Exercise testing first appeared in the medical literature in 1938.1 Since then, exercise testing has achieved an established place in the armamentarium of tests available to the physician for evaluating patients with known or suspected cardiac disease. In clinical practice, the application of exercise testing is often combined with cardiac imaging. This is reflected in recently available appropriate use criteria for myocardial perfusion imaging and stress echocardiography.2,3 However, exercise testing as a standalone test without imaging still has value in properly selected patients. The latest iteration of guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) concerning exercise testing is dominated by diagnostic or prognostic assessments of atherosclerotic coronary artery disease applications.4 Less prominent are those applications that pertain to hypertrophic cardiomyopathy (HCM), valvular heart disease, and arrhythmias including pacemakers, all of which are the subject of this review. In the latest version of the ACC/AHA guidelines for exercise testing published in 2002,4 HCM is listed as a relative contraindication. However, in the ACC/European Society of Cardiology (ESC) expert consensus document on hypertrophic cardiomyopathy published in 2003,5 an abnormal exercise systolic blood pressure response is listed as a risk factor for sudden cardiac death in HCM. The exercise testing guidelines raise the issue of safety. Several reported series address this issue. The University of Minnesota group6 has exercised >3000 HCM patients over a period of 10 years with only 1 potentially fatal event, ie, exercise-induced sustained ventricular tachycardia that was successfully terminated with electric cardioversion. In addition, the Cleveland Clinic7 reported on 263 consecutive HCM patients who underwent exercise stress testing. Major complications occurred in 0.04% and minor events occurred in 23%. Major complications consisted of sustained ventricular tachycardia requiring direct-current cardioversion in 1 patient. Minor complications consisted of mild …
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Dec 31, 2017
Jung-Chul Lee + 2
Open Access