Exercise Testing In Men Research Articles

Prognostic value of risk factors and exercise testing in men with atypical chest pain

Of 551 men with atypical chest pain enrolled in the Seattle Heart Watch Study, annual follow-up over a 5- to 10-year period identified 36 persons who experienced a primary coronary heart disease event. Only three events were fatal, and they were in men over the age of 50. Cox's regression model confirmed a significant association of the conventional risk factors of smoking ( P = 0.03), elevated resting systolic blood pressure ( P = 0.02) and hypercholesterolemia ( P = 0.03) with primary coronary heart disease events. A count of these three variables was highly predictive ( P = 0.002). A positive family history was not predictive. Functional aerobic impairment ( P = 0.002) and ST depression ( P = 0.0003) were the most useful exercise predictors. In men who had neither risk factors nor abnormal exercise predictors, the percentage free of coronary events at 9 years was 96% compared to 76% in men with one or more of the abnormal exercise findings ( P < 0.0001). Of men with only risk factors, 86% remained free of events at 9 years. This study demonstrates that the evaluation of both risk factors and exercise responses enhances the prognostic evaluation of men with atypical chest pain. The classification of men into low-, medium- and high-risk groups can be easily accomplished in office practice.

Comparison of the results and reproducibility of arm and leg exercise tests in men with angina pectoris

The results and reproducibility of arm and leg exercise tests were compared in 11 men with angina pectoris induced by both forms of testing. Leg testing was performed using a bicycle ergometer; arm testing was performed using the same apparatus modified to permit arm cranking. Subjects performed 2 days of arm and 2 days of leg testing over a 2 week period. Four tests were performed on each test day. The duration of exercise, oxygen uptake, heart rate, systolic and diastolic blood pressures and the rate-pressure product were determined at the onset of angina. Within day and between day coefficients of variation were low and similar for arm and leg tests, indicating that both forms of testing are highly reproducible. Performing four tests on a single day did little to reduce variability. Oxygen uptake increased between the first and second arm or leg test on a single day, but there was little change after the second test. Repetition of the arm and leg tests did not affect performance over the study period. It is concluded that the reproducibility of arm exercise testing in men with angina pectoris is comparable with that of leg exercise. Subjects with angina induced by arm exercise who cannot perform leg testing can be evaluated and followed up with arm exercise tests.

Diagnostic quantification of CASS (coronary artery surgery study) clinical and exercise test results in determining presence and extent of coronary artery disease. A multivariate approach.

Multivariate linear discriminant function analysis on maximal exercise treadmill and angiographic data from 500 men with definite angina, 584 men with probable angina and 267 men with nonspecific chest pain identified independent predictors of presence and extent of coronary disease. We used the discriminant function to develop a clinical risk index and a clinical and exercise risk index for each patient subset. Probability curves were generated to predict the presence and extent of coronary disease. In definite angina cases, exercise testing provided more diagnostic information than clinical data alone. However, in the 10% of cases with the smallest risk indexes, half of the patients had coronary disease and one-quarter had multivessel disease. In men with probable angina, exercise testing added substantially more diagnostic information than clinical data. The probability of multivessel disease was reduced to less than 10% for 30% of patients with probable angina, an important diagnostic contribution. Exercise testing in men with nonspecific chest pain was of limited value because disease prevalence was already low.

Exercise testing in men with significant left main coronary disease.

The exercise tests of 26 male patients with significant left main disease were compared with those of 51 patients with three-vessel disease and 38 patients with two-vessel disease. Exercise-induced ischaemia (chest pain and/or greater than 1 mm ST segment change) occurred in 100 per cent of left main, 69 per cent of three-vessel, and 45 per cent of two-vessel disease patients. Though the mean peak work load was significantly higher in the two-vessel disease group than in those with three-vessel of left main disease, there was a wide overlap between groups. No intergroup differences were found in mean peak heart rates. In patients taking propranolol, no differences in mean peak work loads and heart rates were seen. The study showed that the absence of an exercise-induced abnormal electrocardiographic response virtually excludes left main disease. As judged by exercise performance, the presence of left main disease did not correlate with the severity of the patient's symptomatology. Propranolol did not influence the frequency of an ischaemic response in patients with left main or three-vessel disease.