Sensitivity Of Exercise Testing Research Articles

Diagnostic Value Of Post Exercise Systolic Blood Pressure Response In Ischemic Heart Disease

Background: The normal decline in systolic blood pressure during recovery phase of treadmill exercise dose not occur in most patients with coronary artery disease, in others recovery values systolic blood pressure may even exceed the peak exercise value. Objectives: Treadmill exercise test parameters indicating the presence and extent of coronary artery disease have traditionally included such as exercise duration, blood pressure and ST-segment response to exercise. The three –minute systolic blood pressure ratio is another important indicator of presence and significance of coronary artery disease is useful and obtainable measure that can be applied in all patients who are undergoing stress testing for evaluation of suspected ischemic heart disease and this increase the sensitivity of exercise test . Type of the study: A prospective study. Methods: Between April 2011 and April 2012 ,all patients underwent treadmill exercise test , echocardiography coronary angiography in Ibn Ab-bitar Hospital Cardiac Surgery. Clinical and procedural data for patients undergoing treadmill and coronary angiography were prospectively collected and entered into database specially designed for the present study.To calculate mean systolic blood pressure ratio for each , Measurement of blood pressure in the 3rd minute of recovery time and divided by peak systolic blood pressure during exercise test ,after excluding patients . Coronary angiography was done for all patients who under went treadmill exercise test and multiple views were taken accordingly to clarify the lesion and critical lesion defined as >50% stenosis in LMS and >70% stenosis in LAD,LCX and RCA. Results: We studied 100 patients In the period from April 2011 to April 2012, 78(78%) male and 22 (22%) a female with a mean age 55.49±7.60 who undergone treadmill exercise testing and coronary angiography to assess the chest pain, 32 patient had normal blood pressure 68 had hypertension and 24 patients had normal coronary angiography and 76 patients had abnormal coronary angiography. SBP/3 minute recovery blood pressure ratio was significantly higher in patient with coronary artery disease than patient without coronary artery disease (mean ±SD O.92±0.09 VS 0.81 SBP/3 minute recovery blood pressure ratio was significantly related with the severity of coronary artery disease its higher in three vessels than one vessel disease 0.95±0.10 vs0. 91 ±0.01 p-value 0.0001. Conclusions: post exercise blood pressure response in patients with coronary artery diseaseis higher than patients with normal coronary artery .post exercise blood pressure is related to the severity of coronary artery disease

The diagnostic value of the ECG treadmill exercise test in women with coronary heart disease

Objective To explore the diagnostic value of the ECG treadmill exercise test in women with coronary heart disease.Methods The clinical data of 108 female patients who received the electrocardiogram treadmill exercise test and coronary angiography and suspected coronary heart disease were analyzed.The results of treadmill exercise test and coronary angiography were comparatively analyzed.Results Treadmill exercise test sensitivity was 57.64％ (49/85),specificity was 73.46％ (36/49),positive predictive value was 79.03％ (49/62),negative predictive value was 78.26％ (36/46),accuracy was 78.70％ (85/108).False-positive group exercise time,ST-segment depression amplitude,duration,number of leads were lower than the true-positive group (t =2.49,6.08,4.68,8.00,all P ＜0.05).Coronary artery stenosis in patients with ECG treadmill exercise test ECG display the difference was statistically significant.The more serious coronary artery stenosis lesions electrocardiogram showed lack of blood type ST-segment depression appear sooner,the longer the duration,the greater the magnitude of depression.Conclusion Treadmill exercise is an ideal noninvasive method in the diagnosis of women with coronary heart disease. Key words: Exercise test; Electrocardiography; Coronary angiography; Female

Comparison of Usefulness of Exercise Testing Versus Coronary Computed Tomographic Angiography for Evaluation of Patients Suspected of Having Coronary Artery Disease

In patients suspected of having coronary artery disease (CAD), we compared the diagnostic sensitivity and specificity of exercise testing using ST-segment changes alone and ST-segment changes, angina pectoris, and hemodynamic variables compared to coronary computed tomographic angiography (CTA). Quantitative invasive coronary angiography was the reference method (>50% coronary lumen reduction). A positive exercise test was defined as the development of significant ST-segment changes (> or =1 mV measured 80 ms from the J-point), and the occurrence of one or more of the following criteria: ST-segment changes > or =1 mV measured 80 ms from the J-point, angina pectoris, ventricular arrhythmia (the occurrence of > or =3 premature ventricular beats), and > or =20 mm Hg decrease in systolic blood pressure during the test. Positive results on CTA were defined as a coronary lumen reduction of > or =50%. In 100 patients (61 +/- 9 years old, 50% men, and 29% prevalence of significant CAD), the diagnostic sensitivity and specificity of exercise testing using ST-segment changes was 45% (95% confidence interval 53% to 87%) and 63% (95% confidence interval 61% to 84%), respectively. However, the inclusion of all test variables yielded a sensitivity of 72% (95% confidence interval 53% to 87%) and a specificity of 37% (95% confidence interval 26% to 49%). The diagnostic sensitivity of 97% (95% confidence interval 82% to 100%) and specificity of 80% (95% confidence interval 69% to 89%) for CTA, however, were superior to any of the exercise test analysis strategies. In conclusion, in patients suspected of having CAD, the diagnostic sensitivity of exercise testing significantly improves if all test variables are included compared to using ST-segment changes exclusively. Furthermore, the superior diagnostic performance of CTA for the detection and exclusion of significant CAD might favor CTA as the first-line diagnostic test in patients suspected of having CAD.

Assessing the hemodynamic response to exercise - a novel MR approach

Introduction Exercise is a powerful stimulator of the cardiovascular system. Therefore, it can be used to unmask subtle vascular changes in early hypertensive disease. Routinely only blood pressure and heart rate response to exercise are measured. However measuring cardiac output (CO), systemic vascular resistance (SVR) and arterial compliance would increase the sensitivity of exercise testing. MRI is a proven method of measuring CO and deriving SVR and compliance at rest. Unfortunately the lack of appropriate sequences has made it difficult to perform MRI during exercise.

Using right and left precordial leads increased the sensitivity of exercise testing for detecting coronary artery disease

Source Citation Michaelides AP, Psomadaki ZD, Dilaveris PE, et al. Improved detection of coronary artery disease by exercise electrocardiography with the use of right precordial leads. N Engl J Med...

Acute Myocardial Infarction: Risk Stratification in the Thrombolytic Era

Acute Myocardial Infarction: Risk Stratification in the Thrombolytic Era

Visualization of the coronary arterial lesions in Kawasaki disease by coronary angiography

SummaryFormation of coronary aneurysms is often seen on the patients in the acute phase of Kawasaki disease by echocardiography, and after the convalescent phase, some patients show disappearance of aneurysms but some of them show combining stenotic lesions at inlets and/or outlets of aneurysms on coronary arteriography. According to follow-up studies of coronary arterial lesions, the degree of stenosis quite frequently increases and progresses over a period up to 10 years or more after the onset of the disease. The severe stenosis appears the most frequently at the proximal portion of the left anterior descending artery and secondly at the main trunk of the main coronary artery. They die suddenly or suffer from severe myocardial infarction unless they are treated with aortocoronary bypass surgery. However, it is rare to have symptoms of ischemic heart disease even in patients with severe obstructive lesions. In fact, the sensitivity of exercise testing in diagnosis of myocardial ischemia is very low. Dipyridamole thallium myocardial imaging is reasonably useful, but dipyridamole can he dangerous when it is given without the precise information of the patient's stenosis. Coronary arteriography is, therefore, essential not only to determine the appropriate treatment of the c ronary arterial lesions but also for follow-up. According to the histopathologic study, even the patients in whom coronary arterial lesions were not visualized on coronary arteriography often show some intimal proliferation. These patients may well present a problem in the future due to the sequels of angiitis. Because of this, continuous regular follow-up should be necessary, even in patients with no evidence of coronary arterial lesion.

Effect of type A behavior on exercise test outcome in coronary artery disease

The outcome of the diagnostic exercise test depends on such patient-related factors as age, maximum exercise heart rate, exercise time and severity of the underlying coronary artery disease (CAD). This study examined the hypothesis that type A behavior would affect the amount of effort expended, as indicated by the exercise time and the maximum heart rate achieved, thereby resulting in differences in exercise test outcome. A total of 1,260 patients with suspected CAD, all of whom had coronary angiography, a structured interview to assess type A behavior and a treadmill exercise test, participated. Of these patients, 818 (65%) had significant CAD, and 852 (68%) were type A. There were no differences between type A and B patients in either maximum heart rate or total exercise time. Among both type A and B subjects, 36% of treadmill tests were positive. Exercise test sensitivity was similar for both groups (69% for type A vs 72% for type B, p = 0.39). Similarly, specificity was similar for both groups (87% for type A vs 80% for type B, p = 0.09). Results did not change after using logistic regression to control for potential confounding factors. Thus, type A behavior does not need to be taken into account when interpreting exercise test outcome.

Early Exercise Testing After Stabilization of Unstable Angina

Abstract To evaluate the safety and diagnostic use of exercise testing in patients with unstable angina, 78 patients underwent submaximal exercise testing and diagnostic cardiac catheterization early after stabilization of their pain. Thirty-six patients (46%) had a positive exercise test manifested as angina or ST segment depression of ≥0.1 mV during or immediately after exercise. Thirty-three of 36 patients (92%) with a positive exercise test had multivessel coronary disease compared to 18 of 42 patients (43%) with a negative exercise study ( p p = 0.004). The sensitivity of exercise testing in detecting multivessel disease was 65%, specificity 89%, predictive value of a positive test 92%, predictive value of a negative test 57%, and overall accuracy 73%. When the 42 patients taking beta blockers were examined, these values were essentially unchanged. Ventricular arrhythmias during exercise testing were associated with a lower ejection fraction, 61.1 ± 12.5%, compared to 67.9 ± 11.1% in patients without ventricular arrhythmias ( p

Early exercise testing after stabilization of unstable angina: Correlation with coronary angiographic findings and subsequent cardiac events

To evaluate the safety and diagnostic use of exercise testing in patients with unstable angina, 78 patients underwent submaximal exercise testing and diagnostic cardiac catheterization early after stabilization of their pain. Thirty-six patients (46%) had a positive exercise test manifested as angina or ST segment depression of ≥0.1 mV during or immediately after exercise. Thirty-three of 36 patients (92%) with a positive exercise test had multivessel coronary disease compared to 18 of 42 patients (43%) with a negative exercise study ( p < 0.001). Twenty-two of 36 patients (61%) with a positive exercise test had three-vessel disease compared to 12 of 42 patients (29%) with a negative test ( p = 0.004). The sensitivity of exercise testing in detecting multivessel disease was 65%, specificity 89%, predictive value of a positive test 92%, predictive value of a negative test 57%, and overall accuracy 73%. When the 42 patients taking beta blockers were examined, these values were essentially unchanged. Ventricular arrhythmias during exercise testing were associated with a lower ejection fraction, 61.1 ± 12.5%, compared to 67.9 ± 11.1% in patients without ventricular arrhythmias ( p < 0.05). Submaximal exercise testing after stabilization of patients with unstable angina is safe and useful in evaluating patients for the presence of multivessel coronary artery disease.

Lead Selection and Time of Monitoring in Diagnostic Exercise Testing.

In brief: The authors examined the effects of variations in lead selection and time of monitoring during recovery on the predictive value and sensitivity of exercise testing. Eighty-six patients received a standard Bruce protocol exercise test and follow-up angiography. The results showed that 12-lead monitoring for at least six minutes of recovery had more sensitivity for diagnosing coronary artery disease, and the greater the ST-segment depression, the greater the predictive value of the test.

Superior QRS axis of ventricular premature complexes: An additional criterion to enhance the sensitivity of exercise stress testing

The presence or frequency of ventricular premature complexes during exercise is not highly predictive for identifying patients with coronary artery disease. To determine whether the morphologic features or axis of exercise-induced ventricular premature complexes may increase this predictability, a study was made of 63 symptomatic patients with coronary artery disease (electrocardiographic evidence of infarction or occlusive lesions seen on coronary angiography, or both) and 10 control patients with normal coronary arteriograms. In 48 of the 63 patients with coronary artery disease the exercise-induced ventricular premature complexes had a superior frontal plane QRS axis between −30 ° and −120 °; in 12 the axis was between −30 ° and +150 °, and in 2 the axis was indeterminate, between +150 ° and −120 °. In all 10 control subjects without coronary artery disease the QRS axis of the exercise-induced ventricular premature complexes was in the normal range, between −30 ° and +150 °. If the standard criterion of 1 mm S-T segment depression were used to predict coronary artery disease during exercise stress testing, 25 of the 63 patients with coronary artery disease would have had a normal or borderline exercise test. However, in 21 of these 25 patients the exercise-induced ventricular premature complexes had a superior axis, a criterion that would enhance the predictive sensitivity of the exercise test from 60 to 94 percent. A left bundle branch block pattern of ventricular premature complexes was not helpful in detecting patients with coronary artery disease, although a right bundle branch block pattern was infrequent in the control subjects. The occurrence of ventricular premature complexes with a superior axis during exercise testing can enhance the exercise test's sensitivity for detecting the presence of coronary artery disease, particularly when this criterion is used in patients with a nondiagnostic S-T segment response to exercise.

Thallium-201 myocardial perfusion imaging at rest and during exercise. Comparative sensitivity to electrocardiography in coronary artery disease.

The sensitivity of myocardial perfusion imaging (MPI) using thallium-201 injected both at rest and during peak exercise was compared to simultaneously recorded 12 lead electrocardiography (ECG) for the detection of transient ischemia in 20 normal subjects and 63 patients with coronary artery disease (CAD). No significant perfusion defects or ECG changes were seen on either the rest or exercise studies in any of the normal subjects. Fifty-six percent of patients with CAD developed new perfusion defects with exercise compared to 38% who developed ischemic ST-segment depression (P less than 0.02). However, when chest pain and/or ST depression were considered indices of ischemia, the sensitivity of exercise testing and thallium-201 MPI was similar. The increased sensitivity of MPI compared to ST-segment depression on the ECG was due to patients with baseline ECG abnormalities and those who failed to achieve 85% of predicted maximum heart rate with exercise. Analysis of the exercise results according to the extent of coronary artery disease revealed a progressive increase in both positive ECGs and MPI with the number of vessels involved. In patients with single vessel disease the MPI was more sensitive than the ECG (P less than 0.02). The combination of the rest and exercise ECG, MPI and chest pain during exercise failed to identify 11% of patients with CAD. Exercise thallium-201 MPI is a useful adjunct to conventional exercise testing particularly when evaluating patients with abnormal resting ECGs, those who develop ventricular conduction defects of arrhythmias during exercise, and those who fail to achieve their predicted heart rate because of fatigue or breathlessness.