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At least 127 records · Page 7Linked to original sources

PubMed1995

Oxygen deficit during exercise testing in heart failure. Relation to submaximal exercise tolerance.

Measurements of oxygen deficit during submaximal exercise were correlated with the anaerobic threshold (as measured by gas exchange analysis), peak work rate on a ramp protocol, and the ability to perform constant work rate exercise in 10 male patients with New York Heart Association class 2 congestive heart failure and 12 age- and gender-matched normal controls. All subjects performed a maximal ramp exercise test for measurement of the anaerobic threshold. In addition, several 15-min constant work rate exercise sessions were conducted to evaluate oxygen deficit, measured as the area between the "ideal" square curve of oxygen consumption at the onset of constant work rate exercise and the actual exponentially shaped curve. Since the oxygen deficit significantly correlated with the plateau oxygen consumption during the 25-W constant work rate exercise (r = 0.61, p = 0.002), the oxygen deficit was normalized by the rectangular area of 15-min oxygen consumption above baseline. This normalized value significantly correlated with the inverse of the anaerobic threshold (r = 0.81, p < 0.0001). The logarithm of the normalized oxygen deficit significantly correlated with the maximum ramp work rate (r = -0.86, p < 0.0001) and the highest constant work rate sustained for 15 min (r = -0.82, p < 0.0001). In addition, the time to reach plateau oxygen consumption for the 25-W exercise significantly correlated with the inverse of the anaerobic threshold (r = -0.78, p < 0.0001), the maximum ramp work rate (r = -0.76, p < 0.0001), and the highest constant work rate sustained for 15 min (r = -0.74, p < 0.0001). Thus, the oxygen deficit seen in patients with heart failure during constant work rate exercise results from abnormally slow oxygen uptake kinetics and correlates with exercise capacity as measured by anaerobic threshold (via gas exchange analysis) and maximal and submaximal exercise tolerance. Oxygen deficit warrants further evaluation as a submaximal index of functional capacity in patients with heart failure.

Adult↗

PubMed1983

Exercise testing and training: clinical applications.

The application of exercise in clinical cardiology continues to progress because of research findings. Advances have occurred in the applications, methodology and interpretation of exercise testing. Exercise training has been documented to have a place in the primary prevention of coronary heart disease. In regard to cardiac rehabilitation, both early ambulation and early discharge are safe and beneficial in patients with uncomplicated infarction, and a subsequent exercise program is at least as effective as other interventions. High intensity exercise training in the patient with heart disease may be necessary to cause changes in myocardial perfusion and performance, but it carries an increased risk.

Adult↗

PubMed1989

[The clinical significance of the low level treadmill exercise test in acute myocardial infarction].

To clarify the clinical significance of the exercise test in acute myocardial infarction (AMI), the relationship between the results of exercise test and clinical features was studied. The low level treadmill exercise test (maximum exercise time was 1080 seconds and the maximum oxygen consumption was 7 METs) were performed in 111 patients within 2 months after the onset of AMI. The exercise time, the endpoint of the exercise test, the exercise-induced ST-segment deviation and ventricular premature beats (VPC) were evaluated from the exercise tests. Among the clinical features, age, sex, the severity in the acute period (Killip's classification and Forrester's hemodynamic subset), the findings in cardioangiography (the number of diseased coronary arteries, left ventricular ejection fraction and abnormal wall motion in the left ventricle) and short term prognosis after AMI were evaluated. The prognosis was judged as poor when cardiac death, congestive heart failure, postinfarction angina, the decrease of exercise tolerance and reattack of AMI occurred, or when an aorto-coronary bypass graft or percutaneous transluminal coronary angioplasty was performed. The exercise time was shorter in patients over the age of 60 years (578 +/- 360 seconds) than in younger patients (818 +/- 296 seconds), and also in females (487 +/- 392 seconds) than in males (767 +/- 319 seconds). The patients classed as Forrester's hemodynamic subset IV had shorter exercise time than the others. But, there was no relationship between the exercise time and Killip's classification. Low left ventricular ejection fraction (55% or less) was associated with short exercise time and the apperance of exercise-induced VPC. But the number of diseased coronary artery and abnormal wall motion in the left ventricle were not related to the exercise test. The patients with high exercise tolerance (4.2 METs or more) in the AMI recovery period showed better prognosis than those with low exercise tolerance within one year after AMI (96% vs 50%, p less than 0.0001, respectively). In conclusion, the low level exercise test in AMI was influenced by age, sex and cardiac function, and it was useful in evaluating the short term prognosis after AMI.

Adult↗

PubMed1984

Evaluating the cardiac patient for exercise therapy. Role of exercise testing.

Several types of exercise tests and their use are reviewed. Suggestions are made for modification of tests to enhance their value in the counseling of normal individuals and patients with cardiac problems regarding occupational, recreational, and training activity. Also discussed are indications and contraindications to testing, end points in testing, and evaluation of test results.

Arm↗

PubMed1991

Respiratory gas exchange during treadmill exercise testing: reproducibility and comparison of different exercise protocols.

Ten subjects performed 4 maximal exercise tests to evaluate reproducibility and effects of treadmill inclination on submaximal and maximal oxygen consumption. They performed a standard Bruce protocol twice, and 1 protocol with progressive speed increase with constant, or without, inclination. At maximal exercise there was no significant difference between the protocols in oxygen consumption, respiratory gas exchange ratio, minute ventilation, plasma lactate, serum potassium or heart rate. Exercise time and treadmill distance were shorter than Bruce protocol with inclination, and considerably prolonged without. Reproducibility for Bruce protocol was good for group comparison of oxygen consumption throughout exercise. The individual variations for oxygen consumption were small at maximal exercise, but were considerable at rest and at the lowest exercise steps, this was slightly improved by analysing longer sampling time. Thus, measurement of oxygen consumption is reliable for group analysis, but interpretation must be careful in individuals unless maximal exercise is obtained. Treadmill inclination may be adjusted according to individual preferences.

Adolescent↗

PubMed1988

Lack of diurnal variation in maximal symptom-limited exercise test response in chronic stable angina.

Exercise testing is widely used to evaluate the effects of anti-ischemic drugs. Many studies have reported good reproducibility when it is performed in the morning, but little information is available regarding the diurnal variation of exercise test response in patients with chronic stable angina. With the advent of new long-acting anti-ischemic drugs, it has become necessary to perform the exercise testing at various times of the day to determine the duration of action of a given drug. To examine the diurnal variation, exercise tests were performed on 41 patients, aged 53 to 75 years, with established chronic stable angina on 2 occasions 5 days apart at 10 A.M. and 4 P.M. on each day. On day 1, the mean +/- standard error of the mean exercise time was 5.0 +/- 0.4 minutes at 10 A.M. and 5.1 +/- 0.4 minutes at 4 P.M., and on day 5, it was 5.6 +/- 0.4 minutes at 10 A.M. and 5.5 +/- 0.4 minutes at 4 P.M. These values did not differ in statistical significance. Similarly, the time to the development of 1 mm of ST-segment depression did not show any statistically significant change during either test period on either day nor did maximal ST-segment depression. Heart rate at rest was 79 +/- 3 beats/min at 10 A.M., 81 +/- 3 beats/min at 4 P.M. on day 1 and 78 +/- 2 beats/min at 10 A.M. and 80 +/- 3 beats/min at 4 P.M. on day 5 (difference not significant). Similarly, no significant changes were observed in maximal heart rate or rate-pressure product at peak exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1989

The safety of maximal exercise testing.

Previous reports on the safety of exercise testing have been based on surveys from different testing facilities with a variety of testing protocols and patient types. From 1971 through 1987, 71,914 maximal exercise tests conducted in a population with a low prevalence of known coronary heart disease under uniform conditions at a single medical facility resulted in six major cardiac complications including one death. No complications have occurred in the past 10 years in 45,000 maximal tests. The overall cardiac complication rate in men and women is 0.8 complications per 10,000 tests with 95% confidence intervals of 0.3-1.9 complications per 10,000 tests. Maximal exercise testing appears safer than some previously published reports have suggested and seems to be getting safer with time.

Accident Prevention↗

PubMed1987

Implications of positive treadmill exercise tests in asymptomatic adult African blacks.

Maximal exercise tests in 225 apparently healthy adult Africans (148 men, 77 women) aged 26 to 70 years revealed 35 subjects (18 men and 17 women) with ischaemic ST changes. Out of these, 6 men and 4 women developed chest pain that necessitated termination of the tests. Significant ventricular arrhythmias were observed in 27 patients (20 men and 7 women) all of whom had an otherwise negative response to exercise tests. During a follow-up period ranging from 6 months to 4 years, 2 male positive-responders--both of whom developed chest pain during exercise testing--sustained acute myocardial infarction. The coronary arteries of both men were found to be normal at coronary angiography. A third male positive-responder, who also developed chest pain during exercise testing, subsequently experienced repeated attacks of angina with no ECG or serum enzyme changes. Coronary angiography, in this patient, revealed significant proximal vessel disease necessitating coronary angioplasty. One female positive responder, who developed chest pain during exercise-testing, experienced episodes of restrosternal discomfort of considerable duration with no ECG or serum enzyme changes. Her coronary arteries were subsequently shown to be normal. While coronary artery disease would no doubt account for a significant percentage of positive exercise responses in adult African blacks, it seems likely that non-coronary causes play a dominant role.

Adult↗

PubMed1984

Submaximal exercise testing early after myocardial infarction. Prognostic importance of exercise induced ST segment elevation.

Seventy four patients (66 men, eight women; mean age 54.3 years) underwent submaximal exercise testing 7-23 days (mean 10.7) after acute myocardial infarction. Follow up was a mean period of 11.3 months. When compared with patients with no exercise induced abnormality, ST segment elevation, ST shift (depression or elevation or both), ST depression, inability to complete five metabolic equivalents, and inadequate blood pressure response to exercise were predictive of subsequent cardiac events (cardiac death, left ventricular failure, recurrent myocardial infarction, angina). When the presence or absence of specific variables was assessed, only ST elevation and ST shift predicted subsequent cardiac events. The presence of exercise induced ST elevation was the only exercise test variable which predicted cardiac death. ST segment elevation was, therefore, the exercise induced abnormality which best predicted the risk of future complications.

Adrenergic beta-Antagonists↗

PubMed1978

[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↗

PubMed1988

Serial exercise testing in pulmonary embolism.

A patient underwent exercise testing during evaluation for unexplained dyspnea. Evidence of ventilation-perfusion mismatch was noted and subsequent testing revealed multiple pulmonary emboli. Ventilation perfusion parameters by serial exercise testing progressively improved during the course of the patient's illness but did not totally normalize. A discussion of the utility of exercise testing in the evaluation of the patient with unexplained dyspnea is provided and the potential value of serial exercise testing in the management of patients with pulmonary emboli is discussed.

Adult↗

PubMed1992

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↗

PubMed1990

Autonomic dysfunction and silent myocardial ischaemia on exercise testing in diabetes mellitus.

The incidence and mechanism of painless myocardial ischaemia on exercise testing in diabetic patients is not clear. Therefore, two studies were performed. Retrospectively, all exercise tests carried out in our hospital during the past 5 years were reviewed for silent ischaemia. Prospectively, diabetic patients with known or suspected coronary artery disease underwent autonomic function testing and a second exercise test. Of 1653 exercise tests reviewed, 247 were positive (ST depression greater than 0.1 mV). Of the 29 diabetic patients with positive tests 20 (69%) had painless ST depression, compared with 77 (35%) of the 218 non-diabetic patients (p less than 0.001). The diabetic patients with painful and painless ST depression were comparable for age, sex, therapy, but the 20 with no pain on exercise testing had a longer duration of diabetes and a higher incidence of microvascular complications than the 9 with pain (70 vs 22%, p less than 0.05). In the prospective study, 12 of 30 diabetic patients with positive exercise tests had pain in association with ST depression and 18 had no pain. Six patients had mild and 12 severe autonomic neuropathy on formal testing. Twelve had no autonomic dysfunction. Eleven (92%) of 12 patients with severe neuropathy had painless ST depression, compared with 7 (39%) of 18 without severe neuropathy (p less than 0.01). Thus, silent myocardial ischaemia on exercise testing is common among patients with diabetes mellitus and is associated with severe autonomic dysfunction.

Aged↗

PubMed1985

Exercise testing.

In the athletic horse, an exercise test may be required to measure the adaptation of the animal to a specific training program; to modify the training program in response to the progress achieved; to investigate the reasons for failure to perform at the expected level; and to form part of an overall clinical examination of a horse with a specific disability. This article includes information on the scope and form of an exercise test, the parameters measured during the test and their interpretation, treadmill and track tests, and the clinical applications of exercise tests.

Animals↗

PubMed1983

[Early exercise test after myocardial infarct: prognostic stratification].

Exercise testing in myocardial infarction before discharge has been used for treatment and exercise prescription in the post-hospital phase. Aim of this study was to investigate the prognostic significance, within one year after the infarction, of submaximal exercise testing before discharge. 428 patients performed the test 14.5 days after the acute episode and were followed for 12 months. The following variables were examined: heart rate, blood pressure, rate-pressure product at maximum exercise, total work and reasons for stopping the test (fatigue, submaximal HR, BP greater than or equal to 200/110, hypotension, ischemic or arrhythmic response). Two events were considered: 1) non fatal reinfarction; 2) cardiac death. Two methods of multivariate analysis (Cox's model regression analysis and discriminant analysis) were used. None of the considered variables was found to be predictive of non fatal reinfarction. According to Cox's model total performed work and hypertensive response were found to be predictive of cardiac death, while using discriminant analysis only total work had a predictive value (discriminant function: L = 0.00094 X total work performed + 1.48643; p less than 0.01). In detail, the higher the total work, the better the probabilities of survival, while in patients who stopped the test because of hypertension, the probabilities of cardiac death were lower. Exercise testing performed in uncomplicated myocardial infarction before hospital discharge provides, the basis for a more rational management of patients in the post-infarction phase, and contributes to identify a subset of high-risk patients.

Aged↗

PubMed1992

[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↗

PubMed1995

[Value of the exercise test in the study of arrhythmia].

Exercise testing may be used to assess symptoms occurring on effort, to search for and evaluate arrhythmias or conduction defects, antiarrhythmic drugs, pacemakers or implantable cardioverter defibrillators. Interpretation of exercise testing is difficult because of the complexity of the factors in play. Exercise itself induces changes in myocardial metabolism and the autonomic nervous system, the nature and importance of which are influenced by the underlying cardiac disease and the presence of cardiac failure or myocardial ischaemia. This is particularly true when studying the behaviour of arrhythmias on effort, which depends on many parameters, in that they may appear or disappear during exercise, irrespective of their relationship to autonomic nervous system activation. The main problem lies in the interpretation of changes in the heart rate before the onset of an arrhythmia. The sinus rhythm is both a passive indicator of the vago-sympathetic equilibrium and one of the determining factor of the arrhythmia (relationship to the rate), but it is, itself, dependent on the presence of myocardial dysfunction, a source of arrhythmias, and its changes then become difficult to interpret. These reasons explain why exercise testing is certainly a valuable tool in assessing arrhythmias but the poor reproducibility, especially in the evaluation of ventricular arrhythmias, advises prudence in the interpretation of results.

Arrhythmias, Cardiac↗

PubMed1992

[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↗