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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↗

PubMedDate not supplied

Exercise testing, training and arm ergometry.

Standard exercise testing and training methods require leg work, but alternative methods involving arm work appear to be particularly applicable for selected subjects. An understanding of the physiology of upper extremity exercise and of the implications for arm exercise testing and training will assist in the diagnostic and functional evaluation and prescription of exercise. The cardiorespiratory and haemodynamic responses to submaximal and maximal arm and leg exercise are reviewed and practical information and guidelines for the recommendation of arm exercise testing and training in wheelchair-confined individuals, normal subjects, and patients with coronary heart disease are provided.

Adult↗

PubMed1990

"Recovery only" ST-segment depression and the predictive accuracy of the exercise test.

STUDY OBJECTIVE: To clarify the predictive value of exercise-induced ST-segment depression occurring in recovery only, and to determine whether the addition of recovery data improves the interpretation of the exercise test. DESIGN: Retrospective analysis of data collected during exercise testing and coronary angiography. SETTING: A 1000-bed Veterans Affairs Medical Center. PARTICIPANTS: The study included 328 male patients who had had both a sign- or symptom-limited treadmill test and coronary angiography. MEASUREMENTS AND MAIN RESULTS: Of the 168 patients who had abnormal ST-segment responses, 26 had such responses only during recovery. The positive predictive value of this pattern for significant angiographic disease (84%) was not statistically different from the predictive value of ST depression occurring during exercise (87%). Inclusion of ST depression during recovery significantly increased the sensitivity of the exercise test from 50% to 59% (P = 0.01) without a change in predictive value. In addition, ST-segment depression occurring only during exercise is usually associated with less-severe angiographic coronary artery disease. CONCLUSION: The occurrence of ST-segment depression during the recovery period only, does not generally represent a "false-positive" response. The inclusion of findings from this period increases the diagnostic yield of the exercise test. Previously proposed exercise test scores, as well as exercise electrocardiography (ECG) analysis done in conjunction with scintigraphy, have a falsely lowered sensitivity that could be increased by considering ST-segment changes occurring in recovery.

Aged↗

PubMed1983

Serial exercise testing up to 6 years after coronary bypass surgery: behavior of exercise parameters in groups with different degrees of revascularization determined by postoperative angiography.

To evaluate the behavior of exercise parameters in patients with different angiographically defined degrees of revascularization, serial exercise tests were analyzed in 435 patients 1 to 6 years after coronary artery bypass grafting (CABG). All patients had undergone postoperative angiography 2 to 12 months after CABG to determine the degree of revascularization achieved. Revascularization was complete in 182 patients (all significantly stenosed arteries had patent grafts), sufficient in 176 patients (at least the dominant artery supplying the left ventricle had a patent graft) and incomplete in 57 patients (the dominant artery supplying the left ventricle had a closed graft). Twenty patients had all grafts occluded. Exercise tolerance, angina-free exercise tolerance (angina threshold), maximal double product, prevalence of greater than or equal to 0.1 mV exercise-induced S-T segment depression, and the prevalence of the combination of S-T segment depression plus angina pectoris were determined in serial exercise tests (average of 3.0 postoperative exercise tests per patient for a mean follow up of 3.5 years). Patients with complete, sufficient, and incomplete revascularization showed improvement of all exercise parameters for 6, 4, and 1 year after CABG, respectively. Patients with all grafts occluded had improvement of only some exercise parameters. Five years after CABG, exercise tolerance was improved by 24 W (p less than 0.0005) and 21 W (p less than 0.005) in patients with complete and sufficient revascularization, respectively, and not improved in patients with incomplete revascularization or with all grafts occluded. The angiographically determined completeness of revascularization correlates with the extent and the duration of improvement of exercise parameters after CABG.

Angina Pectoris↗

PubMed1987

Patterns of oxygen consumption during exercise testing in peripheral vascular disease.

Exercise testing on a treadmill was performed in 15 patients with peripheral vascular disease to determine the pattern of oxygen consumption during exercise. A plateau in the oxygen consumption over the final 90 s of exercise was used as a criterion for maximal effort and only 4 out of 15 (27%) obtained a plateau of oxygen consumption compared to 20 out of 26 (77%) normal subjects (chi 2 7.9, p less than 0.005). These findings may account for the limited value of exercise testing in detecting coronary artery disease in patients with peripheral vascular disease.

Adult↗

PubMed1991

[Early exercise test after acute myocardial infarction].

PURPOSE: To study the predischarge exercise testing importance in determining prognosis after acute myocardial infarction (AMI). PATIENTS AND METHODS: Treadmill exercise testing was performed in 50 stable and without complications patients with AMI, just before hospital discharge; there were 43 men and 7 women, mean age of 53.6 +/- 9.3 years. It was used the modified Naughton protocol and there were no casualties during the exercise testing. Patients were followed up for a mean period of 22.2 +/- 7.7 months. RESULTS: The test was positive in 32% of the patients, abnormal (inadequate blood pressure, heart rate response or arrhythmia) in 36% and normal in 42%. During the first year of follow-up, eleven patients presented with a serious cardiac event. There was one cardiovascular death, 6 patients with unstable angina, 2 reinfarctions and 7 patients had a coronary bypass revascularization. The cumulative risk for these events at one year after myocardial infarction was 50% in patients with a positive exercise test, and 5% in those with a normal exercise test (p less than 0.005). CONCLUSION: The predischarge exercise testing proved to be a simple and safe method to determine prognosis after acute myocardial infarction, identifying a high risk group early after the acute event.

Adult↗

PubMed1988

Use of the cardiopulmonary exercise test to evaluate the patient with chronic heart failure.

Isotonic exercise testing imposes a physiological stress on the cardiopulmonary unit. Accordingly, monitoring of oxygen, carbon dioxide and air flow during an exercise test (i.e. a cardiopulmonary exercise test) can be used to assess heart function in patients with chronic heart failure. Specifically, an incremental treadmill cardiopulmonary exercise test represents a non-invasive means to determine aerobic capacity, or maximal oxygen uptake (VO2max ml min-1 kg-1), and anaerobic threshold (AT, ml min-1 kg-1). These objective measures of cardiopulmonary function are then used to grade the severity of failure and the functional capacity of the patient. In addition, they may be used to predict the cardiac reserve, or maximal cardiac index (CImax, l min-1 m-2) during exercise. That is, the severity is considered to be mild (class A) when AT greater than 14 or VO2max greater than 20, mild to moderate (class B) when AT falls between 11 and 14 or VO2max between 16 and 20, moderate to severe (class C) when AT ranges between 8 and 11 or VO2max between 10 and 16, and severe (class D) when AT less than 8 or VO2max less than 10. The predicted CImax for classes A, B, C and D are greater than 8, 6-8, 4-6 and less than 4, respectively. Finally, a major objective of medical therapy in patients with heart failure is to improve cardiac output and oxygen delivery to working skeletal muscle and thereby enhance effort tolerance. This therapeutic endpoint can be gauged by cardiopulmonary exercise testing from the response in AT and VO2max.

Anaerobic Threshold↗

PubMed1989

Ischemia in the ambulatory setting--the total ischemic burden: relation to exercise testing and investigative and therapeutic implications.

To establish the relation between treadmill exercise testing and ambulatory St segment monitoring in the detection of ischemia in patients with coronary artery disease, and to assess whether standard medical therapy affects any such relation, 277 patients with stable angina and angiographically documented coronary artery disease were studied with treadmill exercise testing and 48 h ambulatory ST segment monitoring. One hundred forty-six patients (52%) were studied while receiving no routine antianginal therapy, and 131 (48%) while receiving standard medical therapy. In 187 patients (67%) the exercise test was positive for ischemia. During 11,964 h of ambulatory monitoring, 881 episodes of ischemia (645 [73%] silent) were recorded, of which 809 (92%) occurred in patients with a positive exercise test. The mean heart rate at the onset of ischemic episodes during ambulatory monitoring was significantly less than that at the onset of 1 mm ST segment depression during exercise testing (94.5 versus 105.9 beats/min, p less than 0.0001). However, the frequency of ambulatory ischemic episodes was strongly related to a positive exercise test (p less than 0.001), and this relation was similar for both silent and painful ischemia (p less than 0.0001 for both) and in patients who were and were not receiving therapy (p less than 0.0001 for both). The total duration of ischemia was similarly related to a positive exercise test (p less than 0.0001). Only one patient with a negative exercise test had frequent (greater than 5/day) episodes of ischemia on ambulatory monitoring and had documented coronary artery spasm. Thus, exercise testing identifies the majority of patients likely to have significant ischemia during their daily activities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

The evolving role of exercise testing prior to lung resection.

Exercise testing prior to lung resection has long and honored tradition. It began as a test of tolerance using simple techniques such as stair climbing. This was followed by aggressive and invasive protocols using right cardiac catheterization in the search for pulmonary hypertension. More recently, measurement of VO2 with exercise has been reported to predict both postoperative mortality and survivable morbidity. Exercise testing holds promise as a noninvasive test to predict the physiologic outcome from lung resection. Significant questions remain concerning the pathophysiologic mechanisms responsible for an abnormal result and who should be denied thoracotomy based on these results.

Exercise Test↗

PubMed1976

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↗

PubMed1994

A new "complex exercise test" for children with cardiac diseases.

In view of the characteristics of children's play or exercise activity, we designed a new method of exercise testing for children, called the "Complex Exercise Test" (CET), which includes three kinds of exercise test: (1) a graded exercise test on the treadmill, (2) a simple bending and stretching test to evaluate momentary exercise tolerance and (3) a swimming test with the ECG in the water. The CET was applied to a total of 25 cases which included 10 cases of postoperative tetralogy of Fallot and 15 cases with ventricular premature contraction (VPC). A two-way exercise test, which included the treadmill test and the simple bending and stretching test, was also applied to 36 postoperative cases (21 cyanotic and 15 non-cyanotic), 20 VPC cases and 16 control children without any organic cardiac disorders, for a total of 72 cases. The treadmill test was useful to evaluate the maximal exercise tolerance. The simple bending and stretching test, on the other hand, seemed useful for observation of VPC changes by exercise (including postoperative VPC), since the heart rate immediately after bending and stretching exceeded that observed at the time VPC disappeared during the treadmill test, thus proving VPC disappearance by this testing. With ECG during diving, it is possible to detect VPC associated with possible risks which could not be identified by the above two methods of testing. Since each one of the three different types of exercise tests has different characteristics, it seems desirable to control children's exercise after performing the CET.

Adolescent↗

PubMed1986

Significance of the walk-through angina phenomenon during exercise testing.

Out of 3,900 patients who performed an exercise test at our clinic, 3 patients demonstrated a walk-through phenomenon (WTP), defined as the occurrence of mild angina during the first stages of exercise with disappearance of chest pain at higher workloads despite a greater pressure-rate product. 2 patients had variant angina, one with normal coronary arteries and the other with single vessel disease, while the third patient had stable exertional angina and a severe coronary artery disease with occlusion of two major vessels retrogradely filled by collateral channels. Repeat exercise tests failed to reproduce constantly the WTP in the 2 patients with variant angina, while in the third patient the phenomenon was repeatedly induced by exercise testing. Thus the WTP, although rarely found during exercise testing, can be observed in two subsets of patients. In variant angina the WTP is not reproducible and is probably due to coronary spasm, spontaneously subsiding during exercise. In patients with exertional angina and severe coronary artery disease, the WTP can be repeatedly observed during exercise and is likely to be secondary to a delayed vasodilation of collateral vessels. The clinical characteristics of the patients and the response to repeat exercise tests may be useful in identifying the different pathogenetic mechanisms.

Adult↗

PubMed1994

Exercise testing in the evaluation of impairment and disability.

Integrative cardiopulmonary exercise testing has evolved from a specialized research laboratory tool into a valuable clinical test that is especially useful for assessment of symptoms of exertional dyspnea and exercise intolerance. There is increasingly convincing evidence that evaluation and quantitation of impairment are enhanced by use of exercise testing. In particular, exercise testing has the advantages of objective determination of abnormal exercise tolerance, increased sensitivity for subtle pulmonary gas exchange abnormalities, the ability in many instances to identify unsuspected or unanticipated non-pulmonary causes of impairment, and a useful quantitation of impairment. Although exercise testing is especially valuable in those with mild-to-moderate lung disease in whom questions about the presence of occupational disease and its contribution to impairment are raised, other important questions can be addressed with these methods (Table 10). Therefore there is a high likelihood that the logic of assessing work capacity while the subject performs work will become increasingly clear.

Disability Evaluation↗

PubMed1984

The pacing stress test: thallium-201 myocardial imaging after atrial pacing. Diagnostic value in detecting coronary artery disease compared with exercise testing.

Many patients suspected of having coronary artery disease are unable to undergo adequate exercise testing. An alternate stress, pacing tachycardia, has been shown to produce electrocardiographic changes that are as sensitive and specific as those observed during exercise testing. To compare thallium-201 imaging after atrial pacing stress with thallium imaging after exercise stress, 22 patients undergoing cardiac catheterization were studied with both standard exercise thallium imaging and pacing thallium imaging. Positive ischemic electrocardiographic changes (greater than 1 mm ST segment depression) were noted in 11 of 16 patients with coronary artery disease during exercise, and in 15 of the 16 patients during atrial pacing. One of six patients with normal or trivial coronary artery disease had a positive electrocardiogram with each test. Exercise thallium imaging was positive in 13 of 16 patients with coronary artery disease compared with 15 of 16 patients during atrial pacing. Three of six patients without coronary artery disease had a positive scan with exercise testing, and two of these same patients developed a positive scan with atrial pacing. Of those patients with coronary artery disease and an abnormal scan, 85% showed redistribution with exercise testing compared with 87% during atrial pacing. Segment by segment comparison of thallium imaging after either atrial pacing or exercise showed that there was a good correlation of the location and severity of the thallium defects (r = 0.83, p = 0.0001, Spearman rank correlation). It is concluded that the location and presence of both fixed and transient thallium defects after atrial pacing are closely correlated with the findings after exercise testing.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1975

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↗