[Combination of discriminating tests with the cycloergometric exercise test in the differential diagnosis of ischemic and "pseudo-ischemic" cardiopathy].
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Adult↗
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Detection of ventricular ectopy in patients with coronary heart disease and normal subjects by exercise testing and ambulatory electrocardiography.
Maximal exercise testing and 24-hour ambulatory electrocardiographic recording (Holter monitor) were utilized in the detection of ventricular ectopy in 90 patients with stable chronic coronary heart disease and in 30 normal subjects. Although the occurrence of any ventricular ectopic activity, as detected by either or both methods, was common, the incidence was significantly higher (P less than 0.001) in patients with coronary heart disease (86 percent; 77/90), as compared to that in normal subjects (40 percent; 12/30). Ventricular arrhythmia was more frequently detected by the 24-hour continuous electrocardiographic recording, being found in 70 of the 90 patients with coronary heart disease and in ten of the 30 normal subjects. In comparison, exercise testing disclosed ventricular ectopy in 56 of the 90 patients with coronary heart disease and in two of the 30 normal subjects. Multiform and repetitive patterns of ventricular ectopy were detected twice as commonly by continuous electrocardiographic recording than with exercise testing, and these patterns were present in one-half of the patients with coronary heart disease. Both methods of examination adjunctively disclosed more ventricular ectopy than either method alone.
Angina Pectoris↗
[Hyperventilation test in coronary disease: a comparison with a bicycle ergometer exercise test. Report of 100 cases].
A hundred cases have been studied and divided into three categories:--60 normal subjects;--30 coronary subjects with a positive exercise test;--10 subjects with defective nervous control of the circulation; using the exercise test, we studied the effects of hyperventilation on repolarisation of the ventricle. In the normal subjects there was no ischaemic depression of the ST segment, but there were minor changes in repolarisation which affected the T wave in 73% of subjects and were essentially posterior in distribution. In the coronary subjects, we found three with ischaemic depression of the ST segment and one with ST elevation of 2.5 mm (6.7% of the coronary subjects). This last finding is evidence against the commonly held hypothesis that reproduction of ST depression by hyperventilation during the exercise test indicates a false positive test. In the patients with defective nervous control of the circulation, 9 had an ischaemic type of ST depression, either as a new feature or as a more severe one compared with that found at rest. The mechanism by which these depressions are produced has not been totally explained:--in the cases with defective nervous control of the circulation, it appears that latent increased sympathetic activity is increased by the hyperventilation;--in the coronary subjects, it may be caused by true ischaemia or by an associated defect in nervous control of the circulation.
Adult↗
Symptom-limited versus low level exercise testing before hospital discharge after myocardial infarction.
OBJECTIVE: This study was undertaken to compare a low level and a symptom-limited test performed before hospital discharge after an uncomplicated myocardial infarction. BACKGROUND: Exercise testing after myocardial infarction provides useful prognostic information. Usually either a low level test is performed before hospital discharge or a symptom-limited test is performed at 3 weeks. METHODS: The study group comprised 202 patients with an uncomplicated myocardial infarction; 58 patients had a non-Q wave infarction and 115 patients had received thrombolytic therapy. Both a low level and a symptom-limited exercise test were performed in 200 of the 202 study patients in randomized order on consecutive days, a mean of 7.4 +/- 2.3 days after infarction. RESULTS: The symptom-limited test required a considerably greater effort than the low level test: exercise duration was 554 +/- 209 versus 389 +/- 125 s (p less than 0.0001), and peak work load was 5.7 +/- 1.8 versus 4.2 +/- 1.1 METs (p less than 0.0001). The peak heart rate was higher during the symptom-limited test (121 +/- 20 vs. 108 +/- 14 beats/min, p less than 0.0001), as was the rate-pressure product. The number of patients who developed ST segment depression greater than or equal to 1 mm increased from 56 during the low level test to 89 during the symptom-limited test (p less than 0.0001). ST segment depression greater than or equal to 2 mm occurred in 22 patients during the low level test and in 41 patients during the symptom-limited test, an 86% increase (p less than 0.0001). The number of patients with either angina or ST depression greater than or equal to 1 mm increased from 66 to 105 (p less than 0.0001) with the symptom-limited test. Exercise test results were similar for patients with a Q wave or a non-Q wave infarction. Exercise duration was longer and exercise-induced ST depression less frequent in patients who had received thrombolytic therapy. CONCLUSIONS: A symptom-limited exercise test performed before hospital discharge after uncomplicated myocardial infarction provides a significantly greater cardiovascular stress than does a low level test and is associated with an ischemic response nearly twice as frequently. The prognostic significance of a positive response at higher work loads has not been defined.
Angina Pectoris↗
[Hypertensive reaction to exercise. Retrospective studies of 1363 consecutive exercise tests].
OBJECTIVE: To study exercise hypertensive reaction and its relation with rest blood pressure, hypertension type and hypertensive cardiac disease. DESIGN: Retrospective study of treadmill exercise testes (ET) performed from January/89 to June/91: (n: 1703). SETTING: Stress tests Laboratory of Cardiology Service of a Military Hospital. METHODS: 1363 consecutive ET of male subjects, performing at least the 3rd stage of the Bruce protocol, were studied. From each ET record were obtained general data, including the reason for test, medication and the rest and exercise blood pressure. Exercise hypertensive reaction was defined as a Bruce protocol 3rd stage systolic blood pressure above 187 mmHg, which corresponds to mean +2SD of 130 normal male subjects previously studied. The Echocardiograms of non-treated hypertensives, obtained less than a month from ET, were reviewed. The diagnosis of borderline or moderate hypertension was base on the clinical records. RESULTS: 1) The 1363 ET included 132 (9.7%) ET to study hypertensive subjects, and 68 of these had hypertensive reaction. 86 ET were performed by non-treated hypertensive subjects, of whom 73 had Echocardiogram. 43 (3.5%) from 1231 ET performed by non-hypertensive subjects also had exercise hypertensive reaction. 2) The left ventricular (LV) mass index of non-treated hypertensive patients had a positive correlation with exercise systolic pressure (r: 0.45; p < 0.001), more important than with rest blood pressure or exercise systolic pressure response; there was a relation with LV wall thickness, but not with internal ventricular dimensions, that was only observed in hypertensive subjects that also had hypertensive reaction to exercise. 3) Exercise systolic blood pressure was usually normal in borderline and elevated in moderate hypertensives (Qui2: 27.249; p < 0.001). 4) Subjects with exercise hypertensive reaction, but not previously diagnosed as hypertensives, were usually true hypertensives. CONCLUSIONS: 1) Hypertensive peaks seem to be an important determinant factor in LV hypertrophy of hypertension, but its influence is felt only above a certain blood pressure threshold; it results on LV concentric type hypertrophy. 2) Exercise systolic blood pressure had a discrimination power of about 80% to separate borderline and moderate hypertensive subjects. 3) All subjects having an exercise hypertensive reaction must be carefully observed, even if their blood pressure at rest is normal, because most of them are true hypertensive patients.
Adult↗
[Effect of beta adrenergic blocking drugs on the prognostic value of ST-segment depression during exercise electrocardiogram testing].
Exercise testing has been shown to be predictive for future cardiac events in patients with established diagnosis of coronary heart disease. Exercise test parameters associated with poor prognosis may be unreliable if patient is receiving beta adrenergic agents. The purpose of this study was: 1) to compare the results of exercise testing performed before and during beta blocking therapy, and 2) to determine the role of beta blockers in the prognostic significance of the ST-segment response recorded during exercise testing. The study population consisted of 518 patients (mean age 52 +/- 7 years) with coronary heart disease. The diagnosis was based on the presence of one of the following three criteria: 1) typical history and significant ST-segment depression on resting or exercise electrocardiogram, 2) history of myocardial infarction, 3) significant coronary angiographic abnormalities. In all patients symptom-limited exercise test was performed before and two weeks after the onset of beta blocker therapy. The data from the first and second tests were estimated for significance of differences between the mean values with following results: maximal heart rate--135 +/- 21 and 123 +/- 19 bpm (p less than 0.001), maximal work load achieved--98 +/- 43 and 109 +/- 44 W (p less than 0.001), maximal systolic blood pressure--171 +/- 28 and 163 +/- 26 mmHg (p less than 0.001). Occurrence of characteristic ST-segment depression was more frequent during the first than during the second test (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Adrenergic beta-Antagonists↗
Effects of training on resting and postexercise ECG in standardbred horses, using a standardized exercise test.
Five healthy, mature, previously trained Standardbred horses were given no exercise (left in a stall) for 4 months, then jogged (slow exercise) for 3 weeks, and placed in a 6-week training period. Cardiac variables were measured at the beginning of training and after 14, 20, 35, and 42 days of training before and at 10, 15, 20, 25, and 30 minutes after a 1.8-km (in 3:12 +/- 2 seconds) standard, submaximal exercise test on a deep 0.53-km track. There was no significant change during the 6-week conditioning period in the following variables at rest or at any of the times observed during recovery from test exercise: heart rate, PQ-interval, QRS-duration, QT-interval, and ratio of electrical systole to diastole. It appeared that measuring heart rate by electrocardiogram at rest and during recovery from execise is not of significance in evaluating the fitness in the previously trained adult horse.
Animals↗
Significant sex differences in the correlation of electrocardiographic exercise testing and coronary arteriograms.
Two hundred fifty-one patients (195 male and 56 females) referred for evaluation of chest pain were studied by multistage submaximal stress testing and selective coronary arteriography. In men with positive exercise tests the incidence rate of true positive exercise test results--that is, positive tests associated with 75 percent of greater coronary stenosis--was 89 percent in contrast to a 33 percent incidence rate of true positive exercise test results in women. The incidence rate of false positive excercise test results--that is, positive tests associated with no coronary stenosis or less than 50 percent stenosis--was 8 percent in men in contrast to 67 percent in women. Conversely, the incidence rate of false negative exercise test results (that is, negative exercise tests associated with 75 percent or greater coronary stenosis) was higher in men (37 percent) than in women (12 percent). It is concluded that in men a positive multistage stress test is useful in predicting the presence of significant coronary artery disease although a negative stress test cannot be relied upon to rule out the presence of significant disease. In women, a positive exercise test is of little value in predicting the presence of significant coronary artery disease, whereas a negative test is quite useful in ruling out the presence of significant disease. New criteria should be developed for stress testing of women.
Adult↗
The predictive value of anginal chest pain as an indicator of coronary disease during exercise testing.
To determine the significance of anginal chest pain during exercise testing, a series of 302 patients undergoing coronary arteriography with exercise testing was reviewed. Of the 302 patients, 85 had ischemic ECG changes and chest pain (Group I); 87 patients had ischemic ECG changes but no chest pain (Group II); 25 patients had chest pain but no ischemic ECG changes (Group III); 105 patients had neither chest pain nor ischemic ECG changes (Group IV). Coronary artery disease was present in 95% of Group I, 75% of Group II, 72% of Group III, and 28% of Group IV. Of those patients with coronary disease, multiple vessels were involved in 94% of Group I, 51% of Group II, 67% of Group III, and 21% of Group IV. The predictive value for presence and extent of coronary disease showed Group I greater than Groups II and III greater than Group IV (p less than 0.025). We conclude that (1) anginal chest pain during exercise testing predicts the presence and extent of coronary disease more accurately than its absence; (2) the presence of chest pain even without an ischemic ECG response during exercise testing appears to be as predictive of coronary disease as an ischemic ECG response alone; and (3) the combination of anginal chest pain during exercise testing and an ischemic ECG response is highly predictive of multivessel coronary artery disease.
Angina Pectoris↗
[Exercise-induced left bundle branch block in treadmill exercise test: clinical significance and prognosis].
Exercise induced left bundle branch block (LBBB) is poorly understood. We investigated its clinical characteristics and prognosis. The records of 3,459 consecutive patients who underwent treadmill exercise testing were reviewed. Exercise induced LBBB was identified in 6 patients (0.17%). Three out of six patients had underlying cardiac disease; two had coronary artery disease and one dilated cardiomyopathy. Three out of five had redistribution on Tl-201 myocardial scintigraphy. In one of these three patients, however, coronary angiography demonstrated no significant narrowings. Tl-201 myocardial scintigraphy in patients with exercise induced LBBB may be undetermined for coronary artery disease. During follow-up, one of six patients had depressed left ventricular function and was diagnosed as having dilated cardiomyopathy. It is thus obvious that exercise induced LBBB without a specific underlying heart disease should be followed up carefully.
Aged↗
[Clinical and epidemiological criteria of evaluation of the exercise test (author's transl)].
Exercise test diagnostic and prognostic value depends on the purpose for which is performed and on the population studied. In typical angina patients the test is usefull for choosing between medical and surgical therapy and for evaluating treatment efficacy. In patients with atypical chest pain a diagnostic value is recognized. In asymptomatic subjects results of a number of epidemiological studies suggest that this test is recommended only in selected groups or for research purpose. In the appendix definitions of epidemiological measures used in screening tests evaluation are given with examples.
Adolescent↗
[Value of the exercise test after aortocoronary bypass].
The 100 patients who underwent an exercise test and a follow-up coronary arteriogram at a mean interval of 10.1 months after an aorto-coronary bypass had suffered preoperatively from incapacitating angina 50%), a threatened infarction syndrome (35%), or Prinzmetal's angina (15%). The majority had a single bypass graft (72%), but 28% had two or three grafts. The exercise test was positive 39 times, negative 51 times, and indeterminate in 10. Correlation with the clinical picture shows that 27% of the patients in functional category I had a positive exercise test. Correlation with coronary arteriography shows that a positive test is reliable evidence for a defect or occlusion of the graft. On the other hand, a negative exercise test is a less reliable indicator of a good result. No instances of positive exercise tests were found when there was complete alleviation of the coronary condition.
Adult↗
Complementary role of ambulatory electrocardiographic monitoring and exercise testing in evaluation of myocardial ischemia.
For detection of myocardial ischemia, exercise testing is a better tool than AEM and therefore should be preferred procedure for this purpose. In patients who exhibit ischemic changes on exercise testing, the presence of ischemic changes on AEM carries significant prognostic information beyond the results of exercise testing; therefore, it is recommended that this test be performed in those who have ischemic changes on exercise at a moderate or low workload. AEM together with exercise testing can be used to assess efficacy of anti-ischemic drugs, can help to define the underlying mechanism of ischemia during daily life, and in certain groups of patients, like those with unstable angina, peripheral vascular disease, or after cerebrovascular events, it can replace exercise testing as a method for detecting ischemic changes.
Coronary Disease↗
The magnitude of exercise-induced ST segment depression and the predictive value of exercise testing.
The assess whether the magnitude of exercise induced ST segment depression improves the predictive values of symptom limited exercise tests, and helps in the recognition of patients with more severe coronary heart disease, 90 consecutive patients with positive treadmill tests who also underwent selective coronary arteriography were reviewed. The predictive value improved progressively with the increasing ST depression and was most reliable in a select group of patients with normal electrocardiographic baseline who were not receiving digitalis (73% with ST depression greater than or equal to 1 mm to 100% with ST depression greater than or equal to 4 mm). The incidence of 2 and 3 vessel disease increased from 61% with ST depression greater than or equal to 1 mm in the overall population to 100% with ST depression greater than or equal to 4 mm in the select group, and the incidence of left main trunk lesions increased, respectively from 6 to 30%. The prediction of 2 and 3 vessels disease was found to be significantly greater when patients were dichotomized into those with ST depression greater than or equal to 4 mm compared to less than 4 mm. It is concluded that the magnitude of ST segment depression definitely improves the predictive values of exercise tests as well as the ability to recognize the patients with more severe disease. However, the markedly positive exercise tests cannot be utilized to accurately predict the presence of 2 or 3 vessel disease in individual cases unless ST depression attains 4 mm or more in patients with normal electrocardiographic baseline who are not taking digitalis. In this group, the ability to predict left main trunk lesion is approximately 30%.
Coronary Angiography↗
Work intensities of different modes of exercise testings in clinical use.
Several different exercise testings with treadmill, bicycle ergometer and two-step were carried out by healthy Japanese men to study oxygen consumption per minute and circulatory responses. Stress imposed on the heart by dynamic leg exercise varied depending on the mode of exercise even if energy expenditure expressed in VO2 was identical. This should be fully taken into consideration in comparison of results of different modes of exercise testing. For estimation of VO2 during treadmill slope walk, an equation was derived by multiple regression analysis with use of belt speed and slope as independent variables.
Adult↗
The current value of exercise testing soon after acute myocardial infarction.
We performed exercise testing in 236 of 289 survivors of acute myocardial infarction to test the hypothesis that exercise-related parameters contribute to cardiac prognosis. Beta-blockers and/or calcium antagonists were used by 50% and 55% respectively of the study population. Of the 236 patients 67 had received thrombolytic therapy during the acute event. By either univariate or multivariate analysis, we found that exercise-related parameters were poor predictors of cardiac prognosis. Therefore, in our population, exercise testing performed 3 weeks after myocardial infarction provides little information of prognostic value.
Academic Medical Centers↗
Comparison of the electrocardiographic changes induced by maximam exercise testing with treadmill and cycle ergometer.
Maximum exercise testing using treadmill walking and cycle ergometry was compared in 40 male patients who had suffered a myocardial infarction in the preceeding twelve months. Maximum oxygen uptake was on average 17% greater in the treadmill than the cycle test and maximum heart rate was also higher, but the rate pressure product (RPP) was a similar due to a higher blood pressure in the cycle ergometer test. Eleven subjects showe ST-segment depression greater than 1 min and eight subjects showed ST-segment elevation greater than 1 mm. There was a close relationship (r2 = 0.96) between the magnitude of ST-segment changes in the two tests. Four subjects showing ST depression of 1 mm in the treadmill test showed depression during the cycle ergometer test which was less than this conventionally "positive" value. In these subjects RPP was lower during cycling than in treadmill walking. With both tests maximum ST-segment changes were measured immediately on stopping exercise: resolution of ST depression was more rapid than ST elevation. The two exercise testing modes are closely comparable in their ability to reveal changes of myocardial ischemia.
Adult↗
[Frequency of life-threatening complications associated with exercise testing (author's transl)].
Most of the statistics on complications of ergometric exercise tests come from the United States and are largely related to treadmill ergometry. A questionnaire was sent in the summer of 1978 to 198 investigative units in the German-speaking regions. The results of 1065 923 person-tests were made available. Exercise testing of 353 638 sports-persons revealed no serious complications. On the other hand, testing of 712 285 patients, predominantly with coronary heart disease, lead to 17 deaths and a total of 96 life-threatening complications. The result of this survey indicates that one must expect one such complication for every 7500 ergometry tests. The danger of pulmonary oedema on exercise in recumbency is about five times higher than that on sitting or standing. The most frequent complication was ventricular fibrillation. A defibrillator should therefore always be immediately available during exercise tests.
Coronary Disease↗