Cardiopulmonary exercise testing data processing and storage tools

ABSTRACT Conducting a clinical study is a complex and challenging task, so using technology to facilitate the process is necessary for the medical and scientific community. Data digitization is needed to store and process it. Digitization speeds up data visualization techniques so scientists can analyze it most effectively depending on their goals. In this project, we developed two digital tools related to the cardiopulmonary exercise test (CPET) data, one for digitizing PDF reports and the other for generating databases. The latter was a web-based database visualization dashboard. Users can select parameters of interest and check for differences among subgroups. Basic statistical tests are performed for each variable under analysis, and its results are presented in numerical and graphical formats. The initial statistical tests and the derived recommendation will guide the research team in deeper statistical analysis and robust analysis supporting more decisive conclusions. We ended up with the first version for both tools and validated it using patients' CPET data from the Dante Pazzanese Institute of Cardiology. We conducted a pilot study to verify if the tools served their purpose and observed that both programs worked as planned. The tools can be further tailored to be clinically or research-oriented. On the analysis of CPET's results, the conclusions for our example study were in line with what is presented in the bibliography for cardiorespiratory physiology.

Association between non-alcoholic hepatic steatosis and hyper reactive blood pressure response on the exercise treadmill test.

AIMS: Non-alcoholic hepatic steatosis (HS) is associated with hypertension and increased cardiovascular risk. While Blood pressure hyper-reactive response (HRR) during peak exercise indicates an increased risk of incident hypertension and increased cardiovascular risk, no data on the association of non-alcoholic HS and HRR exists. In this study, we have evaluated the association of HS with HRR. METHODS: We included 13 410 consecutive individuals with a mean age: 42.4 ± 8.9 years, 3561 (26.6%) female with normal resting blood pressure and without a previous diagnosis of hypertension, who underwent symptom limited exercise treadmill test, abdominal ultrasonography and clinical and laboratory evaluation. HS was detected by abdominal ultrasonography. HRR was defined by a peak exercise systolic blood pressure >220 mmHg and/or elevation of 15 mmHg or more in diastolic blood pressure from rest to peak exercise. RESULTS: The prevalence of HS was 29.5% (n = 3956). Overall, 4.6% (n = 619) of the study population presented a HRR. Subjects with HS had a higher prevalence of HRR (8.1 vs. 3.1%, odds ratio 2.8, 95% CI 2.4-3.3, P < 0.001). After adjustment for body mass index, waist circumference, fasting plasma glucose and low density lipoprotein cholesterol, HS (odds ratio 1.4, 95% CI 1.1-1.6, P = 0.002) remained independently associated with HRR. HS was additive to obesity markers in predicting exercise HRR. CONCLUSIONS: Non-alcoholic HS is independently associated with hyper-reactive exercise blood pressure response.

Exercise may cause myocardial ischemia at the anaerobic threshold in cardiac rehabilitation programs.

Myocardial ischemia may occur during an exercise session in cardiac rehabilitation programs. However, it has not been established whether it is elicited when exercise prescription is based on heart rate corresponding to the anaerobic threshold as measured by cardiopulmonary exercise testing. Our objective was to determine the incidence of myocardial ischemia in cardiac rehabilitation programs according to myocardial perfusion SPECT in exercise programs based on the anaerobic threshold. Thirty-nine patients (35 men and 4 women) diagnosed with coronary artery disease by coronary angiography and stress technetium-99m-sestamibi gated SPECT associated with a baseline cardiopulmonary exercise test were assessed. Ages ranged from 45 to 75 years. A second cardiopulmonary exercise test determined training intensity at the anaerobic threshold. Repeat gated-SPECT was obtained after a third cardiopulmonary exercise test at the prescribed workload and heart rate. Myocardial perfusion images were analyzed using a score system of 6.4 at rest, 13.9 at peak stress, and 10.7 during the prescribed exercise (P < 0.05). The presence of myocardial ischemia during exercise was defined as a difference > or = 2 between the summed stress score and summed rest score. Accordingly, 25 (64%) patients were classified as ischemic and 14 (36%) as nonischemic. MIBI-SPECT showed myocardial ischemia during exercise within the anaerobic threshold. The 64% prevalence of ischemia observed in the study should not be looked on as representative of the whole population of patients undergoing exercise programs. Changes in patient care and exercise programs were implemented as a result of our finding of ischemia during the prescribed exercise.

Exercise may cause myocardial ischemia at the anaerobic threshold in cardiac rehabilitation programs

Myocardial ischemia may occur during an exercise session in cardiac rehabilitation programs. However, it has not been established whether it is elicited when exercise prescription is based on heart rate corresponding to the anaerobic threshold as measured by cardiopulmonary exercise testing. Our objective was to determine the incidence of myocardial ischemia in cardiac rehabilitation programs according to myocardial perfusion SPECT in exercise programs based on the anaerobic threshold. Thirty-nine patients (35 men and 4 women) diagnosed with coronary artery disease by coronary angiography and stress technetium-99m-sestamibi gated SPECT associated with a baseline cardiopulmonary exercise test were assessed. Ages ranged from 45 to 75 years. A second cardiopulmonary exercise test determined training intensity at the anaerobic threshold. Repeat gated-SPECT was obtained after a third cardiopulmonary exercise test at the prescribed workload and heart rate. Myocardial perfusion images were analyzed using a score system of 6.4 at rest, 13.9 at peak stress, and 10.7 during the prescribed exercise (P < 0.05). The presence of myocardial ischemia during exercise was defined as a difference ≥2 between the summed stress score and summed rest score. Accordingly, 25 (64 percent) patients were classified as ischemic and 14 (36 percent) as nonischemic. MIBI-SPECT showed myocardial ischemia during exercise within the anaerobic threshold. The 64 percent prevalence of ischemia observed in the study should not be looked on as representative of the whole population of patients undergoing exercise programs. Changes in patient care and exercise programs were implemented as a result of our finding of ischemia during the prescribed exercise.

Princípios gerais e aplicaçöes de reabilitaçäo / Rehabilitation: principles and applications

A reabilitaçäo cardíaca é o processo de desenvolvimento e manutençäo de nível desejável de atividade física, social e psicológica após o início da doença coronária sintomática. Trata-se de terapêutica multidisciplinar para patologia multifatorial. Os maiores objetivos säo: melhora da capacidade funcional e da qualidade de vida, mudança de hábitos após evento coronário, com modificaçäo dos fatores de risco e reduçäo dos índices de mortalidade. Säo discutidos os vários efeitos do treinamento físico, clusive sobre a qualidade de vida de homens e mulheres, os tipos de exercício apropriados, conforme o tipo de doença cardiovascular, bem como a estratificaçäo quanto ao risco para atividade física após evento coronário. finalmente, säo apresentadas as indicaçöes e contra-indicaçöes atuais da reabilitaçäo cardíaca.

[Diagnosis using nuclear medicine of anterior descending artery stenosis in patients with left bundle branch block]. / Diagnóstico de lesão obstrutiva da artéria coronária descendente anterior em pacientes com bloqueio de ramo esquerdo através da medicina nuclear.

PURPOSE: To evaluate septal perfusion and contractility in patients with left bundle branch block (LBBB). METHODS: Twenty patients were submitted to myocardial scintigraphy with Tecnecium-99m isontrile after exercise and dipyridamole infusion. The septal contractility was observed during the radionuclide ventriculography. All patients were submitted to coronariography. RESULTS: Twenty patients were studied and 17 (85%) had a normal left anterior descending (LAD) artery. Nine (53%) patients had abnormalities in septal perfusion after the exercise and 2 (12%) after dipyridamole infusion. All patients had abnormalities in septal contractility during the radionuclide ventriculography. CONCLUSION: The myocardial scintigraphy after dipyridamole infusion showed better specificity in the diagnosis of a LAD lesion. The radionuclide ventriculography was an efficient method to evaluate the septal contraction abnormalities in patients with LBBB.

[Evaluation of the effects of macerated oral dipyridamole on the ergometric test]. / Avaliação dos efeitos do dipiridamol oral macerado no teste ergométrico.

Eighteen male patients with ages varying from 42 to 72 years (average 60.6), with coronary heart disease confirmed by angiography, on regular rehabilitation program and on regular use of dipyridamole were submitted to three exercise stress tests: a control test (TE1) and forty minutes after oral administration of macerated dipyridamole in doses of 150 mg (TE2) and 300 mg (TE3), respectively. The comparison between the data of TE2 and TE1 demonstrated that in TE2 the ST depression was more accentuated in the smallest maximal load attained and in the effort peak as well. The comparison between the data of TE3 and TE1 showed that in TE3: 1) the ST depression was more evident in the effort peak and in the smallest attained load; 2) the heart rate and the product heart rate x blood pressure were smaller in the effort peak; 3) the total time of angina and the time for its relief after effort, were longer. The other exercise stress test parameters did not show any significant changes. These data, suggest that the physical effort overload, after dipyridamole administration, produced a more marked myocardial ischemia, whose degree was proportional to the dose.