Master Two-step Test Research Articles

Prognostic significance of preoperative exercise tolerance in patients with early-stage lung cancer

ObjectiveTo investigate the influence of simple preoperative exercise tests as prognostic factors for early-stage lung cancer. MethodsThis single-institution retrospective study included consecutive patients who underwent pulmonary resection for stage 0 to I lung cancer between April 2017 and December 2019. Before surgery, 7 metabolic equivalents of task in the double Master 2-step test were loaded into the exercise echocardiogram. The relationship between prognosis and exercise stress test results in terms of availability, symptoms, and saturation of percutaneous oxygen was investigated. ResultsThis study included 862 patients with pathological stage 0 to I lung cancer. Among the 862 patients, 673 patients (78.1%) who were able to complete 7 metabolic equivalents of task exercise for 3 minutes without assistance were classified into the complete group. The 5-year survival of the complete group was significantly better than that of the incomplete group. Multivariable analysis revealed that age (hazard ratio, 1.06; P = .008), male sex (hazard ratio, 2.23; P = .011), carcinoembryonic antigen level >5 ng/mL (hazard ratio, 2.33; P = .011), and inability to complete 7 metabolic equivalents of task exercise (hazard ratio, 3.90; P < .001) were the prognostic factors. Patients in the older group who had the ability to complete exercise had a better prognosis than those in the younger group without the ability (P = .003). ConclusionsPreoperative exercise ability is a prognostic factor for early-stage lung cancer. Patients who can tolerate an exercise load of 7 metabolic equivalents of task, even if they are aged 70 years or older, have a better prognosis than patients younger than age 70 years without exercise tolerance.

Comparison of master two-step exercise stress test versus six-min walk test in patients tested positive for SARS-CoV-2.

There has been a lack of uniformity on how to triage coronavirus disease 2019 (COVID-19) patients visiting the emergency units of hospitals. Triage tools are themselves spreading the pandemic in hospital areas. The present study compared a master two-step (M2ST) exercise stress test versus a 6-min walk test (6MWT) in COVID-19-positive patients visiting the emergency unit of a hospital. Thirty-nine patients underwent 6MWT followed by M2ST, while another set of 38 patients underwent M2ST followed by 6MWT in this randomized, crossover, open-label, and noninferiority study. The exercise tests assessed the change from baseline in SpO2, heart rate (HR), respiratory rate, blood pressure, exertion, and dyspnea on the modified-Borg scale. Noninferiority was established for SpO2 (P < 0.05), systolic blood pressure (SBP; P < 0.001), and diastolic blood pressure (DBP; P < 0.05), but not for HR (P = 0.3) and respiratory rate (P = 0.6). The difference between the pretest and posttest (delta change) values for the parameters SpO2, respiratory rate, HR, SBP, and DBP correlated significantly (P < 0.001) with Pearson correlation coefficient (r = 0.764, 0.783, 0.473, 0.838, and 0.783, respectively). The delta change values of modified-Borg scale for dyspnea (P = 0.291) and exertion (P = 0.208) were statistically insignificant between the two exercise tests. However, the correlation between the tests was statistically significant (P < 0.001). M2ST, a timesaving, cost-effective, and easy to perform exercise stress test, has been identified as a reliable alternative for 6MWT.

Simple exercise echocardiography using a Master's two-step test for early detection of pulmonary arterial hypertension

BackgroundEarly detection of pulmonary arterial hypertension (PAH) is indispensable, although, echocardiography at rest alone does not provide sufficient evidence for it. Here, this study aimed to investigate the usefulness of simple exercise echocardiography using a Master's two-step test for detecting early PAH. MethodsThis study included 52 connective tissue disease patients who had mild symptoms in World Health Organization functional classification 2, suspected as having early PAH, and underwent exercise echocardiography and right heart catheterization. Echocardiography was performed before and after the Master's two-step exercise test; the study patients were classified into the non-PAH (mean pulmonary arterial pressure<25mmHg, n=37) or PAH (mean pulmonary arterial pressure≥25mmHg, n=15) groups. ResultsRest systolic pulmonary artery pressure estimated using echocardiography did not significantly differ between the two groups; however, a significant difference in post-exercise systolic pulmonary artery pressure was found (non-PAH, 58.8±10.8mmHg; PAH, 80.2±14.3mmHg, p<0.0001). The multiple logistic regression analysis indicated post-exercise systolic pulmonary artery pressure as an independent predictor of PAH (p=0.013). The area under the curve by post-exercise systolic pulmonary artery pressure was 0.91 for PAH. Post-exercise systolic pulmonary artery pressure≥69.6mmHg predicted PAH with the sensitivity of 93% and the specificity of 90%. ConclusionsSimple exercise echocardiography using the Master's two-step test could detect PAH in mildly symptomatic connective tissue disease patients. The usefulness of this method should be verified for the early detection of PAH.

J-Point Elevation Induced by Double Master Two-Step Test

J-Point Elevation Induced by Double Master Two-Step Test

A new screening method to diagnose coronary artery disease using multichannel magnetocardiogram and simple exercise.

Magnetocardiography (MCG) is a non-contact mapping technique to record cardiac action currents. The Master's two-step electrocardiogram (ECG) test is a simple exercise method for screening coronary artery disease (CAD), but it is inadequate concerning the sensitivity. Our aim was to develop a new screening method using multichannel MCG instead of ECG. Thirty subjects (aged 54 +/- 16 years, 27 males), 17 of whom had CAD confirmed by coronary angiography, underwent the Master's exercise ECG test. After the exercise, MCG signals were acquired every minute during recovery with a 64-channel MCG system (MC-6400, Hitachi Ltd). We integrated tangential components of the MCG signals within QRS (during 20, 40, 80, and 120 ms centering on R-wave peak) immediately after exercise (Iex) and 5 minutes after exercise (Irec). The exercise-induced change of currents [(Iex-Irec)/Irec] was determined and normalized for each channel, and the maximal change among 64 channels, maximal QRS integral change, was used as a diagnostic index for myocardial ischemia. The maximal QRS integral change during 40 ms was significantly higher in the CAD group than in the control group (0.81 +/- 0.51 vs. 0.36 +/- 0.19, p < 0.01). A sensitivity and specificity for predicting CAD by the change > 0.44 were 82 % and 85 %, respectively, yielding a diagnostic accuracy of 83 %. The conventional Master's ECG test identified the CAD patients with a diagnostic accuracy of 63 % (sensitivity 47 %, specificity 85 %). The Master's two-step exercise test with a 64-channel MCG system showed the high diagnostic accuracy, despite of non-contact recording and simple exercise. The magnetic field in the depolarization process has the potential to detect the subtle myocardial ischemia induced by exercise.

Mental stress test is an effective inducer of vasospastic angina pectoris: comparison with cold pressor, hyperventilation and master two-step exercise test

Background: Cold pressor, hyperventilation and exercise stress tests were usually used for inducing an angina attack in patients with vasospastic angina pectoris. We induced vasospastic angina attack using the mental calculation stress test, and compared the results with those using other stress tests. Subjects and methods: Subjects were 29 patients with vasospastic angina pectoris. Their ages were 60.8±8.4 years. Coronary vasospasm was induced by an acetylcholine infusion test during coronary angiography. The mental stress test was performed as follows; after memorizing six digits numbers, they repeated these numbers in reverse for 5 min, and performed serial subtraction of 17 from 1000 for 5 min. Blood pressure, heart rate and ECG were recorded every 1–5 min during the mental stress test. The serum concentrations of epinephrine and norepinephrine were measured before and during the mental stress test. We compared these results with those obtained using cold pressor, hyperventilation and the Master two-step exercise stress test. Results: (1) Eight of the 29 patients (28%) showed ischemic ST–T change, which was caused by the mental stress test. (2) The increase in norepinephrine was greater in patients with an ST–T change than without an ST–T change (0.11±0.06 vs. 0.04±0.04 ng/ml, P<0.01). (3) The incidence of the ST–T change caused by the mental stress test (28%) was similar to the cold pressor test (27%) and greater than that caused by the hyperventilation test (13%). The incidence of ST–T change caused by the Master two-step test was 55%. Conclusions: The mental stress test is an effective inducer of vasospastic angina attack, and attack may be induced by neurohumoral vasoconstrictive reflex and/or increased left ventricular afterload.

A simple, reliable method of assessing exercise capacity in patients with chronic heart failure.

The accurate determination of limitations in physical activity is important in evaluating patients with heart failure and in assessing the efficacy of treatment. However, the conventional measures used to evaluate hemodynamics, functional class, and exercise capacity all have limitations. Our objective was to develop a simple method (The Master-Borg test) for evaluating the physical activity of patients with chronic heart failure using self-evaluation of the sensation of dyspnea at a constant workload. Patients with NYHA class I (N = 20), class II (N = 20), and class III (N = 20) chronic heart failure performed a symptom-limited treadmill exercise test to determine peak VO2 and anaerobic threshold (AT). Patients subsequently performed Master's two-step test for 90 s and maximal dyspnea was self-rated using the visual analog Borg scale (the Master-Borg test). The mean workload in the Master-Borg test was 15.2+/-1.6 mL x min(-1) x kg(-1). A significant correlation was found between the Master-Borg score and peak VO2 (r = 0.87) or AT (r = 0.84). The reproducibility of the Master-Borg tests was represented by a correlation coefficient of 0.93. Although simple and inexpensive, the Master-Borg test accurately represents ordinary activity levels, relates the sensation of dyspnea to peak exercise tolerance, and can be completed by most patients with heart failure. Master-Borg scores correlated with peak VO2 and AT, and can differentiate among NYHA classes I, II, and III. The Master-Borg test appears to be clinically useful for evaluating the value of physical activity and exercise capacity of patients with chronic heart failure.

Hemodynamic characteristics of patients with coronary artery disease presenting false-negative exercise stress test.

The present study was designed to clarify the characteristics of left ventricular hemodynamics and coronary arteries in patients with coronary artery disease presenting false-negative response to the Master's two-step stress test. Eighty-eight consecutive patients performed the Master's two-step stress test and had coronary angiography for evaluation of suspected or known coronary artery disease. The frequency of false-negative and true-positive responses in the Master's two-step stress test was 20% and 45%, respectively. Elevated left ventricular end-diastolic pressure, reduced ejection fraction, and low cardiac output characterized the left ventricular hemodynamics in patients with false-negative responses, as compared with those with true-positive response. The severity and extent of coronary artery disease, as well as prior myocardial infarction, did not affect the frequency of false-negative response. This study indicates that the false-negative response to the Master's two-step test is unexpectedly frequent in coronary artery disease with severe left ventricular dysfunction. Thus, one should be careful in judging the results of the Master's two-step test in symptomatic patients with severe left ventricular dysfunction.

Ambulatory monitoring of indirect beat-to-beat arterial pressure in human fingers by a volume-compensation method

Using a volume-compensation technique, a portable device has been designed for the indirect measurement of beat-to-beat arterial pressure and its waveforms in the basal phalanx of fingers of ambulatory subjects. The device consists of (1) a transmission infra-red photoelectric plethysmograph (TIPP) to detect the variation of arterial volume, (2) a pneumatic cuff with an actuator, (3) a servosystem to control the cuff pressure, and (4) a stereo cassette tape recorder. Arterial pressure was determined from the cuff pressure which was controlled by the servosystem so as to maintain the arterial volume constant at the 'vascular unloading' state. This device is equipped with a compensator for any hydrostatic pressure difference between the heart and finger. Thus, the blood pressure at heart level can be obtained for any finger height. The total weight of the device was 1.6 kg. Blood pressure changes during walking, jogging, jumping, and exercises such as side-stepping, Master's two-step test and car driving, have been successfully recorded.

Nasal resistance in school children and students

In terms of the nozzle active anterior rhinomanometry, nasal resistance was measured in 297 school children and students with no history of nasal and respiratory diseases (151 males and 146 females), aged 6 to 17 years. Nasal resistance was evaluated at rest and after physical exercise. Single master two-step test was employed as physical exercise. Then, the relationships among the nasal resistance, age and the effect of exercise were studied. Subjects were divided into four groups by means of nasal resistance at rest and their response to the physical exercise: the age of 6 to 8, 9 to 11, 12 to 14 and 15 to 17 years. 1) Nasal resistance at rest From 6 to 8 years, nasal resistance was very high. This high value may be due to the large anatomical size of their adenoid. From 9 to 11 years, the older the age was, the smaller the nasal resistance became. The difference between mean values of the nasal resistance of 9 and 11 year old children was statistically significant. However, from 12 to 14 years, nasal resistance once increased and then decreased again during this particular period. This chronological change of resistance may be contributed to the discrepancy of the anatomical maturation of the nasal structure. That is, the nasal turbinates seems to develop prior to the growth of the nasal frame work. Therefore nasal air passage may relatively be narrow until the nasal frame work is well developed. This transient increment of nasal resistance was statistically significant. Thereafter, from 15 to 17 years, nasal resistance was continuously decreased and approaching to the adult value. 2) Effect of physical exercise From 10 to 14 years, nasal resistance was significantly decreased after physical exercise. From 6 to 7 and 15 to 17 years, changes after exercise were unpredictable. This may be attributed to the prematurity of the autonomic nervous system in 6 to 7 years and the instability of autonomic control in 15 to 17 years. These results suggest that the autonomic nervous system gives much influence to the regulation of the nasal resistance.

A Simplified Master's Two‐Step Test for Preschool Children: A Preliminary Report

AbstractTo investigate a simplified Master's two‐step test (MTT) for preschool children aged 4 to 6 years exercise tests with new stairs, with risers 18 cm and 20 cm high, were employed. The subjects were 162 preschool children who were divided into four groups according to the height of the riser and the number of steps taken (60 and 72 steps per 3 minutes).In these tests, the 4‐year‐old children obtained similar mean heart rates immediately after exercise (156.9 to 161.6 BPM) in spite of different exercise tests, and the 5‐ and 6‐year‐old children obtained significantly higher mean heart rates (166.0 and 162.1 BPM, respectively) in the test with a 20 cm riser taking 72 steps. If a single protocol is to be used for children aged 4 to 6, the test with a 20 cm riser and taking 72 steps seems to be the best with reference to the achieved heart rates and performance ratios.

Cardiovascular Responses During Ordinary Activities in Healthy Subjects

Heart rate, systolic blood pressure, and oxygen uptake were measured in nine healthy subjects during ordinary activities, using an ambulatory blood pressure monitoring system and a device to measure oxygen consumption. The activities were standard exercise tests (treadmill, cycle ergometer, weight holding, and the Master two-step exercise test), three different ways of carrying a 10-kg weight, activities in a squatting posture, climbing stairs with and without a pause, desk work, and painting a wall. The activities with isometric components, such as holding a weight, carrying a weight in one hand, activities performed in a squatting posture, and climbing stairs without a pause, elicited a more prominent blood pressure response than dynamic exercise, such as treadmill walking. When the work intensity of ordinary activities is considered, blood pressure must be taken into account as well as heart rate, oxygen uptake, or both, and patients with ischemic heart disease should be advised to avoid activities with isometric components that can cause an unexpected increase in myocardial oxygen consumption.

Exercise-induced QRS axis shift and its clinical significance.

Exercise tests occasionally induce a QRS axis shift. Reviewing single Master's two-step test electrocardiograms of 1810 patients, we examined the incidence of the QRS axis shift and the relations of the QRS axis shifts to ischemic heart disease. The QRS axis shift was 30 degrees or more to the right in 38 (2.1%), 15 to 29 degrees to the right in 304 (16.8%), less than 15 degrees to the right or to the left in 1375 (75.9%), 15 to 29 degrees to the left in 81 (4.5%), and 30 degrees or more to the left in 12 patients (0.7%). The frequency of positive Master's tests and clinical ischemic heart disease were both significantly greater in the patients with QRS axis shifts of 30 degrees or more to the right (15.8% and 26.3%, respectively) and the patients with those of 30 degrees or more to the left (33.3% and 50.0%, respectively) than in the patients with shifts less than 15 degrees (6.5% and 8.5%, respectively). These results indicate that the exercise-induced QRS axis shift is a useful clue for the diagnosis of ischemic heart disease.

第14回日本総合健診医学会学術大会講演抄録 血圧の変動―健診時心電図運動負荷前後の血圧変動を中心として―

第14回日本総合健診医学会学術大会講演抄録 血圧の変動―健診時心電図運動負荷前後の血圧変動を中心として―

Preventive Medicine and Preventive Law: An Essay That Belongs to My Heart

This essay reflects my experiences as an open heart surgery patient. It also makes some comparisons of the roles of lawyers and doctors. The skills of the medical profession in pursuing the concept of preventive medicine have for more than three decades stirred my interest in developing the concept of preventive law.As is my custom, aided by the good practices of my personal physician for a decade, I received an annual medical examination on Tuesday, June 8, 1982. The preliminary results were reported to me with the customary comment that I would receive the complete results in a few days. I did notice a slight downcast expression on the good doctor's face as he looked at the electrocardiogram, but I remained silent. The E.K.G. included a four-minute bicycle exercise. For most previous years, the exercise was the Master's two-step test so I did not have a good basis of comparison of this year's test with my previous E.K.G.s. I excused the slight difference that I felt this year on the basis that each year I am getting older.

独協学園における循環器疾患の健康管理に関する研究 ＩＩ 健診成績の経時的観察

Health and clinical examinations of circulatory organs on 1, 400 high-school boys aged 12 to 17 years have been conducted from 1967 to 1981. The followed up data of health examination and clinical tests of cardiovascular disorders were analyzed, and the following conclusions were obtained. 1. Annual Fluctuation of Blood Pressure (observed number: 1, 061) 1) The annual blood pressure fluctuation are shown differently in high and low pressure groups which are divided at 120mmHg of systolic pressure and 70mmHg of diastolic pressure. In the higher blood pressure group, many boys had rather lower pressures at the second year than at the first year, while many boys in the lower blood pressure group had rather higher pressures at the last than at the former. It seems roughly that blood pressures in both groups are gathering to the average of the group. 2) Using both a erage blood pressures and the standard deviations in data for two years, the boys were categorized into three groups according to their blood pressure levels: high blood pressure groups (2.0%), increasing blood pressure group (1.1%), and decreasing blood pressure group (1.3%). 3) The incidence of families with a positive history of hypertension was significantly higher for the high blood pressure group than for the normal blood pressure and low blood pressure groups, thus suggesting that genetic factors give also school-age males some loading of the high blood pressure disposition. 2. Development of Ventricular Conduction Defect in 931 Boys Followed up. 1) After three years' observation, percentage figures for persistent fixation of cardiac ventricle conduction defect were obtained 83.3% for CRBBB, 62.5% for IRBBB, and 43.8% for IRBBB (R>R'), with a clear tendency for the more serious codes to be more fixed. 2) The number of improved cases (39.1%) was greater than that of the deteriorated (19.6%). Such a difference is more evident in cases with a short history of the disease, (improving group: 29.4% and deteriorated group: 8.8%). 3. Time-Course Results of A-V Conduction Defect (observed number: 1, 396) 1) Three years' observation showed that the incidence of I A-V block was 0.64%, WPW syndrome 0.14%, and P-R shortening 0.07%. 2) The fluctuations of this defect in the course of time showed that the unchangeable type with a constant code was 59.7%, the improving type whose symptoms disappered completely was 22.6%, and the subjects newly developping the condition was 17.7%. 3) The results of Master's two-step test (double) conducted for I A-V block (observed number: 22) (except for temporary and intermittent cases) showed that the improving type in which the P-R interval tends to be shorter after physical exertion accounted for 77.3%, while the deteriorating type in which this interval tends to be longer after physical exertion for accounted for 9.1%.

A double Master's two-step test: Correlations of patients with collaterals and those without collaterals

A double Master's two-step test: Correlations of patients with collaterals and those without collaterals

A-V block and A-V dissociation in electrocardiographic surveys of middle school students.

(1) ECG surveys were performed on 12,523 middle school students. The incidence of A-V block was 0.04% (0.37% in males and 0.43% in females). The incidence of A-V dissociation was 0.11% (0.09% in males and0.13% in females). (2) There was no case of Mobitz type II or complete A-V block in this survey. (3) Sixty-four school students were picked at random from the students with A-V block who had been diagnosed by ECG surveys during the last there years and were given the Master's two-step test. The following four types of response were recognized; Type 1, Type 2, Type 3A, B, C, and Type 4. (4) Elevation of ASLO and antistreptkinase (ASK) were found in 6.4% and 13.5%, respectively. The serum cold agglutinin titer was elevated in four of the 12 students tested. (5) Most students with A-V block or A-V dissociation had no past history of severe disease or no major complaints.

Verbal conditioning of angina pectoris during exercise testing

A 40 year old man with far advanced coronary heart disease consistently experienced pain and exhibited marked S-T segment depression after 44 crossings during a Master two-step test. When the number of times traversed was miscounted so that he exercised less, the pain occurred at the precise count of 44 and he showed the same marked degree of S-T depression. However, when the count was accurate, he had neither pain nor S-T segment deviation at the reduced exercise level. The possible basis for verbal conditioning provoking angina pectoris is explored.

The significance of chest pain occurring with the Master two step test.

This study has assessed whether chest pain occurring during or after a step test could improve the accuracy of exercise testing in the diagnosis of coronary artery disease (CAD). One hundred and fifty-three consecutive men underwent the double Master two-step test prior to diagnostic coronary arteriography. On hundred and twenty-five had CAD, 28 insignificant disease (NCA). The post-exercise ECG showed at least 0-5 mm of ischaemic ST depression in 71 (57%) of the men with CAD and in five (18%) with NCA. Ischaemic ST depression of at least 2-0 mm occurred in 24 men, all of whom had CAD. Chest pain occurred during or after the test in 78 (62%) men with CAD and in nine (33%) with NCA. The accuracy of diagnosis of CAD could be improved by combining the occurrence of chest pain in the test with a positive post-exercise ECG. Either a 2 mm positive post-exercise ECG with or without test angina or 0-5 mm to 1-9 mm positive post-exercise ECG with test angina was found in 56 (45%) of men with CAD and one (4%) with NCA. Thus the concurrence of chest pain during or after a double Master two-step test, together with ischaemic ST segment depression after the test, strongly suggests the presence of CAD.