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Exercise Stress Test

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1. Stressed out about stress testing? The utility of stress testing after non-ACS chest pain

for potential morbidity and/or mortality benefit of stress testing? Introduction to stress testing An exercise stress test commonly refers to a stress EKG, in which the patient exercises on a treadmill at progressive levels of intensity. Most commonly, the test is carried out in accordance with the Bruce protocol. The treadmill starts at 1.7 mph at a 10% incline and advances to 3.4 mph at a 14% incline over a period of 9 minutes. ​1​ Throughout this time, the patient’s EKG tracing is monitored for inducible (...) examination, EKG and troponin, the majority of patients can be “ruled out” for myocardial infarction. The next question is what to do for those patients with negative tests. Historically, practice guidelines have recommended the use of short-term provocative testing, such as graded exercise stress testing, to further rule out underlying coronary disease in patients that have ruled out for acute coronary syndrome but not deemed to be very low risk. The role of stress-testing has more recently come

2019 CandiEM

2. Does Stress Result in You Exercising Less? Or Does Exercising Result in You Being Less Stressed? Or Is It Both? Testing the Bi-directional Stress-Exercise Association at the Group and Person (N of 1) Level. (PubMed)

Does Stress Result in You Exercising Less? Or Does Exercising Result in You Being Less Stressed? Or Is It Both? Testing the Bi-directional Stress-Exercise Association at the Group and Person (N of 1) Level. Psychosocial stress contributes to heart disease in part by adversely affecting maintenance of health behaviors, while exercise can reduce stress. Assessing the bi-directional relationship between stress and exercise has been limited by lack of real-time data and theoretical and statistical (...) models. This lack may hinder efforts to promote exercise maintenance.We test the bi-directional relationship between stress and exercise using real-time data for the average person and the variability-individual differences-in this relationship.An observational study was conducted within a single cohort randomized controlled experiment. Healthy young adults, (n = 79) who reported only intermittent exercise, completed 12 months of stress monitoring by ecological momentary assessment (at the beginning

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2017 Annals of behavioral medicine : a publication of the Society of Behavioral Medicine Controlled trial quality: uncertain

3. Prediction of the Wingate anaerobic mechanical power outputs from a maximal incremental cardiopulmonary exercise stress test using machine-learning approach. (PubMed)

Prediction of the Wingate anaerobic mechanical power outputs from a maximal incremental cardiopulmonary exercise stress test using machine-learning approach. The Wingate Anaerobic Test (WAnT) is a short-term maximal intensity cycle ergometer test, which provides anaerobic mechanical power output variables. Despite the physiological significance of the variables extracted from the WAnT, the test is very intense, and generally applies for athletes. Our goal, in this paper, was to develop a new (...) approach to predict the anaerobic mechanical power outputs using maximal incremental cardiopulmonary exercise stress test (CPET). We hypothesized that maximal incremental exercise stress test hold hidden information about the anaerobic components, which can be directly translated into mechanical power outputs. We therefore designed a computational model that included aerobic variables (features), and used a new computational \ predictive algorithm, which enabled the prediction of the anaerobic

2019 PLoS ONE

4. High-sensitive cardiac Troponin T and exercise stress test for evaluation of angiographically significant coronary disease. (PubMed)

High-sensitive cardiac Troponin T and exercise stress test for evaluation of angiographically significant coronary disease. Exercise stress test (EST) has a moderate precision for diagnosis of CAD and could potentially obtain improved accuracy if adding a reliable cardiac biomarker to the test.We aimed to investigate resting levels and change in hs-cTnT during EST in patients with and without angiographically significant CAD. Moreover, we intended to explore the additive value of hs-cTnT to EST (...) results in diagnosis of stable CAD. We hypothesized that hs-cTnT would be higher in CAD patients and increase diagnostic precision of EST.Patients presenting with symptoms of stable CAD, performed a maximal EST on a bicycle ergometer. Venous blood samples were taken at rest and within 5 min post-exercise. All patients underwent coronary angiography. Significant CAD was defined as having ≥75% stenosis in one or more segments of the coronary arteries.Out of the 297 participants, significant CAD

2019 International journal of cardiology

5. Incremental Prognostic Value of Exercise Stress Testing in Primary Prevention. (PubMed)

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

2019 American Journal of Cardiology

6. Usefulness of Excellent Functional Capacity in Men and Women With Ischemic Exercise Electrocardiography to Predict a Negative Stress Imaging Test and Very Low Late Mortality. (PubMed)

Usefulness of Excellent Functional Capacity in Men and Women With Ischemic Exercise Electrocardiography to Predict a Negative Stress Imaging Test and Very Low Late Mortality. Exercise electrocardiography (ExECG) is widely employed to assess patients for coronary artery disease but it has limited diagnostic accuracy. Many patients with positive (ischemic) tests based on exercise-induced ST depression undergo secondary evaluation by noninvasive stress imaging. We hypothesized that high functional (...) capacity in patients with positive ExECG could predict: (1) negative results in secondary evaluation by exercise echocardiography (ESE) or myocardial perfusion scintigraphy (MPS) and (2) low mortality on late follow-up. We evaluated 511 consecutive patients (312 men, 199 women; age 51 ± 9 years) referred for ESE or MPS after an ischemic ExECG at a treadmill workload of ≥10 metabolic equivalents. All-cause mortality was also obtained. Of 511 patients, 401 underwent ESE and 110 had MPS for secondary

2019 American Journal of Cardiology

7. Usefulness of Achieving ≥10 METs With a Negative Stress Electrocardiogram to Screen for High-Risk Obstructive Coronary Artery Disease in Patients Referred for Coronary Angiography After Exercise Stress Testing. (PubMed)

Usefulness of Achieving ≥10 METs With a Negative Stress Electrocardiogram to Screen for High-Risk Obstructive Coronary Artery Disease in Patients Referred for Coronary Angiography After Exercise Stress Testing. Functional capacity in exercise stress testing is an independent predictor of cardiac events. Routine use of nuclear perfusion imaging increases radiation burden and cost. Our goal was to assess the clinical utility of exercise functional capacity with stress electrocardiogram (ECG (...) ) as an adjunct in predicting the presence of high-risk obstructive coronary artery disease (CAD) on diagnostic coronary angiography. We performed a retrospective study of patients who underwent exercise stress testing for the evaluation of chest pain and underwent diagnostic coronary angiography within the subsequent 3 months. High-risk CAD was defined as coronary artery diameter stenosis of ≥70% in the proximal left anterior descending artery, ≥70% diameter stenosis in 3 major epicardial arteries, or ≥50

2017 American Journal of Cardiology

8. Core IM 5 pearls on stress testing

Core IM 5 pearls on stress testing Core IM 5 Pearls on Stress Testing – Clinical Correlations Search Core IM 5 Pearls on Stress Testing April 28, 2019 2 min read Podcast: | Subscribe: | For a transcript of the podcast and show notes: Time Stamps What are the indications for a stress test? ( 2:18) How to choose stress protocol in a stress test? (8:29) How to choose diagnostic modality in a stress test? (14:46) How do we interpret results from stress tests, and how should this be communicated (...) with depressed left ventricular function and low transvalvular gradients. The American journal of cardiology , 75 (2), 191-194. Bourque, J. M., & Beller, G. A. (2015). Value of exercise ECG for risk stratification in suspected or known CAD in the era of advanced imaging technologies. JACC: Cardiovascular Imaging, 8(11), 1309-1321. Heijenbrok-Kal, M. H., Fleischmann, K. E., & Hunink, M. M. (2007). Stress echocardiography, stress single-photon-emission computed tomography and electron beam computed tomography

2019 Clinical Correlations

9. Diagnostic Value of Electrocardiogram in Predicting Exaggerated Blood Pressure Response to Exercise Stress Testing (PubMed)

Diagnostic Value of Electrocardiogram in Predicting Exaggerated Blood Pressure Response to Exercise Stress Testing It is believed that an exaggerated blood pressure response (EBPR) to exercise stress test is associated with a higher risk of cardiovascular events. It is also assumed that QT dispersion (QT-d), which was originally proposed to measure the spatial dispersion of ventricular recovery times, may have a relationship to cardiovascular events. The objective of this study was to examine (...) -qquare, independent samples t-test, and receiver operating characteristic (ROC) curve were used as statistical methods in IBM SPSS version 19.Sixty patients (55% male) with a mean age of 50.48 ± 10.89 years were studied in two groups of normal (n=30) and exaggerated blood pressure response (n=30) to exercise testing. Maximum QT and QT dispersion were statistically different in individuals' exaggerated blood pressure response to exercise stress test (p < 0.05). The logistic regression analysis

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2016 Electronic physician

10. Specific changes in circulating cytokines and growth factors induced by exercise stress testing in asymptomatic aortic valve stenosis. (PubMed)

Specific changes in circulating cytokines and growth factors induced by exercise stress testing in asymptomatic aortic valve stenosis. We evaluated exercise-induced changes in the profile of circulating cytokines and growth factors in patients with AS.We studied 32 consecutive asymptomatic moderate-to-severe AS patients and 32 age and sex-matched controls. Plasma levels of interleukin (IL)-6, IL-10, hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), and transforming (...) growth factor (TGF)-β were measured at 4 time points, i.e. at rest, at peak bicycle exercise, one hour and 24 hours after a symptom-limited exercise.Exercise increased all the 5 markers in both groups (all p<0.0001). The maximum levels of all tested cytokines were higher in the AS group (all p<0.05) compared with controls. In AS patients the highest levels of VEGF, IL-6, and IL-10 were observed one hour after exercise, while in the control group at peak exercise. In both groups maximum TGF- β levels

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2017 PLoS ONE

11. Effect of Beta-Blocker Therapy, Maximal Heart Rate, and Exercise Capacity During Stress Testing on Long-Term Survival (from The Henry Ford Exercise Testing Project). (PubMed)

Effect of Beta-Blocker Therapy, Maximal Heart Rate, and Exercise Capacity During Stress Testing on Long-Term Survival (from The Henry Ford Exercise Testing Project). Whether lower heart rate thresholds (defined as the percentage of age-predicted maximal heart rate achieved, or ppMHR) should be used to determine chronotropic incompetence in patients on beta-blocker therapy (BBT) remains unclear. In this retrospective cohort study, we analyzed 64,549 adults without congestive heart failure (...) or atrial fibrillation (54 ± 13 years old, 46% women, 29% black) who underwent clinician-referred exercise stress testing at a single health care system in Detroit, Michigan from 1991 to 2009, with median follow-up of 10.6 years for all-cause mortality (interquartile range 7.7 to 14.7 years). Using Cox regression models, we assessed the effect of BBT, ppMHR, and estimated exercise capacity on mortality, with adjustment for demographic data, medical history, pertinent medications, and propensity

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2016 American Journal of Cardiology

12. Clinical Exercise Stress Testing in Adults

Clinical Exercise Stress Testing in Adults The Cardiac Society of Australia and New Zealand Position Statement Clinical Exercise Stress Testing in Adults SUMMARY 1. Exercise testing is generally safe but has a small but definite risk of fatal and non-fatal cardiac events. 2. Testing should be supervised by a medical practitioner capable of recognising symptoms and signs of cardiac disease. The practitioner should have training in exercise testing and be capable of interpreting the exercise test (...) findings. The practitioner should either be present in the room, or if the test is conducted by an appropriately trained healthcare professional, should be in close proximity and easily accessible during the exercise test. 3. The test can be conducted by a healthcare professional who has trained in a related health area, has appropriate training in the supervision of exercise stress tests, and is capable of performing cardio-pulmonary resuscitation. 4. For optimal patient safety, two persons should

2014 Cardiac Society of Australia and New Zealand

13. Stress Tests Part 3: Stress test accuracy

outcomes. Mostly, however, if is because there are no emergency department studies in which all patients are assessed using the same gold standard, meaning the sensitivity and specificity will be inflated in all the studies discuss below because of and , among others. This post is part of a series exploring the practice of stress testing. The appraisal of these articles is based on the conclusions of the other posts, so it’s probably worthwhile reading the entire series. Does exercise stress testing (...) evaluation (using a chest pain protocol). Patients had to be over the age of 40 and present to the emergency department with chest pain. After serial troponins, patients are risk stratified into low, intermediate and high risk based on cardiac risk factors. Only the low risk patients were managed as outpatients, and that is what is studied here. Exercise stress test was used unless there was a contraindication. The primary outcome was death or MI at 6 month follow-up. Of 7178 patients over 40 years

2019 First10EM

14. Arm Exercise Versus Pharmacologic Stress Testing for Clinical Outcome

Arm Exercise Versus Pharmacologic Stress Testing for Clinical Outcome Arm Exercise Versus Pharmacologic Stress Testing for Clinical Outcome - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Arm Exercise (...) , 2018 See Sponsor: VA Office of Research and Development Collaborator: VA St. Louis Health Care System Information provided by (Responsible Party): VA Office of Research and Development Study Details Study Description Go to Brief Summary: This is a 5-year clinical trial to evaluate whether arm exercise electrocardiographic (ECG) stress testing without or with coronary artery calcium scoring (-/+ CAC) is non-inferior to treadmill ECG stress testing -/+ CAC and pharmacologic myocardial perfusion

2018 Clinical Trials

15. Comparison of Preoperative Assessment of Patient's Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing (PubMed)

Comparison of Preoperative Assessment of Patient's Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing Preoperative anesthetic evaluations of patients before surgery traditionally involves assessment of a patient's functional capacity to estimate perioperative risk of cardiovascular complications and need for further workup. This is typically done by inquiring about the patient's physical activity, with the goal of providing an estimate (...) of the metabolic equivalents (METs) that the patient can perform without signs of myocardial ischemia or cardiac failure. We sought to compare estimates of patients' METs between preoperative assessment by medical history with quantified assessment of METs via the exercise cardiac stress test.A single-center retrospective chart review from 12/1/2005 to 5/31/2015 was performed on 492 patients who had preoperative evaluations with a cardiac stress test ordered by a perioperative anesthesiologist. Of those

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2018 Anesthesiology research and practice

16. Relation of Atrial Premature Complexes During Exercise Stress Testing to the Risk for the Development of Atrial Fibrillation in Patients Undergoing Cardiac Rehabilitation. (PubMed)

Relation of Atrial Premature Complexes During Exercise Stress Testing to the Risk for the Development of Atrial Fibrillation in Patients Undergoing Cardiac Rehabilitation. Atrial fibrillation (AF) is associated with increased morbidity and mortality. We sought to determine whether atrial premature complexes (APCs) detected during a standard exercise stress test (EST) in patients undergoing cardiac rehabilitation (CR) are associated with an increased risk of AF. The present study population

2018 American Journal of Cardiology

17. A pilot study of cardiopulmonary exercise testing and cardiac stress positron emission tomography before major non-cardiac surgery. (PubMed)

A pilot study of cardiopulmonary exercise testing and cardiac stress positron emission tomography before major non-cardiac surgery. Cardiac events are a common cause of peri-operative morbidity. Cardiopulmonary exercise testing can objectively assess risk, but it does not quantify myocardial ischaemia. With appropriate dietary preparation to suppress basal myocardial glucose uptake, positron emission tomography with 18 F-fluorodeoxyglucose can identify post-ischaemic myocardium, providing (...) an attractive complement to exercise testing. We aimed to investigate the feasibility of this diagnostic algorithm. Patients referred for cardiopulmonary exercise testing before major cancer surgery were prospectively recruited. Exercise testing and positron emission tomography imaging were performed after a high fat-low carbohydrate meal. Protocol feasibility (primary end-point) included compliance with pre-test diet instructions and the completion of tests. Stress myocardial perfusion imaging

2018 Anaesthesia

18. Feasibility and safety of exercise stress testing using an anti-gravity treadmill with Tc-99m tetrofosmin single-photon emission computed tomography (SPECT) myocardial perfusion imaging: A pilot non-randomized controlled study. (PubMed)

Feasibility and safety of exercise stress testing using an anti-gravity treadmill with Tc-99m tetrofosmin single-photon emission computed tomography (SPECT) myocardial perfusion imaging: A pilot non-randomized controlled study. Exercise is the AHA/ACC guideline-recommended stress modality for myocardial perfusion imaging, but many patients are unable to exercise to target heart rate on a conventional treadmill. We examined the feasibility and safety of stress imaging using an anti-gravity (...) treadmill in patients with perceived poor exercise capacity.49 patients were recruited for stress testing by anti-gravity treadmill (n = 29) or to a regadenoson control group (n = 20). Seventeen anti-gravity test patients (59%) reached target heart rate obviating the need for a pharmacologic stress agent. Adverse effects of the anti-gravity treadmill were limited to minor muscle aches in 5 subjects. Stress myocardial perfusion image quality judged by 3 blinded readers on a 5-point scale was comparable

2018 Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology Controlled trial quality: uncertain

19. Diagnostic accuracy of exercise stress testing for coronary artery disease: a systematic review and meta-analysis of prospective studies

Diagnostic accuracy of exercise stress testing for coronary artery disease: a systematic review and meta-analysis of prospective studies Diagnostic accuracy of exercise stress testing for coronary artery disease: a systematic review and meta-analysis of prospective studies Diagnostic accuracy of exercise stress testing for coronary artery disease: a systematic review and meta-analysis of prospective studies Banerjee A, Newman DR, Van den Bruel A, Heneghan C CRD summary This generally well (...) -conducted review concluded that exercise testing was more useful at excluding coronary artery disease than confirming it. The reliability of the conclusions is compromised by the low predictive values of likelihood ratios of most tests, potential for missed studies, and methodological limitations of some of the included studies. Authors' objectives To determine the diagnostic accuracy of exercise stress testing for coronary artery disease on angiography. Searching Medion, MEDLINE, EMBASE, Central

2012 DARE.

20. Diagnostic value of ST-segment deviations during cardiac exercise stress testing: Systematic comparison of different ECG leads and time-points. (PubMed)

Diagnostic value of ST-segment deviations during cardiac exercise stress testing: Systematic comparison of different ECG leads and time-points. Exercise ECG stress testing is the most widely available method for evaluation of patients with suspected myocardial ischemia. Its major limitation is the relatively poor accuracy of ST-segment changes regarding ischemia detection. Little is known about the optimal method to assess ST-deviations.A total of 1558 consecutive patients undergoing bicycle (...) exercise stress myocardial perfusion imaging (MPI) were enrolled. Presence of inducible myocardial ischemia was adjudicated using MPI results. The diagnostic value of ST-deviations for detection of exercise-induced myocardial ischemia was systematically analyzed 1) for each individual lead, 2) at three different intervals after the J-point (J+40ms, J+60ms, J+80ms), and 3) at different time points during the test (baseline, maximal workload, 2min into recovery).Exercise-induced ischemia was detected

2017 International journal of cardiology

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