Value Of Exercise Stress Testing Research Articles

Risk Assessment in Patients with Symptomatic and Asymptomatic Preexcitation (RASAP)

Abstract Background Controversy remains as to whether exercise stress test (EST) is sufficient for risk evaluation in patients with preexcitation. Purpose This study aims to clarify the usefulness of EST in risk stratification in both asymptomatic and symptomatic patients, presenting with preexcitation. Methods This prospective study includes consecutive asymptomatic and symptomatic patients with preexcitation, referred for risk assessment. All participants performed an incremental EST (bicycle), prior to an electrophysiology study (EPS). Primary data from the EST included loss of preexcitation during exercise and from EPS included measurement of accessory pathway effective refractory period (APERP), shortest preexcited RR interval (SPERRI), and inducible arrythmia with use of a beta-adrenergic receptor agonist if deemed necessary. Results One hundred and sixty-four patients (59 asymptomatic, 105 symptomatic) completed an EST and EPS. Forty-five patients (27%) demonstrated low-risk findings on EST, of which 19 were asymptomatic and 26 were symptomatic. Six patients with low-risk EST findings had SPERRI/APERP≤250 ms at EPS, two of them were asymptomatic. The sensitivity, specificity, positive and negative predictive value (PPV, NPV) and accuracy of low-risk EST for excluding patients with SPERRI/APERP≤250 ms were 29%, 91%, 80%, 48%, and 55% respectively. The number of patients with inducible arrhythmia at EPS was similar in the asymptomatic 36 (69%) and in the symptomatic 73 (61%) group. Conclusions Sudden loss of preexcitation during EST has a low sensitivity and low NPV in excluding high-risk APs. EPS with use of isoproterenol should be considered to accurately assess the risk of patients with preexcitation regardless of symptoms.Figure

Prognostic Impact of a Routine Six-Month Exercise Stress Test after Complex Left Main Bifurcation Percutaneous Intervention.

The prognostic value of exercise stress test after complex left main (LM) coronary artery bifurcation (LM) stenting has been poorly investigated. To partially fill this gap in knowledge, we retrospectively analyzed the procedural and medical data of consecutive patients referred to our center for complex LM bifurcation disease between January 2008 and May 2018 who were treated using either single- or dual-stenting techniques. The prognostic impact of an exercise stress test, performed 6 months after the coronary intervention, was evaluated in 502 patients (316 males, mean age 70.3 ± 12.8 years, mean Syntax score 31.6 ± 6.3). At follow up after a mean of 37.1 ± 10.8 months (range 22.1-47.3 months), the target lesion failure (TLF) rate was 10.1% while stent thrombosis and cardiovascular mortality were 1.2 and 3.6%, respectively. A positive exercise stress test was detected at 6-month follow up in 42 out of 502 patients (8.4%); the incidence of a significant restenosis was 7.6% (n = 38). Patients with a negative exercise stress test at 6-month follow up had higher freedom from TLF and improved survival compared to those with a positive exercise stress test.

Clinical Pediatric Exercise Laboratories, Reactive Balance, Sleep, and Muscle Stimulation Considerations

Clinical Pediatric Exercise Laboratories, Reactive Balance, Sleep, and Muscle Stimulation Considerations

The value of exercise stress testing in prediction of angiography amongst South African patients using quantitative scoring systems

Background: Accurate pre-test assessment of high risk patients may increase positive yield on angiography. Exercise stress testing (EST) prediction of angiography, may be evaluated by Duke Treadmill Score (DTS), and Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, respectively. Aim: To investigate the value of EST in prediction of angiography amongst South African patients using quantitative scoring systems. Methods: The DTS and SYNTAX score were compared in patients with high risk pre-test assessments selected for angiography. Logistic regression modelling determined the odds ratio of abnormal angiograms using EST as a predictor. Results: Pre-test assessment of 525 suspected coronary artery disease patients, indicated angiography in 131 high risk individuals. The positive yield of abnormal angiograms was 58.0%, with no correlation between DTS and SYNTAX scores (Pearson’s correlation coefficient = 0.113, p=0.200). There was low predictive probability on receiver-operator-curve for DTS when compared to angiogram results (area under curve (AUC)=0.529, p=0.574), and SYNTAX categories (AUC=0.432, p=0.378). Chi-square tests had no significance between angiography and EST (all p-values >0.05). However DTS predicted abnormal angiograms with odds ratio of 1.92 when relevant cardiovascular risk factors (smoking, BMI, age) were added. Conclusion: Pre-test assessment of high risk patients represented a homogenous group with prevalent cardiovascular risk factors. However, the high risk group had no relationship between DTS and SYNTAX scores, indicating DTS alone discounts risk factors. Modelling accounted for DTS limitation by demonstrating an obese, elderly smoker with high risk category DTS is 1.92 times more likely to have an abnormal angiogram.

Incremental Prognostic Value of Exercise Stress Testing in Primary Prevention

In primary prevention, addition of C-reactive protein and family history to standard risk factor assessment (Reynolds Risk Score or RRS) provides superior risk stratification for future cardiovascular (CV) events. We sought to assess whether addition of functional capacity to RRS provided incremental prognostic value. This was a prospective observational cohort study of 3,964 consecutive asymptomatic adults without documented CV disease (mean age 51 years, 78% men) evaluated between 2005 and 2013, who underwent clinical and treadmill stress testing at baseline. RRS was calculated; % age-gender predicted metabolic equivalents (AGP-METs) achieved and heart rate recovery (HRR) were recorded. End point was death and myocardial infarction. Findings were tested in derivation (n = 1,982) and validation samples (n = 1,982). Mean RRS and C-reactive protein were 3.7 ± 4 and 2 ± 4 mg/dl. Nine percent had family history of premature CV disease. %AGP-METs achieved, and HRR were 113 ± 20 and 24 ± 8 beats/min. Forty-six percent achieved <110% AGP-METs, whereas 41% had RRS ≥3. At 7.3 ± 3 years, there were 83 (2%) events (39 in derivation and 44 in validation samples). In derivation group, on multivariable survival analysis, higher RRS (Hazard ratio or HR 1.27 [1.07 to 1.39]), lower % AGP METs (HR 1.21 [1.09 to 1.34]) achieved and abnormal (<12 beats/min) HRR (HR 1.15 [1.02 to 1.23]) were associated with increased longer-term events (all p <0.01). Findings were similar in validation group. Cutoffs of RRS >3 and %AGP-METs <110 were associated with increased longer-term events on spline analysis in the derivation group. The continuous net reclassification improvement for longer-term events, when %AGP-METs was added to RRS was 0.79 (95% confidence interval 0.52 to 1.05; p <0.01). Findings were confirmed in validation group. In conclusion, in primary prevention, addition of exercise capacity to RRS (incorporating traditional risk factors, family history, and inflammation) provides incremental prognostic value.

3136Incremental and synergistic prognostic value of exercise stress testing and standard risk factor assessment in asymptomatic executives: a primary prevention study

3136Incremental and synergistic prognostic value of exercise stress testing and standard risk factor assessment in asymptomatic executives: a primary prevention study

The diagnostic value of exercise stress testing for cardiovascular disease is more than just st segment changes: A review

The diagnostic value of exercise stress testing for cardiovascular disease is more than just st segment changes: A review

Diagnostic value of electrocardiogram stress testing in patients with metabolic syndrome

Summary Objectives:The aim of this study was to assess the diagnostic value of exercise stress testing to detect coronary heart disease (CHD) in the group of patients with metabolic syndrome. Design and methods: 2803 patients without prior diagnosis of CHD and identified metabolic syndrome were investigated. Subjects underwent electrocardiogram (ECG) stress testing and, depending on the results, coronary angiography and/or coronary computed tomography angiography to detect hemodynamically significant stenosis. CHD was confirmed, if lumen narrowing ≥ 50% of coronary arteries was found. Results: Exercise stress testing was interpreted as positive in 12% patients (71.7% women and 28.3% men). CHD was diagnosed in 45 patients (1.6%), 23 of them had positive exercise stress testing. ECG stress testing was more frequently positive in patients, who had typical/atypical anginal chest pain, dyspnea and/or non-anginal chest pain, in comparison to asymptomatic patients (16.6% vs 8.9%, p &lt;0.001). CHD was more often diagnosed in symptomatic patients compared to patients with no symptoms (6.1% vs 0.7%, p &lt; 0.001, women 5.3% vs 0.6%, p &lt; 0.001, men respectively 8% vs 0.8%, p &lt; 0.001). Conclusions: Diagnostic value of exercise stress testing for detecting CHD is limited in population with metabolic syndrome. CHD was more prevalent in patients with chest pain or dyspnea than in asymptomatic patients.

THU0357 Predictive value of exercise stress test (24h test&re-test) and coghealth© in differential diagnosis of chronic fatigue syndrome vs. fibromyalgia

ObjectivesDetermining the discriminating value of the test CogHealth© and its relation with the dual exercise stress test (test re-test 24 hours) in the differential diagnosis between the chronic fatigue syndrome...

Exercise stress testing in clinical practice

Exercise stress testing is an important diagnostic tool for evaluating patient’s cardiovascular performance. The present review describes the accuracy and the value of exercise stress testing in different settings: after an acute coronary event, after percutaneous coronary intervention or coronary artery bypass graft; in patients risk assessment before non-cardiac surgery; in diabetic population; in patients with baseline electrocardiographic abnormalities. Moreover, this review provides insights relating to test accuracy in women and geriatric patients. Finally, this review explores new variables/parameters (dyspnea, chronotropic incompentence, heart rate recovery, functional capacity, integrated scores) that in the last few years added an incremental value to conventional analysis of exercise-induced angina or electrocardiographic changes.

Exercise stress testing in clinical practice

Exercise stress testing is an important diagnostic tool for evaluating patient’s cardiovascular performance. The present review describes the accuracy and the value of exercise stress testing in different settings: after an acute coronary event, after percutaneous coronary intervention or coronary artery bypass graft; in patients risk assessment before non-cardiac surgery; in diabetic population; in patients with baseline electrocardiographic abnormalities. Moreover, this review provides insights relating to test accuracy in women and geriatric patients. Finally, this review explores new variables/parameters (dyspnea, chronotropic incompentence, heart rate recovery, functional capacity, integrated scores) that in the last few years added an incremental value to conventional analysis of exercise-induced angina or electrocardiographic changes.

Exercise Stress Test Results in Patients With Bare Metal Stents or Drug-Eluting Stents - Pathophysiological and Clinical Implications -

Drug-eluting stents (DES) have reduced restenosis following percutaneous coronary intervention (PCI), but they seem to be associated with increased coronary endothelial dysfunction compared to bare metal stents (BMS). No data are available about the prognostic value of exercise stress test (EST) in PCI patients in the DES era. The 160 patients with coronary artery disease (CAD) who underwent PCI with either BMS (n=86) or DES (n=74) were studied. EST was performed 1 month after PCI. DES patients had a higher rate of positive EST compared to BMS patients (49% vs 32%; P=0.03). At a median follow-up of 18 months DES showed a lower rate of target vessel revascularization (TVR) (hazard ratio (HR) 0.37, P=0.07), but a higher rate of acute myocardial infarction (AMI) (HR 3.33, P=0.08). At multivariate Cox-regression time to 1 mm ST and low-workload ischemia were independent predictors of AMI (HR 0.96, P=0.03; and HR 6.24, P=0.009, respectively), as well as of TVR (HR 0.96, P=0.007; and HR 6.43, P=0.001, respectively). DES implantation is associated with a higher rate of positive EST, compared to BMS, 1 month after PCI, likely due to a higher prevalence of endothelial dysfunction. EST seems to be helpful in predicting clinical outcome in patients with coronary stent implantation.

Re: Predictive Value of Exercise Stress Testing in a Family Medicine Population

We read with great interest the article by Newman et al titled “Predictive Value of Exercise Stress Testing in a Family Medicine Population.” The results confirm the findings we have reported in our studies a few years ago.[1][1][,2][2] In our studies, the predictive negative value of the test

Re: Predictive Value of Exercise Stress Testing in a Family Medicine Population

To the Editor: This study adds perspective to the role of exercise stress testing (EST) in triaging primary care patients with cardiac symptoms or risk factors. It also belies its first sentence, “Exercise stress testing (EST) is a screening test for coronary artery disease.”[1][1] Only 2.3% of

Prognostic Value of Exercise Stress Test and Dobutamine Stress Echo in Patients with Known Coronary Artery Disease

The aim of this study was to compare the feasibility of dobutamine stress echocardiography (DSE) and exercise stress test (EST) between patients in different age groups and to evaluate their proportional prognostic value in a population with established coronary artery disease (CAD). The study sample included 323 subjects, subdivided in group 1 (G1), comprising 246 patients aged <75 years, and group 2 (G2), with 77 subjects aged >or=75 years. DSE and EST were performed before enrollment in a cardiac rehabilitation program; for prognostic assessment, end points were all-cause mortality and hard cardiac events (cardiac death or nonfatal myocardial infarction). During DSE, G2 patients showed worse wall motion score index (WMSI), but the test was stopped for complications in a comparable proportion of cases (54 G1 and 19 G2 patients, P = NS). EST was inconclusive in similarly high proportion of patients in both groups (76% in G1 vs. 84% in G2, P = NS); G2 patients reached a significantly lower total workload (6 +/- 1.6 METs in G1 vs. 5 +/- 1.2 METs in G2, P < 0.001). At multivariate analysis, a lower peak exercise capacity (HR 0.566, CI 0.351-0.914, P = 0.020) was associated with higher mortality, while a high-dose WMSI >2 (HR 5.123, CI 1.559-16.833, P = 0.007), viability (HR 3.354, CI 1.162-9.678, P = 0.025), and nonprescription of beta-blockers (HR 0.328, CI 0.114-0.945, P = 0.039) predicted hard cardiac events. In patients with known CAD, EST and DSE maintain a significant prognostic role in terms of peak exercise capacity for EST and of presence of viability and an extensive wall motion abnormalities at peak DSE.

Predictive Value of Exercise Stress Testing in a Family Medicine Population

Exercise stress testing (EST) is a screening test for coronary artery disease. Previous studies from the cardiology literature show an overall sensitivity of 67% and specificity of 72% with variable predictive values depending on pretest probability. The purpose of the current study was to evaluate the predictive value of EST in a family medicine population in eastern North Carolina. This is a retrospective case series of 339 ESTs performed in a family medicine center from July 2001 to April 2005. EST results were classified as positive, negative, or equivocal. Outcomes studied from a review of outpatient and inpatient electronic medical record data and telephone follow-up included myocardial infarction, cardiac catheterization with angioplasty and stenting, coronary artery bypass grafting, a new diagnosis of coronary artery disease, and cardiac death. Mean duration of follow-up was 47 months, with a range of 27 to 72 months. Nearly all patients had low to intermediate risk pretest probability. Five tests were positive, 32 were equivocal, and 302 were negative. There were 2 false-positive tests, both in female patients. There were 2 false-negative tests, both of which were treated with good outcomes. Two of 32 equivocal results had cardiac outcomes. Considering equivocal tests as positive, the overall sensitivity in this series was 71.4%; specificity was 90.4%. The positive predictive value was 13.5% and the negative predictive value was 99.3%. The high negative predictive value for EST in this outpatient family medicine population is noteworthy and reassuring. EST is a cost-effective strategy for triaging the common complaint of chest pain in low- to intermediate-risk patients in primary care practices and should be included in the services offered to family medicine patients.

High European SCORE plus Exercise-Test Results Predict Death

What's the prognostic value of exercise stress testing once baseline global risk has been determined? To find out, researchers prospectively studied 3554 asymptomatic adults (age range, 50-75; 81% men) who each underwent an executive health evaluation, including stress testing, at Cleveland Clinic over 12 years. Two global scoring systems were used separately to identify baseline risk: the well-known Framingham Risk Score (FRS), …

10.51 Value of exercise stress testing in coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) patients assessed by myocardial perfusion scintigraphy

10.51 Value of exercise stress testing in coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) patients assessed by myocardial perfusion scintigraphy

Limited clinical value of exercise stress test for the screening of coronary artery disease in young, asymptomatic adult men

The predictive value of exercise testing for detection of latent coronary artery disease (CAD) in the asymptomatic middle-aged population is controversial.1 The American Heart Association states that the treadmill stress test is warranted for subjects with a high-risk coronary profile, but not for apparently healthy persons.2 The predictive value of ST depression alone, without regard to other variables, is poor when the prevalence of CAD in the population sample is low.3 In such groups, the prevalence of false-positive exercise-induced ST changes is high. This retrospective study evaluates the significance of performing routine exercise stress testing in an asymptomatic male population, the clinical significance of a positive exercise stress test, and the yield from a myocardial perfusion study in this subgroup of subjects.

Prediction of cardiovascular events in clinically selected high-risk NIDDM patients. Prognostic value of exercise stress test and thallium-201 single-photon emission computed tomography.

We evaluated the prognostic value of an exercise stress test and thallium-201 scintigraphy for the prediction of cardiac events in selected high-risk NIDDM patients. NIDDM patients (n = 158, 105 men, aged 63 +/- 9 years) with two or more of the following criteria were prospectively included: age > or = 65 years, active smoking, hypertension > 160/95 mmHg, hypercholesterolemia (cholesterol > 5.70 mmol/l or LDL > 3.10 mmol/l), peripheral artery disease, abnormal rest electrocardiogram, or microalbuminuria (20-200 micrograms/min). An exercise-stress scintigraphy was performed in 77 patients able to exercise, while a dipyridamole scintigraphy was performed in 80 patients unable to exercise. Follow-up was 23 +/- 17 months. Major end points were cardiac deaths or nonfatal myocardial infarction. The annual event rate was 7.31% (deaths: 8, myocardial infarction: 14). Independent predictors of events were as follows: an age > 60 (P = 0.02), an abnormal rest electrocardiogram (P = 0.02), microalbuminuria (P = 0.001), the inability to exercise (P = 0.009), and the presence of more than two defects on scintigraphy (P = 0.001). A cardiac death occurred in 1.3% of patients able to exercise versus 8.8% of patients unable to exercise (odds ratio = 6.8, P = 0.001). Among patients unable to exercise, large perfusion defects corresponded to an annual mortality rate of 22.3%. Conversely, the negative predictive value of a normal scintigraphy for the occurrence of death was 97%. Inability to exercise and large perfusion defects on thallium-201 scan are major predictors of future death and myocardial infarction in high-risk NIDDM patients.