Treadmill Exercise Testing In Patients Research Articles

Abstract 16944: Risk Stratification With Hemodynamic Gain Index and Peak Rate-Pressure Product in Patients With Chronic Heart Failure Undergoing Treadmill Exercise Testing

Introduction: We recently demonstrated the combined prognostic value of two simple non-invasive parameters obtained from treadmill exercise testing in patients with HFrEF, the hemodynamic gain index (HGI) and peak rate-pressure product (pRPP). However, their prognostic value is yet to be validated in patients with undifferentiated HF syndrome. Hypothesis: Both HGI and pRPP predict all-cause mortality in patients with chronic HF. Methods: We identified 126,356 consecutive patients undergoing treadmill exercise testing for HF symptom evaluation between 1/1991-2/2015. Patients with a confirmed diagnosis of HF were included. HGI was calculated from [(SBPpeak x HRpeak) - (SBPrest x HRrest)]/(SBPrest x HRrest), and pRPP was calculated from SBPpeak x HRpeak. Hazard ratios per doubling of HGI and pRPP for all-cause mortality were estimated using multivariable Cox regression models with adjustment for traditional cardiovascular risk factors and exercise testing parameters (chronotropic reserve index, METs, abnormal heart rate recovery, and total exercise time). Optimal cut-off for HGI and pRPP were determined by the Youden’s index. Kaplan-Meier plots with log-rank test across patients with low or high HGI and pRPP were used. Results: There were 5,940 patients with symptomatic HF diagnosis included in the analysis (mean age 56.2±12.4 years, 68.1% male, 46.5% with CAD, 55.8% with beta-blocker use). During the median follow up of 7.1 years, 2,222 (37.4%) patients died. Higher both HGI and pRPP were associated with a lower risk of mortality (hazard ratio 0.85 [0.81-0.90] and 0.72 [0.62-0.84], respectively, all P <0.001). Optimal cut-off values for HGI and peak RPP were 1.06 and 18,966, respectively. Figure 1 shows Kaplan-Meier plots across patients with low and high HGI and pRPP (log-rank P <0.001). Conclusions: Both HGI and pRPP are predictors of mortality in patients with chronic HF and can be used for prognostication and referral for advanced HF therapy evaluation.

The Ability of the Toe-Brachial Index to Predict the Outcome of Treadmill Exercise Testing in Patients with a Normal Resting Ankle-Brachial Index

Peripheral arterial disease (PAD) in the presence of a normal ankle-brachial index (ABI) can be diagnosed noninvasively by measuring a postexercise ABI or by measuring the toe-brachial index (TBI). This was a prospective comparative study. Over a period of 30months, a total of 415 patients who were referred with the suspicion of vascular claudication and resting values of 0.91≤ABI<1.40 were further evaluated for the resting TBI and postexercise ABI by treadmill testing. A total of 325 (39%) of the 830 investigated limbs had a low TBI (≤0.70), and 505 (61%) had a normal TBI. Of the limbs with a low TBI, 160 (49%) had PAD according to a postexercise ABI versus 165 (33%) of the limbs with normal TBI. The overall agreement in PAD classification between the two methods was 500/830 (60%) with a Cohen's kappa=0.166 (95% CI: 0.096-0.232). The data showed an inverse correlation between the magnitude of the TBI decrease, as well as the resting ABI, and the probability of an abnormal postexercise ABI. On average, limbs with a low TBI had a lower resting ABI than patients with a normal TBI (1.07±0.09 vs. 1.13±0.10, P<0.001). The groups with a low TBI had a significantly higher ratio of abnormal test results than patients with a normal TBI, in limbs with ABI (0.96-1.00) and ABI >1.10 (P≤0.022 for both), but there were no statistically significant differences found in other ABI intervals (P>0.200 for all). The magnitude of the TBI reduction correlates with an increased probability of an abnormal postexercise ABI. However, this is due in part to limbs with a low TBI having a lower resting ABI on average than limbs with a normal TBI, which also correlates with the probability of an abnormal exercise test result. This study shows that the TBI and the postexercise ABI are not interchangeable for establishing a PAD diagnosis.

GW28-e0245 Diagnostic Value of Treadmill Exercise Test in Patients with Syncope

GW28-e0245 Diagnostic Value of Treadmill Exercise Test in Patients with Syncope

The Characteristics and Risk Factors of Treadmill Exercise Test in Patients with Myocardial Bridging

Objective: To investigate the value of the treadmill exercise test for guiding the clinical therapy of myocardial bridging (MB) patients. Methods: We retrospectively analyzed the treadmill exercise test (TET) results of 70 patients with MB and their electrocardiography (ECG) characteristics then evaluated the relationship between the TET results and the patients’ clinical characteristics, including sex, age, bridge length, and the degree of bridge compression. Results: There were 27 patients (38.6%) with a positive TET, 31 (44.3%) negative, and 12 (17.1%) probably positive. For positive and probably positive patients, 31 patients had ECGs that shared similar ST segments depression in II, III and avF leads with or without V4-6 segments depression. Male patients had a higher TET positive rate than female patients. No relationships were found between the bridge length, bridge compression and TET results. Additionally, no relationships were identified between hypertension, diabetes, hyperlipemia, smoking, age and TET results. Conclusions: The main ECG characteristics of patients with MB whose TET results were positive were II, III, and avF ST-T segment depression with or without V4-6 segment depression. Male patients had higher TET positive rates than female patients. No relationships were identi ed between the bridge length, bridge compression and the TET results.

A new method for evaluation of the autonomic nervous system in patients with idiopathic hyperhidrosis: systolic blood pressure and heart rate recovery after graded exercise.

Idiopathic hyperhidrosis (IH) is characterized by excessive and uncontrolled production of sweat, mainly localized to the soles, palms, axillae and craniofacial area. Although IH is a disease concerning the autonomic nervous system, it is not clear yet whether this dysfunction is local or systemic. To evaluate the autonomic control of cardiovascular system by measuring values of heart rate recovery (HRR) and systolic blood pressure recovery (SBPR) obtained at various time intervals after maximal graded exercise treadmill testing in patients with IH compared with controls. The study population comprised 36 patients with IH (20 men, 16 women; mean age 25 ± 7 years) and 36 healthy controls (HCs) (12 men, 24 women; mean age 27 ± 5 years). All patients were selected from young, nonobese and healthy sedentary individuals. Peak HR values reached in patients with IH were significantly higher compared with the HC group (P < 0.001). The obtained HRR values at minutes 3, 4 and 5 were significantly lower in the IH than the HC group [57 ± 16 vs. 64 ± 9 (P = 0.03); 61 ± 14 vs. 68 ± 9 (P = 0.03); 64 ± 12 vs. 70 ± 7 (P < 0.01)]. In addition, calculated mean values for SBPR1 and SBPR2 were > 1 in patients with IH (1.04 ± 0.15 vs. 0.98 ± 0.08 and 1.0 ± 0.12 vs. 0.94 ± 0.06, respectively) and these were statistically significant compared with the HC group (P = 0.04 and P = 0.03, respectively). The significantly impaired SBPR and decreased HRR values we observed in patients with IH may indicate that the autonomic dysfunction in IH is a systemic disorder with cardiovascular effects, rather than a merely local disease. Both HRR and SBPR values may provide additional information about predicting adverse cardiovascular events in the future even in apparently healthy young patients with IH.

Related factors for heart rate recovery after treadmill exercise testing in patients with nonalcoholic fatty liver disease

Related factors for heart rate recovery after treadmill exercise testing in patients with nonalcoholic fatty liver disease

PT127 Study of Diagnostic Accuracy of QRS Score During Treadmill Exercise Testing in Patients With Coronary Artery Disease in Bangladesh

PT127 Study of Diagnostic Accuracy of QRS Score During Treadmill Exercise Testing in Patients With Coronary Artery Disease in Bangladesh

Fragmented QRS Is Associated with Improved Predictive Value of Exercise Treadmill Testing in Patients with Intermediate Pretest Likelihood of Significant Coronary Artery Disease.

The predictive value of exercise treadmill testing (ETT) remains inadequate in diagnosing patients with suspected coronary artery disease (CAD) and needs to be improved. The aim of this study was to investigate whether the presence of FQRS on 12-lead ECG would increase the PPV of ETT in patients with an intermediate likelihood of CAD. fQRS, defined as the presence of notched R or S waves without accompanying typical bundle branch block or the existence of an additional wave-like RSR' pattern in the original QRS complex (with a duration of <120 ms), was assessed in 95 patients with positive ETT. Coronary angiogram (CA) was performed in all patients, divided into two groups as the significant CAD group and nonsignificant CAD group according to coronary artery lesions. The differences between the groups in terms of the presence of fQRS and clinical characteristics were investigated. The mean age of patients was 51.3 ± 11.3 years, and 74 of them were males (77.9%). FQRS was present in 47 (49.5%) patients, and significant CAD was demonstrated in 51 subjects (53.7%) among the enrolled subjects. fQRS was more prevalent in the significant CAD group compared to nonsignificant CAD group (P < 0.001). The presence of FQRS increased the PPV of positive ETT from 53.7% to 85.1%. In addition, FQRS was associated with the increased risk of significant CAD in multivariate analysis (OR = 2.839, P < 0.001). In clinical practice, the presence of fQRS in patients with positive ETT may support clinicians during the decision-making process with regard to the referral for a coronary angiography.

OP-106 Higher Red Cell Distribution Width Values is Associated with Impaired Exercise Capacity During Exercise Treadmill Testing in Patients with Non-Obstructive Coronary Artery Disease

OP-106 Higher Red Cell Distribution Width Values is Associated with Impaired Exercise Capacity During Exercise Treadmill Testing in Patients with Non-Obstructive Coronary Artery Disease

研究 非閉塞性肥大型心筋症例におけるtreadmill運動負荷時の血圧反応と心機能の関連:心房ペーシングによる検討

研究 非閉塞性肥大型心筋症例におけるtreadmill運動負荷時の血圧反応と心機能の関連:心房ペーシングによる検討

Comportamento da hiperinsuflação dinâmica em teste em esteira rolante em pacientes com DPOC moderada a grave

To characterize the presence, extent, and patterns of dynamic hyperinflation (DH) during treadmill exercise testing in patients with moderate to severe COPD. This was a cross-sectional study involving 30 non-hypoxemic patients (FEV1= 43 ± 14% of predicted) who were submitted to a cardiopulmonary exercise test on a treadmill at a constant speed (70-80% of maximum speed) to the tolerance limit (Tlim). Serial inspiratory capacity (IC) maneuvers were used in order to assess DH. Of the 30 patients studied, 19 (63.3%) presented with DH (DH+ group), having greater pulmonary function impairment at rest than did those without DH (DH- group). None of the variables studied correlated with exercise tolerance in the DH- group, whereas Tlim, IC, and perception of dyspnea during exercise did so correlate in the DH+ group (p < 0.05). In the DH+ group, 7 and 12 patients, respectively, presented with a progressive and a stable pattern of DH (ΔIC Tlim,2min = -0.28 ± 0.11 L vs. 0.04 ± 0.10 L; p < 0.01). Patients with a progressive pattern of DH presented with higher perception of dyspnea/Tlim rate and lower exercise tolerance than did those with a stable pattern (354 ± 118 s and 465 ± 178 s, respectively; p < 0.05). The presence of DH is not a universal phenomenon during walking in COPD patients, even in those with moderate to severe airflow limitation. In the patients who presented DH, a progressive pattern of DH had a greater impact on exercise tolerance than did a stable pattern of DH.

Exercise blood pressure response and perioperative complications after major vascular surgery

Earlier studies have shown that hypertensive or hypotensive blood pressure (BP) response during a preoperative treadmill exercise test in patients with peripheral arterial disease is associated with a two-fold increased risk of cardiovascular events and mortality. However, it is unknown if these patients also experience an increased perioperative complication risk at major vascular surgery. In total 665 consecutive patients with peripheral arterial disease underwent elective major vascular surgery (carotid endarterectomy, abdominal aorta repair, or lower extremity revascularization). Perioperative complications (infection, myocardial infarction, angina pectoris, cardiac arrhythmia, heart failure, cerebrovascular accident or spinal cord ischemia, dialyses, amputation, thrombectomy, reoperation or death) were defined as occurring within 30 days after surgery and were collected using medical records. Hypertensive BP response was defined as a difference between exercise systolic BP and resting systolic BP of more than 55 mmHg. Hypotensive BP response was defined as a drop in exercise systolic BP below resting systolic BP. Patients with a hypertensive BP response during a preoperative exercise test (n = 66) showed a higher risk of early perioperative thrombectomy [hazard ratio (HR) 2.80 95% CI (1.24-6.33)] compared with patients with a normal BP response (n = 582). Patients with a hypotensive BP response (n = 18) showed an increased risk of perioperative myocardial infarction [HR 3.69 95% CI (1.08-12.64)] and cardiac complications [HR 2.90 95% CI (1.02-8.19)] compared with patients with a normal BP response. Patients with an abnormal BP response have more cardiovascular complications at elective major vascular surgery.

Exercise treadmill testing in patients with claudication, with and without diabetes

To compare symptoms and walking capacities of patients with and without diabetes reporting vascular-type claudication. We recorded self-reported maximal walking distance, maximal walking distance on treadmill test (3.2 km h(-1) , 10% slope), exercise transcutaneous oxygen pressure DROP index [limb transcutaneous oxygen pressure (TcpO2) changes from rest minus chest TcpO2 changes from rest] and symptoms on treadmill in 230 patients with diabetes and 982 patients without diabetes. Exercise-induced proximal and distal symptoms were analysed in the perspective of underlying proximal and distal ischaemia (DROP value < negative 15 mmHg). Self-reported maximal walking distance did not differ between groups, whereas maximal walking distance on treadmill test was lower in patients with diabetes vs. patients without diabetes (261 ± 257 and 339 ± 326 m, respectively; P < 0.05 when adjusted for potential confounders). In patients with ischaemia, the number of ischaemic areas (proximal and/or distal on right and/or left) was comparable between the two groups. Patients with diabetes had more distal ischaemia than patients without diabetes (38 vs. 29%, respectively; P < 0.01), whereas proximal ischaemia was similar between groups. The prevalence of lower-limb exercise-related symptoms without ischaemia was comparable between groups. There were more symptoms other than lower-limb pain in patients with diabetes than patients without diabetes (29.6 vs. 18.3%, respectively; P < 0.01). Patients with diabetes show more severe limitation on the treadmill and more non-limb symptoms than patients without diabetes, although self-reported walking capacity is comparable between the two groups. Using TcpO2, we confirm that patients with diabetes reporting claudication show more distal ischaemia than patients without diabetes, with no difference at the buttock level. Treadmill testing is of interest in patients with peripheral artery disease and diabetes.

Diagnosis value of QTc variation during treadmill exercise test in patients with suspicious positive results of coronary heart disease

Diagnosis value of QTc variation during treadmill exercise test in patients with suspicious positive results of coronary heart disease

Diagnosis value of QTc variation during treadmill exercise test in patients with suspicious positive results of coronary heart disease

Diagnosis value of QTc variation during treadmill exercise test in patients with suspicious positive results of coronary heart disease

Relation of Plaque Characteristics Defined by Coronary Computed Tomographic Angiography to ST-Segment Depression and Impaired Functional Capacity During Exercise Treadmill Testing in Patients Suspected of Having Coronary Heart Disease

Sixty-four-detector-row coronary computed tomographic angiography (CCTA) has been proposed for the evaluation of low- to intermediate-risk patients with suspected coronary artery disease (CAD). Historically, exercise treadmill testing (ETT) measures of ST-segment depression (STD) and the Duke treadmill score (DTS) have been used to evaluate myocardial ischemia and functional capacity. The relation of plaque characteristics on CCTA to STD and DTS is unknown. In this study, 156 low- to intermediate-risk patients without known CAD who underwent ETT and CCTA were evaluated. By ETT, 22% (n = 35) had STD and 27% (n = 42) had abnormal DTS. On CCTA, 21% (n = 33) had obstructive CAD (>or=70% stenosis) and 49% (n = 77) had nonobstructive CAD (<70% stenosis). Forty-six percent of patients (n = 16) with and 15% (n = 15) without STD had obstructive CAD. After multivariate adjustment, only age and obstructive CAD on CCTA predicted STD (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.08 to 2.34 per decade, and OR 3.38, 95% CI 1.32 to 8.64, respectively) and abnormal DTS (OR 1.61, 95% CI 1.14 to 2.28, and OR 4.67, 95% CI 1.97 to 11.03, respectively). After adjustment for age, more coronary segments with mixed plaque, in contrast to calcified or noncalcified plaque, predicted STD (OR 1.48, 95% CI 1.18 to 1.85) and abnormal DTS (OR 1.30, 95% CI 1.05 to 1.61). In conclusion, measures of plaque on CCTA identify patients more likely to have STD and higher risk DTS, while providing incremental diagnostic yield for the detection of obstructive CAD beyond ETT.

An Externally Validated Model for Predicting Long-Term Survival after Exercise Treadmill Testing in Patients with Suspected Coronary Artery Disease and a Normal Electrocardiogram: Lauer MS, Pothier CE, Magid DJ, et al. Ann Intern Med 2007;147:821–8

An Externally Validated Model for Predicting Long-Term Survival after Exercise Treadmill Testing in Patients with Suspected Coronary Artery Disease and a Normal Electrocardiogram: Lauer MS, Pothier CE, Magid DJ, et al. Ann Intern Med 2007;147:821–8

In patients with suspected CAD and normal ECG, a nomogram model based on clinical and exercise variables predicted mortality

Source Citation Lauer MS, Pothier CE, Magid DJ, Smith SS, Kattan MW. An externally validated model for predicting long-term survival after exercise treadmill testing in patients with suspected coronary artery disease and a normal electrocardiogram. Ann Intern Med. 2007;147:821-8. 18087052

Depressive Symptoms Predict Heart Rate Recovery After Exercise Treadmill Testing in Patients With Coronary Artery Disease: Results From the Psychophysiological Investigations of Myocardial Ischemia Study

Depression is associated with increased risk of death among patients with coronary disease. Cardiovascular autonomic dysregulation may be one of the mechanisms by which depression exerts its effects on cardiovascular function. The purpose of this study was to determine whether depressive symptoms are associated with low heart rate variability (HRV) and prolonged HR recovery after exercise testing in patients with coronary artery disease (CAD). The Psychophysiological Investigation of Myocardial Ischemia (PIMI) was a large, multicenter study designed to assess psychological and physiological correlates of stress in patients with CAD. One hundred and eighty-eight patients with CAD as evidenced by at least 50% blockage of one major artery and a previous positive exercise stress test were included in this study. Patients included in this report were not taking beta blockers. Cardiovascular functioning was assessed by a modified Bruce protocol treadmill stress test. Measures of psychological functioning, including the Beck Depression Inventory (BDI), were also obtained. BDI scores were negatively correlated with HR recovery (r = -0.15, p = .04). Depression scores accounted for 3.5% of the variance in HR recovery when controlling for participant age (p < .01). Depressive symptoms were related to two HRV indices (ultra-low frequency, high frequency). Depressive symptoms are associated with cardiovascular autonomic nervous system dysfunction as assessed by HR recovery. This relationship is not merely due to an association of depression severity with beta blocker usage or a failure of depressed patients to achieve an adequate chronotropic response.

An Externally Validated Model for Predicting Long-Term Survival after Exercise Treadmill Testing in Patients with Suspected Coronary Artery Disease and a Normal Electrocardiogram

The exercise treadmill test is recommended for risk stratification among patients with intermediate to high pretest probability of coronary artery disease. Posttest risk stratification is based on the Duke treadmill score, which includes only functional capacity and measures of ischemia. To develop and externally validate a post-treadmill test, multivariable mortality prediction rule for adults with suspected coronary artery disease and normal electrocardiograms. Prospective cohort study conducted from September 1990 to May 2004. Exercise treadmill laboratories in a major medical center (derivation set) and a separate HMO (validation set). 33,268 patients in the derivation set and 5821 in the validation set. All patients had normal electrocardiograms and were referred for evaluation of suspected coronary artery disease. The derivation set patients were followed for a median of 6.2 years. A nomogram-illustrated model was derived on the basis of variables easily obtained in the stress laboratory, including age; sex; history of smoking, hypertension, diabetes, or typical angina; and exercise findings of functional capacity, ST-segment changes, symptoms, heart rate recovery, and frequent ventricular ectopy in recovery. The derivation data set included 1619 deaths. Although both the Duke treadmill score and our nomogram-illustrated model were significantly associated with death (P < 0.001), the nomogram was better at discrimination (concordance index for right-censored data, 0.83 vs. 0.73) and calibration. We reclassified many patients with intermediate- to high-risk Duke treadmill scores as low risk on the basis of the nomogram. The model also predicted 3-year mortality rates well in the validation set: Based on an optimal cut-point for a negative predictive value of 0.97, derivation and validation rates were, respectively, 1.7% and 2.5% below the cut-point and 25% and 29% above the cut-point. Blood test-based measures or left ventricular ejection fraction were not included. The nomogram can be applied only to patients with a normal electrocardiogram. Clinical utility remains to be tested. A simple nomogram based on easily obtained pretest and exercise test variables predicted all-cause mortality in adults with suspected coronary artery disease and normal electrocardiograms.