Effect of smoking habit on cardiopulmonary function in patients with myocardial infarction -A study based on cardiopulmonary exercise testing- / 体力科学

The purpose of this study was to examine the relationship between smoking and cardiopulmonary function, and the effect of smoking habit on exercise tolerance after discharge from the hospital, focusing on CPX test data of patients hospitalized for acute myocardial infarction, and on CPX test data at 6 months after discharge. A total of 123 male patients hospitalized for acute myocardial infarction between April 2014 and December 2020 were included. Laboratory and CPX data were compared between smokers and non-smokers. CPX data of smokers, ex-smokers and non-smokers were also compared in 24 patients who underwent CPX examination 6 months after discharge. HDL-C was significantly decreased (p < 0.05) and τON was significantly prolonged (p < 0.05) during hospitalization in smokers. τON was significantly shorter only in ex-smokers (p < 0.05) 6 months after discharge compared to during hospitalization. These results suggest that τON, which reflects the oxygen uptake kinetics of peripheral tissues, is shortened by smoking cessation.

Respuestas cardiovasculares de pacientes con obesidad en la prueba de esfuerzo / Cardiovascular responses of obese patients to exercise stress test

RESUMEN Introducción: La obesidad es una enfermedad multisistémica que constituye un factor de riesgo coronario y se asocia frecuentemente a otros, como la hipertensión arterial, la diabetes y la dislipidemia, todo lo cual aumenta el riesgo de enfermedad cardiovascular. Objetivo: Determinar la respuesta cardiovascular de los pacientes con obesidad durante una prueba de esfuerzo. Método: Estudio observacional, descriptivo y transversal con 67 participantes obesos (45 mujeres y 22 hombres), con promedio de edad de 35±12,6 años. Para el desarrollo de esta investigación se obtuvieron variables antropométricas, signos vitales, escala de Borg, cuestionario para factores de riesgo cardiovascular, y se realizó una prueba de esfuerzo en tapiz rodante con protocolo de Bruce. Resultados: Los principales factores de riesgo cardiovascular encontrados fueron el sedentarismo (100%) y los antecedentes patológicos familiares (76%). Se obtuvo una frecuencia cardíaca máxima promedio de 172,82±18,81 latidos por minuto, que fue superior en las mujeres (173,9±17,5 vs. 168,9±22,1) y al asociarla con los factores de riesgo cardiovascular se encontró que fue mayor en los pacientes con menos de 4 factores de este tipo (179,4±17,7 vs. 167,1±18,6). Conclusiones: Se encontró una disminución de la respuesta cardiovascular en relación con el esfuerzo esperado para la prueba de esfuerzo. A mayor número de factores de riesgo cardiovascular presentes, menor fue la frecuencia cardíaca máxima alcanzada.

ABSTRACT Introduction: Obesity is a multisystemic disease and a coronary risk factor that is frequently associated with others, such as high blood pressure, diabetes and dyslipidemia. These all increase the risk of heart disease. Objective: We aimed to determine the cardiovascular response of obese patients during a stress test. Methods: An observational, descriptive and cross-sectional study was conducted with 67 obese participants (45 women and 22 men) aged 35±12.6 years on average. To develop our research, we analyzed anthropometric variables and vital signs. The Borg scale, a cardiovascular risk factor interview and a Bruce treadmill stress test protocol were also applied. Results: The main cardiovascular risk factors found were sedentary lifestyle (100%) and family history of disease (76%). An average maximum heart rate of 172.82±18.81 beats per minute was obtained, which was higher in women (173.9±17.5 vs. 168.9±22.1). It was found to be higher in patients with less than four cardiovascular risk factors (179.4±17.7 vs. 167.1±18.6) when associated with cardiovascular risk factors. Conclusions: A decrease in cardiovascular response was found in relation to the expected test effort. The greater the number of cardiovascular risk factors, the lower the maximum heart rate achieved.

Changes of serum cortisol and IL-6 levels before and after exercise stress test and their relationship with white coat hypertension / 国际检验医学杂志

Objective To investigate the changes of serum cortisol and IL-6 levels before and after exercise stress test and their relationship with white coat hypertension .Methods A total of 48 patients with white coat hypertension in Liwan Hospital of Tra-ditional Chinese Medicine from January 2014 to August 2016 were selected as the study group ,30 cases of patients with common hypertension in the same period were selected as common group ,30 cases of healthy volunteers in the same period were selected as control group .All the objects in the three groups completed exercise stress test on an empty stomach ,sat on the power bicycle and pedaling 2 min with 200 W ,and after intermittent 5 min repeated exercise until extreme fatigue .Serum cortisol and IL-6 levels ,mean arterial pressure(MAP) of 3 groups before exercise ,immediately after exercise and 3 h after exercise were detected and compared . Value of serum cortisol and IL-6 on diagnosing white coat hypertension and its relationship with MAP were analyzed .Results Compared with the control group ,serum cortisol ,IL-6 levels and MAP of the study group and common group before and after exer-cise were increased .Compared with the common group ,serum cortisol and IL-6 levels and MAP of the study group were significant-ly increased immediately after exercise and 3 h after exercise (P<0 .05) .Compared with before exercise ,serum cortisol and IL-6 levels and MAP of the study group immediately after exercise and 3 h after exercise were increased(P<0 .05) .ROC curve analysis showed that it′s value to detecting serum cortisol and IL-6 levels before and after exercise stress test for diagnosing white coat hy-pertension ,in which the value of combined detection of serum cortisol and IL-6 immediately after exercise for diagnosing white coat hypertension was the best .Pearson linear correlation analysis showed that serum cortisol and IL-6 levels before and after exercise stress test were positively correlated with MAP of patients with white coat hypertension (r=0 .844 ,0 .802 ,P<0 .05) .Conclusion It′s value to detecting serum cortisol and IL-6 levels before and after exercise stress test for diagnosing white coat hypertension , which are related with blood pressure ,and could be used as reference indexes for the diagnosis and illness severity evaluation of white coat hypertension .

Changes of serum cortisol and IL-6 levels before and after exercise stress test and their relationship with white coat hypertension / 国际检验医学杂志

Objective To investigate the changes of serum cortisol and IL-6 levels before and after exercise stress test and their relationship with white coat hypertension .Methods A total of 48 patients with white coat hypertension in Liwan Hospital of Tra-ditional Chinese Medicine from January 2014 to August 2016 were selected as the study group ,30 cases of patients with common hypertension in the same period were selected as common group ,30 cases of healthy volunteers in the same period were selected as control group .All the objects in the three groups completed exercise stress test on an empty stomach ,sat on the power bicycle and pedaling 2 min with 200 W ,and after intermittent 5 min repeated exercise until extreme fatigue .Serum cortisol and IL-6 levels ,mean arterial pressure(MAP) of 3 groups before exercise ,immediately after exercise and 3 h after exercise were detected and compared . Value of serum cortisol and IL-6 on diagnosing white coat hypertension and its relationship with MAP were analyzed .Results Compared with the control group ,serum cortisol ,IL-6 levels and MAP of the study group and common group before and after exer-cise were increased .Compared with the common group ,serum cortisol and IL-6 levels and MAP of the study group were significant-ly increased immediately after exercise and 3 h after exercise (P<0 .05) .Compared with before exercise ,serum cortisol and IL-6 levels and MAP of the study group immediately after exercise and 3 h after exercise were increased(P<0 .05) .ROC curve analysis showed that it′s value to detecting serum cortisol and IL-6 levels before and after exercise stress test for diagnosing white coat hy-pertension ,in which the value of combined detection of serum cortisol and IL-6 immediately after exercise for diagnosing white coat hypertension was the best .Pearson linear correlation analysis showed that serum cortisol and IL-6 levels before and after exercise stress test were positively correlated with MAP of patients with white coat hypertension (r=0 .844 ,0 .802 ,P<0 .05) .Conclusion It′s value to detecting serum cortisol and IL-6 levels before and after exercise stress test for diagnosing white coat hypertension , which are related with blood pressure ,and could be used as reference indexes for the diagnosis and illness severity evaluation of white coat hypertension .

Ecuación más conveniente para predecir frecuencia cardíaca máxima esperada en esfuerzo / More convenient equation for predicting maximum heart rate expected in exercise testing / Equação mais conveniente para prever frequência cardíaca máxima esperada em teste de esforço

Objetivo. Comparar la frecuencia cardíaca máxima (FCmax) alcanzada con la esperada según la fórmula clásica (220 menos edad) y la propuesta por Tanaka [208,75 - (0,73 x edad)] en diferentes poblaciones para determinar cuál es la ecuación más exacta, en vista de que este parámetro es muy utilizado para la evaluación de la reserva cronotrópica y coronaria. Material y método. Estudio descriptivo, observacional y transversal con 910 pacientes que realizaron prueba ergométrica graduada en el Instituto Médico Río Cuarto (Córdoba, Argentina) durante 2012-2013. Se utilizó el protocolo de Astrand. Se evaluó la FCmax alcanzada y esperada de cada paciente mediante la fórmula clásica y la de Tanaka. Se compararon dichos resultados según el género, rango etario, índice de masa corporal (IMC), presencia de factores de riesgo (hipertensión arterial, diabetes mellitus, dislipidemia, enfermedad coronaria previa y/o tabaquismo) y consumo de beta bloqueantes. Para el análisis estadístico se utilizó Microsoft Excel y SPSS, y la probabilidad estadística mediante el índice de Pearson con un valor <0,01. Resultados. Se analizaron 910 pacientes, 554 (61%) de género masculino y 356 (39%) femenino, la edad promedio fue de 47±16 años, el IMC fue de 27±5. El 48% de la población presentó uno o más factores de riesgo y el 15% estaba bajo tratamiento con beta bloqueantes. Al analizar la FCmax alcanzada por el paciente y compararla con la esperada según ambas fórmulas, se halló una sobreestimación por parte de las mismas, resultando más precisa en los menores de 40 años, la de Tanaka, y en los mayores de 40 años, la fórmula clásica. En los pacientes con IMC >25 y en los tratados con beta bloqueantes, se evidenció una sobreestimación de la FCmax esperada con ambas fórmulas. Conclusiones. La fórmula de Tanaka fue más precisa en los pacientes menores de 40 años sin diferencias respecto al género, por lo que sugerimos utilizar esta ecuación para dicha población y reservar la clásica para los mayores de 40 años. Esta relación se mantuvo en las subpoblaciones según presencia o no de factores de riesgo e IMC. Estos hallazgos tendrían el efecto de subestimar el verdadero nivel de estrés físico impuesto durante la prueba de esfuerzo y la intensidad adecuada de los programas de ejercicios prescriptos. La población que utilizaba beta bloqueantes presentó una sobreestimación con ambas fórmulas, siendo más acentuada cuanto más joven era el paciente.

Objective. To compare the maximum heart rate (HRmax) reached with the expected according to the classical formula (220 minus age) and that proposed by Tanaka [208,75 - (0,73 x age)] in different populations to determine which is the most accurate equation, given that this parameter is used to evaluate the chronotropic and coronary reserve. Material and method. Descriptive, observational and cross-sectional study with 910 patients who underwent exercise stress test graduated at the Medical Institute Rio Cuarto (Cordoba, Argentine) during 2012-2013. Åstrand protocol was used. HRmax achieved and expected of each patient by the classic formula and Tanaka's formula were evaluated. These results were compared by gender, age range, body mass index (BMI), presence of risk factors (hypertension, diabetes mellitus, dyslipidemia, previous coronary disease and/or smoking) and use of beta blockers. Microsoft Excel for statistical analysis and SPSS was used, and the statistical probability by Pearson index with a value <0.01. Results. The 910 patients, 554 (61%) of male and 356 (39%) female, mean age was 47±16 years, BMI was 27±5 were analyzed. The 48% of the population had one or more risk factors and 15% were treated with beta blockers. When analyzing the HRmax reached by the patient and compared with the expected according to both formulas, an overestimation was found by them, resulting in more accurate Tanaka's formula in the under 40 years and the classic formula those over 40 years. In patients with BMI >25 and in those treated with beta blockers, an overestimation of HRmax expected with both formulas was evidenced. Conclusions. Tanaka's formula was more accurate in patients younger than 40 years without sex differences, so we suggest using this equation for this population and reserve the classic formula for over 40 years. This relationship remained in subpopulations according to presence or absence of risk factors and BMI. These findings would have the effect of underestimating the true level of physical stress imposed during the stress test and the right intensity of exercise prescribed programs. The population using beta blockers showed an overestimation with both formulas, being more pronounced the younger was the patient.

Objetivo. Comparar a frequência cardíaca máxima (FCmax) alcançada com a esperada de acordo com a fórmula clássica (220 menos a idade) e o proposto por Tanaka [208,75 - (0,73 x idade)] em populações diferentes para determinar qual é a equação mais precisa, uma vez que este parâmetro é utilizado para avaliar da reserva cronotrópica e coronária. Material e método. Estudo descritivo, observacional e transversal, com 910 pacientes que foram submetidos a teste progressivo de esforço no Instituto de Medicina do Rio Cuarto (Córdoba, Argentina) durante 2012-2013. Foi utilizado o protocolo de Åstrand. Foi avaliada a FCmax alcançada e esperada de cada paciente pela fórmula clássica e fórmula de Tanaka. Estes resultados foram comparados por sexo, faixa etária, índice de massa corporal (IMC), a presença de fatores de risco (hipertensão arterial, diabetes mellitus, dislipidemia, doença coronariana prévia e/ou tabagismo) e consumo de beta-bloqueadores. Para análise estatística foi utilizada Microsoft Excel e SPSS, e a probabilidade estatística pelo índice de Pearson, com um valor <0,01. Resultados. Foram analisados 910 pacientes, 554 (61%) do sexo masculino e 356 (39%) do sexo feminino, com idade média de 47±16 anos, o IMC foi de 27±5. O 48% da população apresentaram um ou mais fatores de risco e 15% foram tratados com betabloqueadores. Ao analisar a FCmax alcançada pelo paciente e comparada com a esperada de acordo com ambas as fórmulas, uma superestimação foi encontrada por eles, resultando mais precisa a fórmula Tanaka em menores de 40 anos e a fórmula clássica em pessoas com mais de 40 anos. Em pacientes com IMC >25 e naqueles tratados com betabloqueadores, foi demonstrada uma superestimação da FCmax esperada com ambas as fórmulas. Conclusões. A fórmula de Tanaka foi mais precisa em pacientes com menos de 40 anos sem diferenças entre os sexos, por isso sugerimos usar esta equação para essa população e fórmula clássica para os maiores de 40 anos. Esta relação manteve-se em subpopulações de acordo com a presença ou a ausência de fatores de risco e IMC. Estes achados teriam o efeito de subestimar o verdadeiro nível de estresse físico imposta durante o teste de esforço e a intensidade certa de programas de exercício prescrito. A população utilizando betabloqueadores demonstrou uma superestimação com as duas fórmulas, sendo mais pronunciada quanto mais jovem foi o paciente.

A case of fitness to work in a worker with COPD using the exercise stress test

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease characterized by persistent airflow limitation. Therefore, both work ability and workday length may be affected in individuals with this disease. We studied a worker with suspected COPD and assessed fitness to work using post-bronchodilator spirometry, symptom assessment scales, and the exercise stress test. CASE REPORT: The patient was a 58-year-old man due to work as a field supervisor in the ship construction sector. He had a 40 pack-year smoking history and experienced occasional dyspnea when climbing stairs. He visited this hospital to receive cardiopulmonary function tests and to determine his ability to work. Post-bronchodilator spirometry revealed severe irreversible airway obstruction corresponding to a modified Medical Research Council grade of 2 on the dyspnea scale. His COPD Assessment Test score was 12, placing him in patient group D (high risk, more symptoms) based on the Global Initiative for Chronic Obstructive Lung Disease classification system. His maximum oxygen uptake (VO2max) was determined to be 19.16 ml/kg/min, as measured by the exercise stress test, and his acceptable workload for 8 h of physical work was calculated to be 6.51 ml/kg/min. His work tasks required an oxygen demand of 6.89 ml/kg/min, which exceeded the acceptable workload calculated. Accordingly, he was advised to adjust the work tasks that were deemed inappropriate for his exercise capacity. CONCLUSION: As COPD incidence is expected to rise, early COPD diagnosis and determination of fitness to work is becoming increasingly important. Performing the exercise stress test, to evaluate the functional capacity of workers with COPD, is considered an acceptable solution.

Analysis of the correlation between electrocardiogram exercise stress test and coronary artery stenosis degree / 中国医师进修杂志

Objective To analyze the correlation between electrocardiogram exercise stress test and coronary artery stenosis degree.Methods A total of 150 patients who performed electrocardiogram exercise stress test were selected,and then coronary angiography were performed within 2 weeks.The sensitivity,specificity,positive predictive value and accuracy of electrocardiogram exercise stress test for diagnosing coronary artery stenosis degree were analyzed.Results Compared with coronary angiography,the sensitivity,specificity,positive predictive value and accuracy of electrocardiogram exercise stress test for diagnosing coronary heart disease were 75％(48/64),74％ (64/86),69％(48/70) and 75％ (112/150),respectively,for diagnosing coronary artery disease were 31％ (19/62),42％ (37/88),27％ (19/70) and 37％ (56/150),respectively.Conclusions Electrocardiogram exercise stress test as a simple,feasible and noninvasive method,has a good concordance with coronary angiography and a high correlation with coronary heart disease,a low correlation with coronary artery disease.It can be used as a good way to screen patients with coronary heart disease.

El análisis del intervalo QT corregido incrementa la capacidad de la ergometría para diagnosticar enfermedad arterial coronaria significativa / The Analysis of the Corrected QT-Interval Increases Exercise Stress Test Capability to Detect Significant Coronary Artery Disease

Introducción: La utilidad clínica de la capacidad de la ergometría para indicar la presencia y gravedad funcional de las obstrucciones coronarias se ve limitada por las relativamente bajas sensibilidad y especificidad del infradesnivel del segmento ST (infra-ST), lo cual hace necesaria la investigación de las modificaciones de otras variables electrocardiográficas durante el esfuerzo que puedan aportar información adicional y complementaria a la del infra-ST. Se ha demostrado que el evento más temprano en la primera fase de la lesión transmural es la prolongación del intervalo QT corregido (QTc). Objetivos: Investigar si las modificaciones del intervalo QTc inducidas por el esfuerzo máximo (QTc máx) sumadas al infra-ST ≥ 1 mm permiten incrementar la capacidad de la ergometría para diagnosticar la presencia de enfermedad arterial coronaria significativa y si otros signos pueden aportar también información útil para identificar a estos pacientes. Material y métodos: Ciento sesenta y seis pacientes con infra-ST ≥ 1 mm durante la fase de ejercicio y/o recuperación de una ergometría a los que posteriormente se les realizó una coronariografía se distribuyeron en dos grupos: Grupo I (GI): 118 pacientes que mostraron prolongación del intervalo QTc máx y Grupo II (GII): 48 pacientes que acortaron normalmente el QTc máx. Se analizaron parámetros clínicos, ergométricos y electrocardiográficos y la angiografía coronaria para comprobar la presencia de enfermedad arterial coronaria significativa. Resultados: En 102 de los 166 pacientes incluidos (61,4%) se diagnosticó enfermedad arterial coronaria significativa, todos ellos pertenecientes al GI. El GI mostró alta prevalencia de pacientes con enfermedad arterial coronaria significativa (86,4% vs. 0%; p < 0,001), bajo umbral isquémico, recuperación tardía del infra-ST, mayor ensanchamiento del complejo QRSmáx, incompetencia cronotrópica y baja tolerancia al ejercicio. Durante la prueba ergométrica graduada los pacientes del GII presentaron mayor prevalencia de hipertensión arterial grave y el infra-ST < 1 mm en el segundo minuto del posesfuerzo. El incremento del intervalo QTc máx resultó un predictor independiente de enfermedad coronaria (p < 0,001). Conclusiones: La prolongación del intervalo QTc máx sumado al infra-ST ≥ 1 mm incrementó notoriamente la capacidad de la prueba ergométrica graduada para diagnosticar la presencia de enfermedad arterial coronaria significativa, patología que estuvo ausente en todos los pacientes con infra-ST que acortaron normalmente el QTc máx.

Background: The clinical usefulness of exercise stress testing to indicate the presence and functional severity of coronary artery stenoses is limited by the relatively low sensitivity and specificity of ST-segment depression. Therefore, the modifications of other electrocardiographic variables during exercise, which may provide additional and complementary information to ST-segment depression, should be investigated. It has been demonstrated that the corrected QT interval (QTc) prolongation is the earliest event during the first stage of transmural ischemia. Objectives: The aim of this study was to investigate whether modifications of the QTc interval induced by maximal exercise (QTcmax) together with ST-segment depression ≥ 1 mm can increase the capability of the stress test to detect significant coronary artery disease and if other signs may also provide useful information to identify these patients. Methods: One hundred and sixty six patients with ST-segment depression ≥ 1 mm during exercise or during the recovery stage of a stress test underwent coronary angiography. They were divided into two groups: Goup I (GI): 118 patients with QTcmax interval prolongation and Group II (GII): 48 patients with normal QTcmax shortening. Clinical, stress test-related and electrocardiographic parameters and coronary angiography were analyzed to identify the presence of significant coronary artery disease. Results: Significant coronary artery disease was detected in 102 of the 166 patients included in the study (61.4%), all from GI. Group I showed high prevalence of patients with significant coronary artery disease (86.4% vs. 0%; p < 0.001), low ischemic threshold, late recovery of ST-segment depression, wider QRSmax complex, chronotropic incompetence and low exercise capacity. During graded exercise stress testing, GII patients presented greater prevalence of severe hypertension and ST-segment depression < 1 mm two minutes after exercise. Increased QTcmax interval resulted as an independent predictor of coronary artery disease (p < 0.001). Conclusions: QTcmax interval prolongation plus ST-segment depression ≥ 1 mm produced a considerable increase in the capability of exercise stress testing to detect significant coronary artery disease, which was absent in all the patients with ST-segment depression and normal QTcmax shortening.

El infradesnivel del segmento ST que se presenta o se profundiza durante la fase de recuperación: su aporte a la utilidad clínica de la ergometría / Clinical Usefulness of Exercise-Induced ST-Segment Depression Occurring or Increasing during the Recovery Phase / Clinical Usefulness of Exercise-Induced ST-Segment Depression Occurring or Increasing during the Recovery Phase

Introducción No obstante la disponibilidad actual de estudios por imágenes que brindan una muy buena capacidad diagnóstica y de evaluación, la prueba ergométrica graduada (PEG) está reconocida como un estudio importante y continúa siendo el procedimiento más utilizado para la evaluación, el diagnóstico y la estratificación de riesgo de los pacientes con enfermedad arterial coronaria (EAC). Objetivos 1) Investigar el valor clínico de la presencia durante una ergometría del infradesnivel del segmento ST (infra-ST) significativo que aparece sólo durante la fase de recuperación o del que es dudoso durante la fase de ejercicio pero que se profundiza tornándose positivo durante la fase de recuperación de la PEG y compararlos con el infra-ST significativo que se presenta durante la fase activa de ejercicio. 2) Evaluar los datos clínicos, ergométricos y de la angiografía coronaria de los pacientes. Material y métodos Se analizaron los datos clínicos y ergométricos de 147 pacientes con PEG positiva por infra-ST significativo, que en 94 pacientes (GI) se presentó durante la fase de ejercicio, en 29 (GII) sólo en la fase de recuperación y en 24 (GIII) fue dudoso durante el ejercicio, pero se profundizó tornándose significativo en la fase de recuperación. En cada grupo se realizó una correlación entre los resultados de la PEG y los hallazgos de la coronariografía. Resultados Se diagnosticó EAC significativa en 78 pacientes del GI (82,9%), 22 del GII (75,8%) y 21 del GIII (87,5%) (p = 0,52). El GIII reunió los pacientes de edad más avanzada y con alta prevalencia de dislipidemia, antecedente de infarto previo y lesión de tres vasos y/o del tronco de la coronaria izquierda. El GII presentó el mayor número de pacientes asintomáticos, con lesión de un vaso y alta prevalencia de historia familiar de EAC. Conclusiones No se observaron diferencias estadísticas en el porcentaje de pacientes con EAC significativa entre los grupos. Los pacientes del GIII mostraron alta prevalencia de enfermedad coronaria extensa y grave. La evaluación correcta del infra-ST que aparece o se profundiza durante la fase de recuperación aumentó la información clínica que aporta una ergometría.

Background Despite the current availability of diagnostic image tests with excellent diagnostic and prognostic accuracy, exercise stress testing (EST) remains as the procedure most commonly used for the evaluation, diagnosis and risk stratification of patients with coronary artery disease (CAD). Objectives 1) To investigate the clinical usefulness of significant exercise-induced ST-segment depression (ST-d) occurring or increasing during the recovery phase of exercise stress test and to compare it with significant ST-segment depression presenting during the active phase of exercise; 2) to evaluate the clinical data and the information provided by EST and coronary angiography. Material and Methods Clinical and EST data from 147 patients with positive stress test were analyzed. All patients had significant ST-segment depression and were divided into three groups: GI, 94 patients with ST-d during exercise; GII, 29 patients with ST-d only during the recovery phase; and GIII, 24 patients with borderline ST-d during exercise which became significant during the recovery phase. The results of the EST were correlated with the coronary angiography findings in each group. Results A diagnosis of significant CAD was made in 78 patients in GI (82.9%), in 22 in GII (75.8%) and in 21 in GIII (87.5%),(p = 0.52). Patients in GIII were older, with high prevalence of dyslipemia, history of previous infarction and three-vessel and/or left main coronary artery disease. GII presented the higher number of asymptomatic patients with one-vessel disease and high prevalence of CAD. Conclusions There were no statistical differences in the percentage of patients with significant CAD among the groups. Patients in GIII had high prevalence of significant and severe CAD. A proper evaluation of ST-d occurring or becoming significant during the recovery phase provided additional clinical information to the results of the EST.

Treadmill exercise testing of asymptomatic men and women without evidence of heart disease

The aim of this study was to test the hypothesis of differences in performance including differences in ST-T wave changes between healthy men and women submitted to an exercise stress test. Two hundred (45.4 percent) men and 241 (54.6 percent) women (mean age: 38.7 ¡À 11.0 years) were submitted to an exercise stress test. Physiologic and electrocardiographic variables were compared by the Student t-test and the chi-square test. To test the hypothesis of differences in ST-segment changes, data were ranked with functional models based on weighted least squares. To evaluate the influence of gender and age on the diagnosis of ST-segment abnormality, a logistic model was adjusted; P < 0.05 was considered to be significant. Rate-pressure product, duration of exercise and estimated functional capacity were higher in men (P < 0.05). Sixteen (6.7 percent) women and 9 (4.5 percent) men demonstrated ST-segment upslope ¡Ý0.15 mV or downslope ¡Ý0.10 mV; the difference was not statistically significant. Age increase of one year added 4 percent to the chance of upsloping of segment ST ¡Ý0.15 mV or downsloping of segment ST ¡Ý0.1 mV (P = 0.03; risk ratio = 1.040, 95 percent confidence interval (CI) = 1.002-1.080). Heart rate recovery was higher in women (P < 0.05). The chance of women showing an increase of systolic blood pressure ¡Ü30 mmHg was 85 percent higher (P = 0.01; risk ratio = 1.85, 95 percentCI = 1.1-3.05). No significant difference in the frequency of ST-T wave changes was observed between men and women. Other differences may be related to different physical conditioning.

The Selection of Exercise Stress Test in Hemiplegic Patients

OBJECTIVE: To suggest the standard tool for the selection of exercise stress tests (EST) by analysis of the initial evaluation factors affecting EST. METHOD: Twenty-two hemiplegic patients carried out treadmill, arm and bicycle ergometer ESTs. Treadmill EST using modified Harbor protocol was performed without taking off AFO. The velocity of the arm and bicycle ergometer was set in 50 rpm, and the resistance was increased up to 5 W at each stage. Each EST was completed at 80% of maximal heart rate. RESULTS: Brunnstrom stage of lower extrimity, Medical Research Council (MRC) scores [hip flexor, knee extensor, finger flexor] and standing balance of twelve patients completing treadmill EST were superior to those of failed group (p<0.05). Twelve patients completing bicycle ergometer EST showed significant differences in MRC scores [hip flexor, knee extensor] and sitting balance (p<0.05). Brunnstrom stage of lower extremity hip flexor and knee extensor power contributed mostly to the completion of treadmill EST (p<0.01). The completion of bicycle ergometer EST was mostly dependent on hip flexor and knee extensor power (p<0.01). CONCLUSION: For bicycle ergometer EST, hip flexor and knee extensor power should be higher than 3 and 4, respectively. Treadmill EST can be suggested when Brunnstrom stage of lower extremity, hip flexor and knee extensor power are above 4, 4 and 3, respectively. The completion rate of treadmill EST can be increased when standing balance ability and Brunnstrom hand score higher than 4 and 2, respectively.

Evaluation of Exercise Efficiency with Change in Oxygen Uptake and Work Rate in Stroke Patients

OBJECTIVE: To evaluate exercise capacity of subacute stroke patients with nonambulatory exercise stress test and to determine whether reduced exercise efficiency is associated with functional performance. METHOD: Experimental design was prospective and observational study. Eighteen patients with moderate to severe impairment after recent stroke performed exercise stress test by repeated knee flexion and extension exercise using isokinetic dynamometer. Work rate, oxygen consumption, heart rate were assessed during exercise stress test. The dynamic response, the ratio of change in oxygen uptake to change in work rate, was measured for correlation with FIM (Functional Independence Measure) scores. Occupational therapist recorded FIM scores on the day of transfer to inpatient rehabilitation unit and on discharge. Age-matched healthy group also performed exercise stress test in same settings. RESULTS: The patients group who had similar dynamic response with age-matched healthy group showed higher FIM scores than the patients group having higher dynamic response. CONCLUSION: Nonambulatory exercise stress test could be effectively used in subacute stroke patients and the ratio of change in oxygen uptake to change in work rate was a useful variable to reveal low exercise efficiency in subacute stroke patients who had a abnormal skeletal muscle metabolic capacity.

Application of exercise stress test after acute myocardial infarction / 中国康复理论与实践

@#ObjectiveTo investigate application of exercise stress test after acute myocardial infarction(AMI). Methods32 patients with AMI performed exercise stress test adopted the Bruce protocol in 16 days-8weeks after onset, at the same time cardiac functional capacity was measured.ResultsThe stress test was positive in 17 cases, whose cardiac functional capacity was 1.5-7 METs,and it was negative in 15 cases, whose cardiac functional capacity is 4-12 METs.Conclusions①Second class amount limited exercise stress test is safe to adaptive AMI patients. ②Cardiac functional capacity measurement is benefit to instruct patient rehabilitation exercise. ③Exercise stress test is valuable to estimate prognosis of AMI.

Evaluation of Cardiopulmonary Function in the Patients with Ankylosing Spondylitis Using Exercise Stress Test

OBJECTIVE: To evaluate cardiopulmonary function and maximal exercise capacity in patients with ankylosing spondylitis using exercise stress test, the possible causes of reduced maximal exercise capacity and the correlation between dynamic pulmonary function and static pulmonary funtion. METHOD: Twenty patients with ankylosing spondylitis were evaluated with incremental exercise stress test, static pulmonary function test and the mobility of thoracic cage and spine. RESULTS: 1) Nineteen patients (95%) showed reduced maximal exercise capacities. 2) Deconditioning was the most frequent cause of reduced maximal exercise capacities (13 patients, 68%). 3) There was no significant correlation between exercise stress test and static pulmonary function test, and between exercise stress test and the mobility of the spine and thoracic cage. CONCLUSION: Maximal exercise capacities were reduced in patients with ankylosing spondylitis, and the most frequent cause of them was deconditioning. To improve exercise capacity, conditioning exercise should be emphasized in patients with ankylosing spondylitis.

Estratificação prognóstica em sobreviventes ao infarto agudo do miocárdio. Teste ergométrico versus cinecoronariografia / Risk Stratification after Acute Myocardial Infarction. Exercise Stress Test versus Coronary Angiography

PURPOSE: To compare the predictive accuracy for future ischemic events of heart rate limited treadmill exercise test (HET) and coronary angiography (CA) applied to survivors of an uncomplicated myocardial infarction. METHODS: 142 consecutive patients (55 +/- 11 years, 80males), presenting a non complicated acute myocardial infarction (AMI) were included. HET was performed 10 +/- 3 days after AMI, and CA during hospital stay or within 4-6 weeks. HET positivity criteria were: 1) horizontal or down-sloping ST segment displacement > or = 1 mm; 2) angina; 3) arterial pressure drop during exercise; 4) low workload (< 6 METS); 5) complex ventricular arrhythmia. At CA lesions causing > or = 50of luminal reduction were considered significant. HET and CA results were correlated to ischemic events occurring during the follow-up (unstable angina in 20, cardiac death 6, and reinfarction 6). RESULTS: HET was positive in 69 (49) patients, exhibiting a positive predictive value for ischemic events (PV+) of 26and a negative predictive value (PV-) of 77. The mean event-free time was 43 +/- 3 months for positive HET and 46 +/- 3 months for a negative one (p = 0.48). CA showed 0-1 vessel involvement in 93 (66) patients and > or = 2 vessels in 49 (34) patients. The presence of multivascular disease at CA presented a PV+ of 37and PV- of 82; the mean event-free time was 37 +/- 4 months for patients with multivascular involvement and 48 +/- 2 months for patients without this pattern (p = 0.007). CONCLUSION: The predictive accuracy of HET for future ischemic events in the thrombolytic era is markedly reduced. This population of AMI survivors presents an overall good prognosis that seems to justify the poor predictive accuracy of this test.

Valor do teste de esforço computadorizado no diagnóstico diferencial entre fenômenos isquêmicos de origem obstrutiva e näo-obstrutiva / Value of Computadorized Exercise Stress Test in the Differentiation Among Ischemic Phenomena of Obstructive and Non-obstructive Origin

PURPOSE--To describe groups of patients who have obstructive and non-obstructive coronary artery disease, through computadorized exercise stress test. METHODS--The test was done in 121 patients, all male, divided into 3 groups: GN group, 50 patients with normal electrocardiographic response to exercise; GLO group, 40 patients with obstructive coronary artery disease and GNO group, 31 patients with normal coronary arteries, showing one or more of the following entities: intramural coronary traject, coronary tortuosity, slow flow, mitral valve prolapse or left ventricular hypertrophy. GLO and GNO groups presented with abnormal response of the ST segment during exercise. The quantitative variables registered by computer were particularly analyzed as follows: STL (point Y depression), slope, index and ST segment integral. The magnitude of ST vector was visually measured and quantified. The statistic study was made through ANOVA and multiples comparison by the Scheffe's method, Fisher's test, quisquare and sensibility, specificity and accuracy calculation. RESULTS--There was a significant statistic difference among the 3 groups relative to slope and index (p < 0.05). The integral variable of ST segment did not allow us to differentiate the GLO and GNO groups. In the association study between the ST vector magnitude and abnormal T loop, there was an increase in sensibility of 15//in the exercise stress test. CONCLUSION--The ST segment slope below zero values, define patients having obstructive disease, and the opposite, non-obstructive disease. Values of ST segment index lower than -2 are linked to obstructive disease and higher than -2 linked to non-obstructive. Values of ST segment lower than -7 microV. s separate individuals with normal exercise stress test from those with ischemic type response. The magnitude of ST vector equal to or lower than 0.20mV define normal vectorcardiographic response to the exercise

A SIMPL EXERCISE STRESS TEST IN CHILDREN WITH VERTICAL JUMPING / 体力科学

A simple exercise test with vertical jumping was developed for children. The vertical acceleration wave form of back was measured with strain gauge type transducer. After amplification and rectification, the signal of positive acceleration was converted to frequency with voltage-to-frequency converter (VFC) and VFC signals were decoded by a digital counter. The digital output was normalized by gravitational value and defined as physical activity rate. 10 young males and 24 schoolchildren jumped at several frequencies and oxygen uptake, physical activity rate and heart rate were measured. Also 28 children under school age jumped arbitrary and heart rate and physical activity rate were recorded. The results showed that the oxygen uptake per body weight had good correlation to the physical activity rate (r=0.95) . Although heart rate was significantly different with ages, physical activity rate which was defined as an index of exrecise test, was no significant difference with ages and weights (α<0.05) . The results indicated that this jumping test was helpful to make exercise stress test for younger children.