Comparison between Bruce and Ramp Protocols for Exercise Testing in the Diagnosis of Myocardial Ischemia

Thiago Teixeira Da Silveira Fagundes,Fabricio Da Costa Wohnrath,Romeu Sérgio Meneghelo,João França,Carolina Christianini Mizzaci,Rica Dodo Delmar Buchler,Luiz Eduardo Mastrocola,Susimeire Buglia,Flavia Medina

doi:10.36660/ijcs.20200403

Thiago Teixeira Da Silveira Fagundes, Fabricio Da Costa Wohnrath + Show 7 more

Open Access

https://doi.org/10.36660/ijcs.20200403

Copy DOI

Abstract

Background: Exercise tests are an important tool in the investigation of myocardial ischemia. The ramp protocol has gained increasing importance in clinical practice because of the possibility of individualizing its exercise intensity. Objective: To assess and compare the sensitivity, specificity, and accuracy of Bruce and ramp protocols for exercise testing in the diagnosis of myocardial ischemia considering myocardial perfusion scintigraphy as the reference standard. Secondary objectives included the assessment of hemodynamic profiles, functional capacity, and the incidence of arrhythmias [...]

Highlights

The stress test consists in a procedure where an individual undergoes programmed physical exercise in order for the physician to assess clinical, hemodynamic, and electrocardiographic responses.[1]
Our sample contemplated 43 participants who went through all 3 study phases: myocardial scintigraphy and exercise testing with the Bruce and ramp protocols, according to randomization
In case the exercise test has the main objective of screening for coronary artery disease (CAD), protocols with higher sensitivity are recommended

Summary

Introduction

The stress test consists in a procedure where an individual undergoes programmed physical exercise in order for the physician to assess clinical, hemodynamic, and electrocardiographic responses.[1] The exercise can be performed using a treadmill or a stationary cycle ergometer, and many protocols are available according to the test objective, being adaptable to patient conditions Even though it was created more than 5 decades ago, the Bruce protocol is still the most widely used in the world’s main laboratories.[2] Its increments are performed every 3 minutes, but an increase of around 3 metabolic equivalents of task (MET) at each stage may hinder the adaptation of sedentary individuals and those who have heart diseases and physical limitations, leading to the early interruption of the test.

Objectives

Methods

Results

Discussion

Conclusion