- 8 years) with suspected coronary artery disease underwent exercise testing and coronary angiography. Exercise testing was considered positive in the presence of ST segment depression > or = 0.10 mV horizontal or downsloping, > or = 0.15 mV upsloping, or in the presence of ST elevation without Q waves. The test was considered negative in the absence of significant ST depression or elevation if the exercise heart rate was > 85% of age-predicted maximum, non-diagnostic if the heart rate was < 85%. In 148 patients (86%) coronary angiography showed CAD (> 70% luminal reduction in at least one major vessel), in 24 patients (14%) non significant CAD or angiographically normal coronary arteries (NoCAD). Exercise testing was positive in 134 patients (78%: 85% in CAD, 33% in NoCAD), negative in 13 patients (8%: 3% in CAD, 38% in NoCAD), non-diagnostic in 25 patients (14%; 12% in CAD, 29% in NoCAD). The sensitivity was 85%, specificity was 38%, and diagnostic accuracy 78%. In the 25 patients with non-diagnostic test (18 CAD, 7 NoCAD) the exercise was repeated 30-90 minutes later, immediately after i.v. injection of 1-2 mg of atropine, and was stopped at the same workload of the index test. RESULTS: The atropine-exercise test was well tolerated and accomplished in all cases. The maximal heart rate (139 +/- 11 vs 121 +/- 11) and the double product (25,308 +/- 4082 vs 22,166 +/- 3569) were significantly greater after atropine. The increase of the maximal heart rate improved the detection of the electrocardiographic signs of exercise-induced myocardial ischemia only in CAD patients. In the 18 CAD patients the atropine-exercise test was positive in 8, negative in 5, non-diagnostic in 5. In the 7 NoCAD patients the atropine-exercise test was positive in 1, negative in 6. The test remained non-diagnostic only in 3% of patients. The sensitivity of the test with atropine was 91%, specificity was 63%, and diagnostic accuracy 87%. CONCLUSIONS: The addition of atropine to exercise testing, which causes further chronotropic stress to the myocardium, is well tolerated and safe, and improves the diagnostic accuracy of the test for the detection of coronary artery disease in patients who cannot achieve an adequate exercise heart rate. The combination with atropine increases the utility and the cost-effectiveness of exercise testing.

Atropine↗
PubMed1990

Ergonovine maleate test detects anginal patients with poorly reproducible exercise tests.

The aim of the study is to evaluate the reproducibility of exercise testing and to determine whether there is any correlation between the reproducibility of exercise test and response to the ergonovine maleate test. Thirty-eight patients with mixed angina and documented coronary artery disease underwent an ergonovine maleate test and four exercise tests on consecutive days in the same basal conditions. The ergonovine test was positive in 20 patients (Group I) and negative in 18 patients (Group II). There were no significant differences in the clinical and angiographic data of the two groups. All 152 exercise tests were positive. The variability of the response of the repeated tests was assessed by means of an analysis of the following parameters: heart rate, blood pressure, rate-pressure product, watts, and minutes were recorded at the onset of ischemia (ST decreases greater than or equal to 0.1 mV). Range (maximal-minimal obtained value), ratio between range and maximal obtained value, and coefficient of variation (standard deviation/mean of the four parameters) were calculated for each patient. The analysis of these values demonstrated that while the test was reproducible in some patients, a high individual variability was present in others. Moreover, the individual variability results were higher in Group I than in Group II, with a statistically significant difference for all considered parameters. In conclusion, it is possible to have a poorly reproducible exercise test in patients with mixed angina. The correlation between a positive ergonovine test and a poorly reproducible exercise test suggests that abnormal coronary vasomotion may sometimes be present during exercise and may affect the reproducibility of the test.

Adult↗
PubMed2006

Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation Part II: How to perform cardiopulmonary exercise testing in chronic heart failure.

Basic and practical information related to equipment, methodology, exercise protocols, conduct of the test and quality control issues for cardiopulmonary exercise testing (CPET) will be addressed in this II part of the statement. CPET users have the responsibility for assuring that measurements remain accurate. CPT, especially when it features breath-by-breath gas exchange analysis, requires meticulous attention to calibration procedures to assure accurate and reproducible measurements. Skills and knowledge of personnel for supervision and test interpretation, as well as patient preparation and information are key features for a correct CPET conduction: all these issues will be faced. Finally, after the test, the investigator needs to format the results in a manner that optimises the ability to discriminate essential response features; that is, to establish 'interpretive clusters' of the variables of interest. An example of a cardiopulmonary summary exercise test data report will be provided, defining the most important information that should be incorporated in a final report.

Cardiology↗
PubMedDate not supplied

Predicting severe ischemic events after uncomplicated myocardial infarction by exercise testing and rest and exercise radionuclide ventriculography.

BACKGROUND: In 183 patients with uncomplicated myocardial infarction, exercise-induced angina, ST segment depression, decrease in ejection fraction, or inadequate increase in systolic blood pressure and low exercise tolerance were significantly associated with 4-year incidence of hard ischemic events. METHODS AND RESULTS: Only the onset of both ST segment depression and a decrease in left ventricular ejection fraction with exercise was an independent predictor. ST segment depression and decrease in left ventricular ejection fraction had low sensitivity (61% and 70%) and specificity (56% and 51%) for hard ischemic events, but specificity increased to 78% when both were present. During medical therapy, 22 of 53 patients with both ST segment depression and a decrease in left ventricular ejection fraction with exercise had an ischemic event (i.e., 48.1% 4-year probability on Kaplan-Meier analysis vs 19.2% in the remaining 130 patients [p < 0.0005]). CONCLUSIONS: Even if no single variable, derived from exercise testing, is a highly sensitive and specific predictor, specificity increases to a clinically relevant level by combining ST segment depression and a decrease in left ventricular ejection fraction with exercise, and in this way patients with recent infarction may be selected for coronary arteriography.

Adult↗
PubMed2006

Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation. Part I: definition of cardiopulmonary exercise testing parameters for appropriate use in chronic heart failure.

Cardiopulmonary exercise testing (CPET) provides a global assessment of the integrated response to exercise involving the pulmonary, cardiovascular, haematopoietic, neuropsychological, and skeletal muscle systems. This information cannot be obtained through investigation of the individual organ systems in isolation. The non-invasive, dynamic physiological overview permits the evaluation of both submaximal and peak exercise responses, providing the physician with relevant information for clinical decision making. The use of CPET in management of the chronic heart failure patient is increasing with the understanding that resting pulmonary and cardiac function testing cannot reliably predict exercise performance and functional capacity and that, furthermore, overall health status and prognosis are predicted better by indices of exercise tolerance than by resting measurements. Our aim is to produce a statement which provides recommendations on the interpretation and clinical application of CPET in heart failure, based on contemporary scientific knowledge and technical advances: the focus is on clinical indications, issues of standardization, and interpretative strategies for CPET.

Cardiac Output↗
PubMed1991

[Diagnosis of Pneumocystis carinii pneumonia in HIV-positive patients. The diagnostic value of induced sputum and exercise test].

The object of investigation is to illustrate the values of two noninvasive procedures: the induced sputum test and the exercise test in the diagnosis of Pneumocystis carinii pneumonia (PCP). Both of the procedures are described. Fifty HIV-positive men in whom interstitial pneumonia was suspected participated. PCP was diagnosed in 16 patients, in ten of these by the induced sputum test, the sensitivity of which is, therefore, 35-85% (95% confidence limits). The exercise test, an investigation for demonstration of exercise induced oxygen desaturation, was of good predictive value. Thus, seven out of nine patients with positive exercise test results had PCP as compared with two out of 19 with normal exercise test results, p = 0.0009. The sensitivity was thus 40-97%. In five out of the six patients with false negative results to the induced sputum test, the exercise test was performed and was positive in all of the case. The method is rapid and simple and merely requires access to an exercycle and a pulse-oxymeter preferably with a recorder. It is concluded that the exercise test and the induced sputum test are valuable investigations which supplement one another in cases of suspected PCP and which avoid the need for bronchoscopy in 53-80% of the patients.

Evaluation Studies as Topic↗
PubMed2000

Clinical correlates and prognostic significance of six-minute walk test in patients with primary pulmonary hypertension. Comparison with cardiopulmonary exercise testing.

The six-minute walk test is a submaximal exercise test that can be performed even by a patient with heart failure not tolerating maximal exercise testing. To elucidate the clinical significance and prognostic value of the six-minute walk test in patients with primary pulmonary hypertension (PPH), we sought (1) to assess the relation between distance walked during the six-minute walk test and exercise capacity determined by maximal cardiopulmonary exercise testing, and (2) to investigate the prognostic value of the six-minute walk test in comparison with other noninvasive parameters. The six-minute walk test was performed in 43 patients with PPH, together with echocardiography, right heart catheterization, and measurement of plasma epinephrine and norepinephrine. Symptom-limited cardiopulmonary exercise testing was performed in a subsample of patients (n = 27). Distance walked in 6 min was significantly shorter in patients with PPH than in age- and sex-matched healthy subjects (297 +/- 188 versus 655 +/- 91 m, p < 0. 001). The distance significantly decreased in proportion to the severity of New York Heart Association functional class. The distance walked correlated modestly with baseline cardiac output (r = 0.48, p < 0.05) and total pulmonary resistance (r = -0.49, p < 0. 05), but not significantly with mean pulmonary arterial pressure. In contrast, the distance walked correlated strongly with peak V O(2) (r = 0.70, p < 0.001), oxygen pulse (r = 0.57, p < 0.01), and V E-VCO(2) slope (r = -0.66, p < 0.001) determined by cardiopulmonary exercise testing. During a mean follow-up period of 21 +/- 16 mo, 12 patients died of cardiopulmonary causes. Among noninvasive parameters including clinical, echocardiographic, and neurohumoral parameters, only the distance walked in 6 min was independently related to mortality in PPH by multivariate analysis. Patients walking < 332 m had a significantly lower survival rate than those walking farther, assessed by Kaplan-Meier survival curves (log-rank test, p < 0.01). These results suggest that the six-minute walk test, a submaximal exercise test, reflects exercise capacity determined by maximal cardiopulmonary exercise testing in patients with PPH, and it is the distance walked in 6 min that has a strong, independent association with mortality.

Adolescent↗
PubMed1986

Provocative test in early post-infarction angina: exercise test.

Nowadays, the majority of patients undergoing aortocoronary bypass surgery have a history of myocardial infarction. In our first series of 1000 patients operated between 1973 and 1979, about two thirds of the patients had suffered myocardial infarction; about 80% of them within the previous three months. The method most frequently used to select post-infarction patients for coronary angiography is a simple exercise test. The post-infarction period in the context of this symposium was defined as the first 12 weeks after infarction. As far as exercise tests are concerned, we may divide this period into three subperiods: the very early post-infarction period, especially the first week after infarction. Exercise testing does not play a role in this very early period; the second period is the time of an early post-infarction exercise test or the predischarge exercise test (second and third week); from the fourth to the twelfth week in many European countries, rehabilitation measures will follow, usually in a special institution. This is the time of what we will call in short 'the late post-infarction exercise test'.

Adult↗
PubMed2001

Predictors of older primary care patients' participation in a submaximal exercise test and a supervised, low-impact exercise class.

OBJECTIVES: This study is an investigation of physical activity promotion among a nonvolunteer sample of community-dwelling, older, urban primary care patients. Our primary interest was in the rates of exercise test and class participation. Of secondary interest were the medical record and baseline survey predictors of test and class participation. METHODS: The first 500 nonterminally ill women ages 50 years or more with a visit at one of two predominantly African-American, inner-city primary care clinics received a physician screen, a referral to a submaximal exercise test, and, subsequently, a free, supervised exercise program located in a nearby community center. RESULTS: Eighty-one percent were eligible for the exercise test per provider screen. Of these, 29% completed the exercise test and 28% attended at least one exercise class. After 1 year, 9.2% were attending the exercise classes. Higher exercise outcome expectations, not smoking, and clinic site were associated with exercise test and class participation. CONCLUSIONS: Providing free, traditional exercise classes and a primary care referral to the classes resulted in limited physical activity participation among older, urban primary care patients. More development and testing of physical activity promotion programs are needed in this population.

Black or African American↗
PubMed2001

Exercise testing in cardiac rehabilitation. Exercise prescription and beyond.

The prescription of exercise, either as a part of a formal exercise training program or as a means to increase physical activity in general, has been and will remain a primary component of cardiac rehabilitation and secondary prevention programming. Wherever possible, this prescription should be based on a recent exercise test that documents the cardiac patient's functional capacity, cardiac and hemodynamic responses to exercise, and signs and symptoms associated with exertion. Clearly the prescription of exercise and suggestions for increasing levels of physical activity must be based on accepted principles of exercise physiology and expected training responses. Nonetheless, the art of exercise prescription should guarantee flexible methodologies to meet the specific needs of each individual patient. Although the patient must accept ultimate responsibility for participation, the clinician bears the burden of continually attempting to reinforce the importance of increasing caloric expenditure and motivating patients to initiate and commit to long-term participation in a safe and appropriately designed program of exercise and increasing physical activity.

Cardiac Rehabilitation↗
PubMed1997

Correlations between coronary flow reserve measured with a Doppler guide wire and treadmill exercise testing.

We compared exercise test results to a physiologic depiction of stenosis severity, coronary flow reserve (CFR), measured with a Doppler guide wire in 35 patients with single-vessel coronary disease. Group 1 (n = 21) had abnormal CFR, and group 2 (n = 14) had normal CFR. In group 1, 14 of 21 had ST-segment depression versus 3 of 14 in group 2 (p < 0.01). Exercise treadmill time (Bruce protocol) was normalized to the age- and sex-predicted time. Exercise time and normalized exercise time were less in group 1 (5.6 +/- 2.3 vs 9.9 +/- 1.8 min and 0.82 +/- 0.32 vs 1.25 +/- 0.23, p < 0.00001). Having either ST-segment depression or a normalized exercise time <1 during exercise had a 95% sensitivity, 71% specificity, and 86% predictive accuracy in identifying abnormal CFR. Coronary stenoses and minimal lumen diameter were similar in groups 1 and 2. By using stepwise logistical regression analysis, exercise time and ST-segment depression predicted CFR with a total r2 of 0.51. Minimal lumen diameter did not significantly add to the model. Exercise test variables, ST-segment depression, and exercise time are predictive of the physiologic significance of coronary lesions.

Aged↗
PubMed2006

[Cardiopulmonary exercise test in the evaluation of exercise capacity in patients with Ebstein anomaly and patent ostium secundum atrial septal defect aged over 30 years].

UNLABELLED: There are few data available on applying the cardiopulmonary exercise test for evaluation of cardiac exercise capacity in adult patients with congenital heart diseases. The aim of the study was to perform this test in adults with Ebstein anomaly and patients with patent ASD II (atrial septal defect) and determination of potential relationships between these parameters and echocardiographically assessed hemodynamic indices. MATERIAL AND METHODS: Twenty patients with Ebstein anomaly mean aged 40.3 +/- 12.3 years were studied. Control group consisted of 19 individuals at mean age of 39.9 years. Echocardiography was performed for the evaluation of severity of the disease. Additionally, 36 patients with ASD II were included, mean age 44.7 +/- 8.2 years. The control group consisted of 25 individuals at mean age of 45.6 years. Maximum exercise treadmill test was carried out and resting and exercise spirometry. RESULTS: Ebstein anomaly. Maximum oxygen uptake, minute ventilation, maximum heart rate and blood pressure at peak exercise were significantly lower in study patients than in control group. VE/VCO2 was increased. No differences were observed between groups with respect to spirometric parameters. Oxygen uptake decreased along with the severity of the disease. ASD II. Maximum oxygen uptake, minute ventilation, maximum heart rate and blood pressure at peak exercise and spirometric parameters were significantly lower in study patients than in control group. Significant negative correlations were shown for VO2 (maximum oxygen uptake) and Qp:Qs (pulmonary to systemic flow ratio) (p = 0.004), maximum heart rate - HRmax and HRmax% and RV (end-diastolic right ventricular diameter) (p = 0.02 i p = 0.01), RV and systolic pressure at peak exercise (p = 0.03), obstruction marker FEV1 and RV (p = 0.04) and between RVSP (right ventricular end-systolic pressure) (p = 0.01). Negative correlation was observed between RQ (respiratory quotient) and RVSP (p = 0.004), and positive correlation between HRmax and VO2 (p = 0.005). CONCLUSIONS: The exercise capacity of adults with Ebstein anomaly and those with patent ASD II is significantly reduced. It decreases along with the echocardiographic severity of the disease in Ebstein anomaly patients and it seems to result from the right ventricular volume overload in patients with patent ASD II.

Abnormalities, Multiple↗
PubMed1982

Cardiovascular reactivity during mental stress testing, the type A interview, and exercise testing in healthy male subjects.

We compared the blood pressure (BP) of 61 healthy male Ss during mental arithmetic plus noise, physical exercise testing and the Type A interview. A consistent association between personality characteristics and cardiovascular reactivity was not found. There was a consistent correlation between systolic BP reactivity during mental arithmetic and the Type A interview. Mental arithmetic and exercise testing correlated significantly for middle aged men. No correlation of BP was found between the Type A interview and exercise testing.

Adult↗
PubMed2001

The role of gas analysis with exercise testing.

Evaluation of exercise performance is an integral component of every medical history. Currently, it is accomplished by means of subjective history taking. Routine exercise testing adds very little information; however, the addition of gas analysis (or cardio pulmonary exercise [CPX] testing) provides the crucial objective assessment by analyzing breath-by-breath oxygen uptake, carbon dioxide production, and anaerobic threshold (AT). Cardiac and pulmonary causes can be reliably differentiated, e.g., cardiac patients cross AT and attain VO2max, use less than 50% of maximal voluntary ventilation (MVV) at peak exercise, and do not develop desaturation. Pulmonary patients, on the contrary, fail to cross AT or achieve VO2max, utilize more than 70% of MVV at peak exercise, and develop arterial desaturation. In the current cost-conscious health care system, CPX proves to be a better cost-effective test because it is objective and more directly targeted to the issues than the conventional exercise test. CPX provides an important link between the disease process and its effect on exercise performance, which is crucial to a comprehensive clinical evaluation, diagnosis, prognosis, exercise prescription, and follow-up after medical or surgical intervention in patients with various diseases causing cardiopulmonary dysfunction.

Carbon Dioxide↗
PubMed2001

Gas exchange and pulmonary hemodynamics during lung resection in patients at increased risk: relationship with preoperative exercise testing.

STUDY OBJECTIVES: To evaluate the intraoperative evolution of patients with COPD during lung resection and to test whether exercise testing could be helpful in the prediction of the intraoperative course. DESIGN: Prospective study. SETTING: University teaching hospital. PATIENTS: Forty patients (mean [+/- SD] age, 65 +/- 9 years) with COPD (ie, FEV(1), 55 +/- 11% of predicted) and resectable lung neoplasms. INTERVENTIONS: Preoperatively, pulmonary function testing, quantitative lung perfusion scanning, and exercise performance testing were administered. Intraoperatively, pulmonary, hemodynamic, and blood gas measurements were performed at five stages, including periods of two-lung ventilation (TLV) and periods of one-lung ventilation (OLV). RESULTS: During OLV, compared with TLV, the PaO(2)/fraction of inspired oxygen (FIO(2)) ratio decreased from 458 +/- 120 to 248 +/- 131 mm Hg (p < 0.05), whereas pulmonary artery pressure (PAP) increased from 18 +/- 5 to 23 +/- 5 mm Hg (p < 0.05). Cardiac output (t) also increased from 4.0 +/- 1.2 to 5.1 +/- 1.9 L/min (p < 0.05), yielding to a higher mixed venous PO(2). Both PaO(2) and t during OLV were significantly lower in patients who had undergone right thoracotomies compared with those who had undergone left thoracotomies. The PaO(2)/FIO(2) ratio during OLV correlated with the PaO(2) during exercise (r = 0.39; p = 0.01) and with the perfusion of the non-neoplastic lung (r = 0.44; p = 0.005). CONCLUSIONS: In COPD patients, OLV leads to a significant derangement of gas exchange, which is more pronounced in right thoracotomies. Preoperative measurement of PaO(2) during exercise and the distribution of perfusion by lung scan might be useful to identify those patients who are at the greatest risk of abnormal gas exchange during lung resections.

Aged↗