587 results on '"exercise stress test"'
Search Results
2. Risk Factors Associated With Exaggerated Blood Pressure Response at the Time of Exercise Treadmill Stress Test.
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Katsi, Vasiliki, Ioakeimidis, Nikolaos, Dimitroglou, Yannis, Vlachopoulos, Charalambos, and Tsioufis, Konstantinos
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TREADMILL exercise tests ,BLOOD pressure ,HYPERTENSION risk factors ,CARDIOVASCULAR diseases risk factors ,HYPERTENSION - Abstract
BACKGROUND Exaggerated blood pressure response (EBPR) to exercise stress testing (EST) may be a marker of future hypertension and carry valuable information for the prediction of cardiovascular events. We sought to evaluate the clinical and resting EST parameters associated with an increased likelihood of EBPR. METHODS The records of 14,073 patients (mean age: 55 ± 11 years) without known cardiovascular disease who underwent a treadmill EST were analyzed. RESULTS The overall prevalence of arterial hypertension was 44%. A considerable proportion (24%) of patients exhibited EBPR. Multivariate analysis of the entire study population showed that middle-aged individuals (40–60 years old), resting systolic BP > 130 mmHg and/or diastolic BP > 80 mmHg, known arterial hypertension, current cigarette smoking, and family history of premature coronary artery disease are all independent risk factors for EBPR (all P < 0.001). Although the presence of arterial hypertension increased the likelihood of EBPR in the analysis of the entire population, the relevant association in subjects above 60 years old is statistically nonsignificant (P = 0.120). Notably, the pre-test systolic BP > 130 mmHg and/or diastolic BP > 80 mmHg level increased significantly the likelihood of manifesting EBPR in all age categories (<40, 40–60, and >60 years old) independent of hypertension presence and in all hypertensive patients independently of antihypertensive treatment intake (all P < 0.001). CONCLUSIONS Considering the diagnostic and prognostic utility of EBPR during treadmill EST the clinical and resting hemodynamic parameters that increase the likelihood of EBPR are targets for interventions and preventive measures to modify lifestyle risk behaviors and reduce hypertension and cardiovascular risk factors in the early stages. [ABSTRACT FROM AUTHOR]
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- 2025
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3. Risk Stratification in Pediatric Wolff-Parkinson-White: Practice Variation Among Pediatric Cardiologists and Electrophysiologists.
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Christmyer, Zane, Pisupati, Meghana, Shah, Maully J, Srinivasan, Chandra, Vetter, Victoria L, Iyer, V. Ramesh, Triguba, Mary, and Janson, Christopher M.
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CARDIAC arrest , *WOLFF-Parkinson-White syndrome , *PEDIATRIC cardiology , *EXERCISE tests , *DIAGNOSIS methods - Abstract
Background: Published guidelines provide recommendations for risk stratification in pediatric Wolff-Parkinson-White (WPW). There are no data on provider concordance with these guidelines. We hypothesized that significant practice variation exists between pediatric cardiologists (PC) and electrophysiologists (EP). Method: The records of all patients, age 8 to 21 years, with a new ECG diagnosis of WPW between 1/1/2013 and 12/31/2018, from a single center, were retrospectively reviewed. Subjects were categorized on the basis of symptoms and resting ECG findings as one of the following: asymptomatic intermittent WPW, asymptomatic persistent WPW, or symptomatic WPW. The performance and results of diagnostic testing, including Holter monitor, event monitor, exercise stress test (EST), and electrophysiology study (EPS), were recorded. The primary outcome was concordance with published guidelines. A secondary outcome was documentation of a discussion of sudden cardiac death (SCD) risk. Results: 615 patient encounters were analyzed in 231 patients with newly diagnosed WPW pattern on ECG (56% male; mean age at diagnosis 13.9 ± 2.5 years). EP were observed to have a significantly higher rate of guideline concordance than PC (95% vs. 71%, p < 0.001). There was significant practice variation between PC and EP in the documentation of a discussion of SCD risk: 96% in EP vs. 39% in PC (p < 0.001). Conclusion: Significant practice variation exists in the non-invasive and invasive risk stratification of pediatric WPW, with lower concordance to published guidelines amongst PC, when compared to EP. This report highlights the need to promote awareness of current WPW guidelines in the pediatric cardiology community at large. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Target Heart Rate Formulas for Exercise Stress Testing: What Is the Evidence?
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Almaadawy, Omar, Uretsky, Barry F., Krittanawong, Chayakrit, and Birnbaum, Yochai
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CHEST exercises , *METABOLIC equivalent , *HEART beat , *EXERCISE tests , *CHEST pain - Abstract
Exercise stress testing (EST) is commonly used to evaluate chest pain, with some labs using 85% of age-predicted maximum heart rate (APMHR) as an endpoint for EST. The APMHR is often calculated using the formula 220-age. However, the accuracy of this formula and 85% APMHR as an endpoint may be questioned. Moreover, failing to reach 85% APMHR (known as chronotropic insufficiency) may also indicate poor cardiovascular prognosis, but measurements, such as percentage heart rate reserve (%HRR), maximum rate pressure product (MRPP), and the maximum metabolic equivalent of tasks (METs) reached during EST may provide better prediction of cardiovascular outcomes than not reaching 85% of APMHR. There is a need to incorporate comprehensive measurements to improve the diagnostic and prognostic capabilities of EST. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Exercise‐induced type 1 Brugada pattern in a child.
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Ciriello, Giovanni Domenico, Romeo, Emanuele, Colonna, Diego, Correra, Anna, Russo, Maria Giovanna, and Sarubbi, Berardo
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RISK assessment , *BRUGADA syndrome , *ARRHYTHMIA , *ELECTROCARDIOGRAPHY , *HEART beat , *CARDIOPULMONARY system , *EXERCISE tests , *DISEASE risk factors ,BRUGADA syndrome diagnosis - Abstract
The exercise stress testing may unmask the type 1 Brugada pattern on the surface electrocardiogram in a portion of patients with Brugada syndrome. The occurrence of the type 1 Brugada pattern during an exercise test in pediatric patients is not common. Consequently, the diagnostic yield of the exercise test in this population is still to be explored. We present a case of exercise‐induced type 1 Brugada pattern in a 12‐year‐old child with episodes of palpitations and discuss the available evidence on the role of the exercise stress test in the diagnosis and risk stratification of patients with Brugada syndrome. [ABSTRACT FROM AUTHOR]
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- 2024
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6. The Relationship Between Blood Pressure and Heart Rate Response During Exercise Testing with Microcirculation Indices
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Liatakis, Ioannis, Dimitriadis, Kyriakos, Manta, Eleni, Andrikou, Ioannis, Pyrpyris, Nikolaos, Tatakis, Fotios, Konstantinidis, Dimitrios, Thomopoulos, Konstantinos, Manolis, Antonios, Tousoulis, Dimitrios, and Tsioufis, Konstantinos
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- 2024
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7. Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathy
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Lu, Dai-Yin, Ventoulis, Ioannis, Liu, Hongyun, Haileselassie, Bereketeab, Pozios, Iraklis, Liang, Hsin-Yueh, Sorensen, Lars L, Canepa, Marco, Bavaro, Nicole, Phillip, Susan, Abraham, M Roselle, and Abraham, Theodore P
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Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Cardiovascular ,Hypertension ,Heart Disease ,Prevention ,Clinical Research ,2.1 Biological and endogenous factors ,Aetiology ,Blood pressure ,Chronotropic response ,Exercise stress test ,Hypertrophic cardiomyopathy ,Outcome ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology - Abstract
ObjectiveHypertensive response to exercise (HRE) is observed in patients with hypertrophic cardiomyopathy (HCM) with normal resting blood pressure (BP). However, the prevalence or prognostic implications of HRE in HCM remain unclear.MethodsIn this study, normotensive HCM subjects were enrolled. HRE was defined as systolic BP > 210 mmHg in men or >190 mmHg in women, or diastolic BP > 90 mmHg, or an increase in diastolic BP > 10 mmHg during treadmill exercise. All participants were followed for subsequent development of hypertension, atrial fibrillation (AF), heart failure (HF), sustained ventricular tachycardia/fibrillation (VT/VF), and all-cause death. Six hundred and eighty HCM patients were screened.Results347 patients had baseline hypertension, and 333 patients were baseline normotensive. 132 (40%) of the 333 patients had HRE. HRE was associated with female sex, lower body mass index and milder left ventricular outflow tract obstruction. Exercise duration and metabolic equivalents were similar between patients with or without HRE, but the HRE group had higher peak heart rate (HR), better chronotropic response and more rapid HR recovery. Conversely, non-HRE patients were more likely to exhibit chronotropic incompetence and hypotensive response to exercise. After a mean follow-up of 3.4 years, patients with and without HRE had similar risks of progression to hypertension, AF, HF, sustained VT/VF or death.ConclusionHRE is common in normotensive HCM patients during exercise. HRE did not carry higher risks of future hypertension or cardiovascular adverse outcomes. Conversely, the absence of HRE was associated with chronotropic incompetence and hypotensive response to exercise.
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- 2023
8. Effect of Exercise on Left Atrium Mechanics in Mild Mitral Stenosis.
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Akbulut, Müge, Kaya, Cansın Tulunay, Tan, Türkan Seda, Uludağ, Demet Menekşe Gerede, and Erol, Çetin
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Copyright of Archives of the Turkish Society of Cardiology / Türk Kardiyoloji Derneği Arşivi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2024
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9. Comprehensive Risk Assessment
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Braun, Lynne T., Lloyd-Jones, Donald M., Dunbar, Sandra B., editor, and Braun, Lynne T., editor
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- 2024
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10. Exercise Stress Testing
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Thannoun, Tariq, Hendel, Robert C., Hendel, Robert C., editor, and Heller, Gary V., editor
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- 2024
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11. Comparison of Baseline and Post-Nitrate Exercise Testing in Patients with Angina but Non-Obstructed Coronary Arteries with Different Acetylcholine Test Results.
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Marino, Angelo Giuseppe, Gentile, Giuseppe, Lenci, Ludovica, De Benedetto, Fabio, Tremamunno, Saverio, Cambise, Nello, Belmusto, Antonietta, Di Renzo, Antonio, Tinti, Lorenzo, De Vita, Antonio, and Lanza, Gaetano Antonio
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EXERCISE tests , *CORONARY arteries , *ANGINA pectoris , *ACETYLCHOLINE , *CORONARY vasospasm , *CORONARY artery disease , *CHEST pain - Abstract
Background: Intracoronary acetylcholine testing may induce epicardial coronary artery spasm (CAS) or coronary microvascular spasm (CMVS) in patients with angina syndromes but non-obstructive coronary artery disease, but their causal role in individual patients is not always clear. In this prospective, observational single-center study, we aimed to assess whether (1) the induction of myocardial ischemia/angina by electrocardiogram (ECG) exercise stress test (EST) differs between patients showing different results in response to acetylcholine testing (i.e., CAS, CMVS, or no spasm); (2) the preventive administration of short-acting nitrates has any different effects on the EST of those patients who showed a positive basal EST. We expected that if exercise-induced angina and/or ischemic ECG changes are related to CAS, they should improve after nitrates administration, whereas they should not significantly improve if they are caused by CMVS. Methods: We enrolled 81 patients with angina syndromes and non-obstructive coronary artery disease, who were divided into three groups according to acetylcholine testing: 40 patients with CAS (CAS-group), 14 with CMVS (CMVS-groups), and 27 with a negative test (NEG-group). All patients underwent a basal EST (B-EST). Patients with a positive B-EST repeated the test 24–48 h later, 5 min after the administration of short-acting nitrates (N-EST). Results: There were no significant differences among the groups in terms of the B-EST results. B-EST was positive in eight (20%) patients in the CAS-group, seven (50%) in the CMVS-group, and six (22%) in the NEG-group (p = 0.076). N-EST, performed in eight, six, and five of these patients, also showed similar results in the three groups. Furthermore, the N-EST results also did not significantly differ compared to B-EST in any group, remaining positive in seven (87.5%), four (66.7%), and four (80%) patients in the CAS-group, CMVS-group, and NEG-group, respectively (p = 0.78). Conclusions: Our data show that patients with angina and non-obstructive coronary artery disease show largely comparable results of the ECG exercise stress test and similar poor effects of short-acting nitrates on abnormal ECG exercise stress test results. On the whole, our findings suggest caution in attributing to the results of Ach testing a definite causal role for the clinical syndrome in individual patients. [ABSTRACT FROM AUTHOR]
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- 2024
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12. Increased minute ventilation-to-carbon dioxide slope during cardiopulmonary exercise test is associated with poor postoperative outcome following lung cancer resection.
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Rushwan, Amr, Stefanou, Demetrios, Tariq, Javeria, Drosos, Polivious, Chaudhuri, Nilanjan, Milton, Richard, Tcherveniakov, Peter, Papagiannopoulos, Kostas, and Brunelli, Alessandro
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EXERCISE tests , *ONCOLOGIC surgery , *LUNG cancer , *MINIMALLY invasive procedures , *LOGISTIC regression analysis , *PREHABILITATION - Abstract
Open in new tab Download slide OBJECTIVES Ventilatory efficiency [minute ventilation-to-carbon dioxide output slope (VE/VCO2 slope)] can be measured at sub-maximal workload during cardiopulmonary exercise test. The aim of this study is to assess the association between VE/VCO2 slope and outcome after lung cancer resections. METHODS Retrospective, single-centre analysis on all patients undergoing lung resection for cancer (April 2014–August 2022) and with a preoperative cardiopulmonary exercise test. VE/VCO2 slope >40 was chosen as high-risk threshold. Logistic regression analysis was used to test the association of VE/VCO2 slope and several patient- and surgery-related factors with 90-day mortality. RESULTS A total of 552 patients were included (374 lobectomies, 81 segmentectomies, 55 pneumonectomies and 42 wedge resections). Seventy-four percent were minimally invasive procedures. Cardiopulmonary morbidity was 32%, in-hospital/30-day mortality 6.9% and 90-day mortality 8.9%. A total of 137 patients (25%) had a slope of >40. These patients were older (72 vs 70 years, P = 0.012), had more frequently coronary artery disease (17% vs 10%, P = 0.028), lower carbon monoxide lung diffusion capacity (57% vs 68%, P < 0.001), lower body mass index (25.4 vs 27.0 kg/m2, P = 0.001) and lower peak VO2 (14.9 vs 17.0 ml/kg/min, P < 0.001) than those with a lower slope. The cardiopulmonary morbidity among patients with a slope of >40 was 40% vs 29% in those with lower slope (P = 0.019). Ninety-day mortality was 15% vs 6.7% (P = 0.002). The 90-day mortality of elderly patients with slope >40 was 21% vs 7.8% (P = 0.001). After adjusting for peak VO2 value, extent of operation and other patient-related variables in a logistic regression analysis, VE/VCO2 slope retained a significant association with 90-day mortality. CONCLUSIONS VE/VCO2 slope was strongly associated with morbidity and mortality following lung resection and should be included in the functional algorithm to assess fitness for surgery. [ABSTRACT FROM AUTHOR]
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- 2024
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13. Post-exercise left atrial conduit strain predicted hemodynamic change in heart failure with preserved ejection fraction.
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Cheng, Jen-Fang, Huang, Pang-Shuo, Chen, Zheng-Wei, Huang, Chen-Yu, Lan, Chen-Wei, Chen, Ssu-Yuan, Lin, Lian-Yu, and Wu, Cho-Kai
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LEFT heart atrium , *VENTRICULAR ejection fraction , *COOLDOWN , *HEART failure , *HEART failure patients - Abstract
Objectives: Left ventricle function directly impacts left atrial (LA) conduit function, and LA conduit strain is associated with exercise intolerance in patients with heart failure with preserved ejection fraction (HFpEF). Pulmonary capillary wedge pressure (PCWP) before and during exercise is the current gold standard for diagnosing HFpEF. Post-exercise ΔPCWP can lead to worse long-term outcomes. This study examined the correlation between LA strain and post-exercise ΔPCWP in patients with HFpEF. Methods: We enrolled 100 subjects, including 74 with HFpEF and 26 with non-cardiac dyspnea, from November 2017 to December 2020. Subjects underwent echocardiography, invasive cardiac catheterization, and expired gas analysis at rest and during exercise. Arterial blood pressure, right atrial pressure, pulmonary artery pressure, and PCWP were recorded during cardiac catheterization. Cardiac output, stroke volume, pulmonary vascular resistance, pulmonary artery compliance, systemic vascular resistance, and LV stroke work were calculated using standard formulas. Results: Exercise LA conduit strain significantly correlated with both post-exercise ΔPCWP (r = − 0.707, p < 0.001) and exercise PCWP (r = − 0.659; p < 0.001). Exercise LA conduit strain differentiated patients who did and did not meet the 2016 European Society of Cardiology HFpEF criteria with an area under the curve of 0.69 (95% confidence interval, 0.548–0.831) using a cutoff value of 14.25, with a sensitivity of 0.64 and a specificity of 0.68. Conclusions: Exercise LA conduit strain significantly correlates with post-exercise ΔPCWP and has a comparable power to identify patients with HFpEF. Additional studies are warranted to confirm the ability of LA conduit strain to predict long-term outcomes among patients with HFpEF. Clinical relevance statement: Exercise left atrial conduit strain was highly associated with the difference of post-exercise pulmonary capillary wedge pressure and may indicate increased mortality risk in patients with heart failure with preserved ejection fraction, and also has comparable diagnostic ability. Key Points: • Left atrial conduit strain is associated with exercise intolerance in patients with heart failure with preserved ejection fraction. • Left atrial conduit strain during exercise can identify patients with heart failure with preserved ejection fraction. • Exercise left atrial conduit strain significantly correlates with the difference of pulmonary capillary wedge pressure during and before exercise which might predict the long-term outcomes of heart failure with preserved ejection fraction patients. [ABSTRACT FROM AUTHOR]
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- 2024
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14. Proceed with caution: Standard protocol exercise stress tests fail to replicate the diagnostic utility of supine‐stand tests for long QT syndrome.
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Pinsky, Alexa M., Kulkarni, Veda K., Bos, J. Martijn, Neves, Raquel, Allison, Thomas G., and Ackerman, Michael J.
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LONG QT syndrome diagnosis , *MEDICAL protocols , *RECEIVER operating characteristic curves , *DATA analysis , *RESEARCH funding , *STANDING position , *STATISTICAL sampling , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *ELECTROCARDIOGRAPHY , *CARDIOPULMONARY system , *SUPINE position , *HEART beat , *MEDICAL records , *ACQUISITION of data , *CASE-control method , *ONE-way analysis of variance , *STATISTICS , *EXERCISE tests , *DATA analysis software , *CONFIDENCE intervals , *GENOTYPES , *SENSITIVITY & specificity (Statistics) - Abstract
Background: Long QT syndrome (LQTS) is a sudden death predisposing condition characterized by ECG‐derived prolongation of the QT interval. Previous studies have demonstrated that the supine‐stand test may aid in the diagnosis of LQTS as patients fail to shorten their QT interval in response to standing up. The aim of this study was to evaluate the diagnostic accuracy of ECG data derived from standard protocol, clinically performed treadmill exercise stress tests (TESTs) in their ability to mimic the formal supine‐stand test. Methods: We performed a retrospective review of 478 TESTs from patients evaluated for LQTS. Patients referred for evaluation of LQTS but who were dismissed as normal served as controls. Heart rate & QT values were obtained from standard protocol TESTs. Results: Overall, 243 patients with LQTS (125 LQT1, 63 LQT2, 55 LQT3; 146 [60%] female, mean age at TEST 30 ± 17 years) and 235 controls (142 [60%] female, mean age 24 ± 15 years) were included. The paired ΔQTc (QTcStand‐QTcSupine) was similar between LQTS (−5 ± 26) and controls (−2 ± 25; p =.2). During position change, the QT interval shortened by ≥20 ms in 33% of LQTS patients, remained unchanged in 62%, and increased in 5% of LQTS patients which was similar to controls (shortened in 40%, unchanged in 54%, and increased in 6% of controls; p =.2). Receiver‐operator curve analysis to test the diagnostic ability of supine‐stand ΔQT performed poorly in differentiating LQTS from controls with an of AUC 0.52 (p =.4). Conclusion: TESTs should be used with caution when trying to interpret supine‐stand changes for diagnosis of LQTS. [ABSTRACT FROM AUTHOR]
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- 2024
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15. The combination of high‐frequency QRS and ST‐segment alterations during exercise stress tests enhanced the diagnostic efficacy for coronary artery disease.
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Liu, Long, Du, Xinyue, Wei, Xue, Dong, Wei, Lu, Hong, Jiang, Guishen, and Deng, Guolan
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EXERCISE tests ,CORONARY artery disease ,DIAGNOSIS methods ,ANGIOGRAPHY ,SEQUENTIAL analysis - Abstract
Background: High‐frequency QRS (HF‐QRS) manifests as a novel adjunct electrocardiographic marker with potential utility in coronary artery disease (CAD) detection. Hypothesis: We hypothesize that HF‐QRS analysis may be superior to conventional ST‐segment analysis in detecting CAD, and the combination of these two analyses in the exercise stress test may enhance the diagnostic efficacy for CAD. Methods: The study incorporated a sample of 157 patients (mean age 62 ± $\pm $ 9 years) referred for nonemergent angiography. Before angiography, patients underwent exercise stress testing utilizing an upright bicycle. High‐resolution electrocardiogram (ECG) data were collected during the exercise test, facilitating both HF‐QRS and conventional ST‐segment analyses. The diagnostic efficacy of HF‐QRS and ST‐segment analysis were compared, utilizing angiographic outcomes as the gold standard. The study design integrated HF‐QRS analysis and ST‐segment analysis via sequential and concurrent testing protocols. Results: In terms of CAD detection, HF‐QRS analysis displayed superior sensitivity compared to conventional ST‐segment analysis (63% vs. 37%, p =.002). The serial test significantly increased specificity from 79% to 97% (p =.002) compared to ST‐deviation analysis alone. It showed a markedly low sensitivity of 26%. The parallel test significantly increased sensitivity from 37% to 77% (p <.001), while retaining a moderate level of specificity of 51%. The quantity of ECG leads exhibiting a positive HF‐QRS response demonstrated a correlation with the severity of CAD (p <.001). Conclusions: HF‐QRS analysis exhibited superior sensitivity in detecting angiographically confirmed CAD relative to conventional ST‐segment analysis. Moreover, the combination of HF‐QRS and ST‐segment alterations during exercise stress test enhanced the diagnostic efficacy for CAD. [ABSTRACT FROM AUTHOR]
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- 2024
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16. An exercise stress test for contrast-enhanced duplex ultrasound assessment of lower limb muscle perfusion in patients with peripheral arterial disease.
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Prior, Steven J., Chrencik, Matthew T., Christensen, Eric, Kundi, Rishi, Ryan, Alice S., Addison, Odessa, and Lal, Brajesh K.
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The aim of the present study was to develop a standardized contrast-enhanced duplex ultrasound (CE-DUS) protocol to assess lower-extremity muscle perfusion before and after exercise and determine relationships of perfusion with clinical and functional measures. CE-DUS (EPIQ 5G, Philips) was used before and immediately after a 10-minute, standardized bout of treadmill walking to compare microvascular perfusion of the gastrocnemius muscle in older (55-82 years) patients with peripheral arterial disease (PAD) (n = 15, mean ankle-brachial index, 0.78 ± 0.04) and controls (n = 13). Microvascular blood volume (MBV) and microvascular flow velocity (MFV) were measured at rest and immediately following treadmill exercise, and the Modified Physical Performance Test (MPPT) was used to assess mobility function. In the resting state (pre-exercise), MBV in patients with PAD was not significantly different than normal controls (5.17 ± 0.71 vs 6.20 ± 0.83 arbitrary units (AU) respectively; P =.36); however, after exercise, MBV was ∼40% lower in patients with PAD compared with normal controls (5.85 ± 1.13 vs 9.53 ± 1.31 AU, respectively; P =.04). Conversely, MFV was ∼60% higher in patients with PAD compared with normal controls after exercise (0.180 ± 0.016 vs 0.113 ± 0.018 AU, respectively; P =.01). There was a significant between-group difference in the exercise-induced changes in both MBV and MFV (P ≤.05). Both basal and exercise MBV directly correlated with MPPT score in the patients with PAD (r = 0.56-0.62; P <.05). This standardized protocol for exercise stress testing of the lower extremities quantifies calf muscle perfusion and elicits perfusion deficits in patients with PAD. This technique objectively quantifies microvascular perfusion deficits that are related to reduced mobility function and could be used to assess therapeutic efficacy in patients with PAD. [ABSTRACT FROM AUTHOR]
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- 2024
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17. Risk assessment in patients with symptomatic and asymptomatic pre-excitation.
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Jemtrén, Anette, Saygi, Serkan, Åkerström, Finn, Asaad, Fahd, Bourke, Tara, Braunschweig, Frieder, Carnlöf, Carina, Drca, Nikola, Insulander, Per, Kennebäck, Göran, Nordin, Astrid Paul, Sadigh, Bita, Rickenlund, Anette, Saluveer, Ott, Schwieler, Jonas, Svennberg, Emma, Tapanainen, Jari, Turkmen, Yusuf, Bastani, Hamid, and Jensen-Urstad, Mats
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Aims Controversy remains as to whether the exercise stress test (EST) is sufficient for risk evaluation in patients with pre-excitation. This study aims to clarify the usefulness of EST in risk stratification in both asymptomatic and symptomatic patients presenting with pre-excitation. Methods and results This prospective study includes consecutive asymptomatic and symptomatic patients with pre-excitation 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 pre-excitation during exercise, and primary data from the EPS included the measurement of accessory pathway effective refractory period (APERP), shortest pre-excited RR interval (SPERRI), and inducible arrhythmia with the use of a beta-adrenergic receptor agonist if deemed necessary. 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, and two of them were asymptomatic. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of low-risk EST for excluding patients with SPERRI/APERP ≤ 250 ms were 40, 91, 87, 51, and 60%, respectively. The number of patients with inducible arrhythmia at EPS was similar in the asymptomatic (36, 69%) and symptomatic (73, 61%) groups. Conclusion Sudden loss of pre-excitation during EST has a low NPV in excluding high-risk APs. The EPS with the use of isoproterenol should be considered to accurately assess the risk of patients with pre-excitation regardless of symptoms (ClinicalTrials.gov Identifier: NCT03301935). [ABSTRACT FROM AUTHOR]
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- 2024
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18. Independent prognostic value of high-risk ventricular premature complexes during exercise or recovery in asymptomatic patients: A meta-analysis of observational studies
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Kartik Gupta, Sulmaz Zahedi, Tanya Singh Kakar, Akhilesh Khuttan, Rajat Kalra, and Bryan M. Zweig
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Ventricular premature complexes ,Premature ventricular contractions ,Ventricular ectopy ,Exercise stress test ,Cardiovascular mortality ,All-cause mortality ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Introduction: Ventricular premature contractions (VPCs) are a common finding during cardiac stress tests. The independent prognostic value of these findings in patients in asymptomatic patients is unclear. Methods: We conducted a systematic review and meta-analysis of observational studies exploring the independent prognostic value of VPCs to predict all-cause mortality. The secondary outcome was cardiovascular (CV) mortality. We excluded studies that did not report outcomes after adjusting for ≥1 confounder. Random effect meta-analyses were used to predict cumulative hazard ratios. We stratified results based on VPC during exercise or recovery. Results: We found 7 studies with 24,518 patients that met our inclusion criteria. Two studies reported all-cause mortality only, 1 study reported CV mortality only, rest 4 reported both. There was significant heterogeneity in the baseline population, definition of high-risk VPCs, and variables used in adjusted models. Using multivariable summary estimates from individual studies, only VPCs during exercise were associated with a higher risk of all-cause mortality (HR 1.27, 95 % CI 1.07, 1.48). Both VPCs during exercise and recovery were associated with a higher risk CV mortality (HR 1.69, 95 % CI 1.19, 2.20, I2 = 17.6 % and 1.62, 95 % CI 1.25, 2.00, p
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- 2023
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19. Rethinking False Positive Exercise Electrocardiographic Stress Tests by Assessing Coronary Microvascular Function.
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Sinha, Aish, Dutta, Utkarsh, Demir, Ozan M., De Silva, Kalpa, Ellis, Howard, Belford, Samuel, Ogden, Mark, Li Kam Wa, Matthew, Morgan, Holly P., Shah, Ajay M., Chiribiri, Amedeo, Webb, Andrew J., Marber, Michael, Rahman, Haseeb, and Perera, Divaka
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MICROCIRCULATION disorders , *MYOCARDIAL ischemia , *CORONARY artery disease , *CORONARY arteries , *BLOOD flow measurement - Abstract
Exercise electrocardiographic stress testing (EST) has historically been validated against the demonstration of obstructive coronary artery disease. However, myocardial ischemia can occur because of coronary microvascular dysfunction (CMD) in the absence of obstructive coronary artery disease. The aim of this study was to assess the specificity of EST to detect an ischemic substrate against the reference standard of coronary endothelium-independent and endothelium-dependent microvascular function in patients with angina with nonobstructive coronary arteries (ANOCA). Patients with ANOCA underwent invasive coronary physiological assessment using adenosine and acetylcholine. CMD was defined as impaired endothelium-independent and/or endothelium-dependent function. EST was performed using a standard Bruce treadmill protocol, with ischemia defined as the appearance of ≥0.1-mV ST-segment depression 80 ms from the J-point on electrocardiography. The study was powered to detect specificity of ≥91%. A total of 102 patients were enrolled (65% women, mean age 60 ± 8 years). Thirty-two patients developed ischemia (ischemic group) during EST, whereas 70 patients did not (nonischemic group); both groups were phenotypically similar. Ischemia during EST was 100% specific for CMD. Acetylcholine flow reserve was the strongest predictor of ischemia during exercise. Using endothelium-independent and endothelium-dependent microvascular dysfunction as the reference standard, the false positive rate of EST dropped to 0%. In patients with ANOCA, ischemia on EST was highly specific of an underlying ischemic substrate. These findings challenge the traditional belief that EST has a high false positive rate. [Display omitted] [ABSTRACT FROM AUTHOR]
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- 2024
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20. Prognostic Impact of a Routine Six-Month Exercise Stress Test after Complex Left Main Bifurcation Percutaneous Intervention.
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Rigatelli, Gianluca, Zuin, Marco, Marchese, Giuseppe, Hiso, Ervis, Rodinò, Giulio, Roncon, Loris, and Pasquetto, Giampaolo
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EXERCISE tests , *CORONARY arteries - Abstract
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. [ABSTRACT FROM AUTHOR]
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- 2024
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21. Spatiotemporal repolarization dispersion before and after exercise in patients with long QT syndrome type 1 versus controls: probing into the arrhythmia substrate.
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Dahlberg, Pia, Axelsson, Karl-Jonas, Rydberg, Annika, Lundahl, Gunilla, Gransberg, Lennart, and Bergfeldt, Lennart
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- *
ARRHYTHMIA , *LONG QT syndrome , *ACTION potentials , *VENTRICULAR tachycardia , *HEART beat , *DISPERSION (Chemistry) - Abstract
Congenital long QT syndrome (LQTS) carries an increased risk for syncope and sudden death. QT prolongation promotes ventricular extrasystoles, which, in the presence of an arrhythmia substrate, might trigger ventricular tachycardia degenerating into fibrillation. Increased electrical heterogeneity (dispersion) is the suggested arrhythmia substrate in LQTS. In the most common subtype LQT1, physical exercise predisposes for arrhythmia and spatiotemporal dispersion was therefore studied in this context. Thirty-seven patients (57% on b-blockers) and 37 healthy controls (mean age, 31 vs. 35; range, 6--68 vs. 6--72 yr) performed an exercise test. Frank vectorcardiography was used to assess spatiotemporal dispersion as Tampl, Tarea, the ventricular gradient (VG), and the Tpeak-end interval from 10-s signal averages before and 7 ± 2 min after exercise; during exercise too much signal disturbance excluded analysis. Baseline and maximum heart rates as well as estimated exercise intensity were similar, but heart rate recovery was slower in patients. At baseline, QT and heart rate-corrected QT (QTcB) were significantly longer in patients (as expected), whereas dispersion parameters were numerically larger in controls. After exercise, QTpeakcB and Tpeak-endcB increased significantly more in patients (18 ± 23 vs. 7 ± 10 ms and 12 ± 17 vs. 2 ± 6 ms; P < 0.001 and P < 0.01). There was, however, no difference in the change in Tampl, Tarea, and VG between groups. In conclusion, although temporal dispersion of repolarization increased significantly more after exercise in patients with LQT1, there were no signs of exercise-induced increase in global dispersion of action potential duration and morphology. The arrhythmia substrate/mechanism in LQT1 warrants further study. [ABSTRACT FROM AUTHOR]
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- 2023
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22. Heart rate response and recovery during exercise predict future delirium risk—A prospective cohort study in middle- to older-aged adults
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Lei Gao, Arlen Gaba, Peng Li, Richa Saxena, Frank A.J.L. Scheer, Oluwaseun Akeju, Martin K. Rutter, and Kun Hu
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Brain health ,Delirium ,Exercise stress test ,UK Biobank ,Sports ,GV557-1198.995 ,Sports medicine ,RC1200-1245 - Abstract
Background: Delirium is a neurocognitive disorder characterized by an abrupt decline in attention, awareness, and cognition after surgical/illness-induced stressors on the brain. There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality. One common indicator for cardiovascular health is the heart rate response/recovery (HRR) to exercise, but how this relates to future delirium is unknown. Methods: Electrocardiogram data were examined in 38,740 middle- to older-aged UK Biobank participants (mean age = 58.1 years, range: 40–72 years; 47.3% males) who completed a standardized submaximal exercise stress test (15-s baseline, 6-min exercise, and 1-min recovery) and required hospitalization during follow-up. An HRR index was derived as the product of the heart rate (HR) responses during exercise (peak/resting HRs) and recovery (peak/recovery HRs) and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile, respectively. Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a 2-year landmark analysis to minimize reverse causation. Sociodemographic factors, lifestyle factors/physical activity, cardiovascular risk, comorbidities, cognition, and maximal workload achieved were included as covariates. Results: During a median follow-up period of 11 years, 348 participants (9/1000) newly developed delirium. Compared with the high HRR group (16/1000), the risk for delirium was almost doubled in those with low HRR (hazard ratio = 1.90, 95% confidence interval (95%CI): 1.30–2.79, p = 0.001) and average HRR (hazard ratio = 1.54, 95%CI: 1.07–2.22, p = 0.020)). Low HRR was equivalent to being 6 years older, a current smoker, or ≥3 additional cardiovascular disease risks. Results were robust in sensitivity analysis, but the risk appeared larger in those with better cognition and when only postoperative delirium was considered (n = 147; hazard ratio = 2.66, 95%CI: 1.46–4.85, p = 0.001). Conclusion: HRR during submaximal exercise is associated with future risk for delirium. Given that HRR is potentially modifiable, it may prove useful for neurological risk stratification alongside traditional cardiovascular risk factors.
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- 2023
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23. A CROSS-SECTIONAL STUDY OF SILENT MYOCARDIAL INFARCTION AMONG TYPE 2 DIABETICS.
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Prashant Kumar, Akhilesh Kumar, and Rahul Raj
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Diabetes ,Silent ischemia ,Exercise stress test ,TMT ,Asymptomatic Coronary artery disease ,General works ,R5-130.5 ,Infectious and parasitic diseases ,RC109-216 ,Surgery ,RD1-811 ,Public aspects of medicine ,RA1-1270 - Abstract
Introduction: Diabetes mellitus type 2 typically affects adults when the body doesn't produce enough insulin or grows resistant to it, leading to several micro- and macrovascular. This study used an activity treadmill test to assess the severity of silent myocardial ischemia, a significant macrovascular consequence, in a subset of asymptomatic diabetic outpatients. Material and Methods: The cross-sectional observational research was conducted from September 2022 to September 2023 at the Darbhanga Medical College and Hospital in Laheriasarai, Bihar, India. The study comprised 250 asymptomatic type 2 diabetes mellitus (DM) patients without clinical symptoms of coronary artery disease (CAD) and normal electrocardiograms. Patients with heart failure, angina pectoris, previous myocardial ischemia (MI), or any other chronic ailment were not eligible to participate in the trial. A silent myocardial infarction was identified by CASE/T2100 sr number GE MAC using a treadmill test (TMT) conducted following the Bruce protocol. Results: Silent MI was present in 12.8% of diabetic individuals with positive TMT. Diabetes for more than 10 years (p=0.001), Age (p=0.002), dyslipidemia (p=0.001), and having an HbA1c were all substantially associated with TMT favorable of more than 10% (p=0.001). It was found that TMT-positive individuals had significantly higher levels of triglycerides, LDL cholesterol, and total cholesterol than TMT-negative patients. Compared to TMT-negative patients, those who tested positive for TMT had significantly lower HDL levels. Conclusion: Many people experienced asymptomatic coronary artery disease or silent myocardial infarctions when they had type 2 diabetes. Silent MI was more common in diabetics who were overweight, dyslipidemic, older, and had increased HbA1C levels. When it first started, TMT might be an easy, non-invasive way to identify this. Recommendation: Being physically active helps you manage your diabetes because it increases your body's sensitivity to insulin, the hormone that permits your body's cells to use blood sugar for energy.
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- 2023
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24. EXPLORING SILENT MYOCARDIAL INFARCTION AND ITS ASSOCIATIONS IN TYPE 2 DIABETIC PATIENTS: A CROSS-SECTIONAL STUDY IN A HOSPITAL SETTING.
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Sanjay Nath Jha
- Subjects
Asymptomatic Coronary artery disease ,Silent ischaemia ,Exercise stress test ,Diabetes ,TMT ,General works ,R5-130.5 ,Infectious and parasitic diseases ,RC109-216 ,Surgery ,RD1-811 ,Public aspects of medicine ,RA1-1270 - Abstract
Introduction: Insulin resistance or insufficient insulin production in the body causes diabetes mellitus type 2, which primarily affects adults. Numerous micro and macrovascular issues are linked to long-term diabetes mellitus type 2. The objective of this study was to determine the incidence of silent MI in unaffected individuals with diabetes mellitus through the utilization of exercise treadmill testing. Materials and Methods: The Darbhanga Medical College & Hospital Department of Medicine conducted this cross-sectional observational study. The study included 120 asymptomatic type 2 Diabetes Mellitus patients with normal resting electrocardiograms and no coronary artery disease. Patients with myocardial infarction (MI), heart failure, angina pectoris, or other chronic illnesses were excluded from the study. The treadmill test (TMT) utilizing the "Bruce protocol" and CASE/T2100 sr number GE MAC revealed silent myocardial infarction. Results: 11.8% had silent MI (positive TMT). TMT positive was substantially linked to advanced age, diabetes for more than ten years, dyslipidemia, and an HbA1c of more than 10%. In comparison to TMT-negative patients, TMT-positive patients were shown to have considerably higher levels of total cholesterol, LDL, and triglycerides. TMT-positive individuals had considerably lower HDL levels than TMT-negative patients. Conclusion: A considerable fraction of individuals with T2DM had asymptomatic CAD or silent myocardial infarction (11.8%). Silent MI was more common in diabetics who were obese, dyslipidemic, older, and had high HbA1c. TMT may be a straightforward, non-invasive method for spotting silent MI early on. Recommendations: Treadmill testing (TMT) should be used to screen asymptomatic type 2 diabetics for silent myocardial infarction, especially those who are older, obese, have had diabetes for more than ten years, or have dyslipidemia and high HbA1c levels. TMT can identify silent MI in this population non-invasively.
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- 2023
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25. Non-invasive Evaluation of Electromechanical Transmission in Patients with Hypertensive Response to Exercise Stress Test.
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KAYA, Ahmet Ferhat, OZDIL, Mehmet Hasan, YILMAZ, Cemalettin, KILIC, Raif, OZBEK, Mehmet, and KAYA, Hasan
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- *
EXERCISE tests , *HYPERTENSION , *LEFT ventricular hypertrophy , *BLOOD pressure , *ATRIAL fibrillation - Abstract
Objective: Excessive hypertensive response to exercise testing is associated with adverse cardiovascular events such as left ventricular hypertrophy and atrial fibrillation (AF). In this study, we examined the relationship between electromechanical delay and excessive hypertensive response to exercise testing. Methods: Twenty-five people who had a hypertensive response to the exercise stress test and 28 people who were similar in age and gender with a normal blood pressure response in the exercise stress test as the control group were included in the study. Results: There was no statistical difference between the study groups in blood pressure holter values, conventional echocardiography findings, and exercise stress test findings. Lateral PA-TDI time (the time from the beginning of the P wave measured by tissue Doppler imaging to the beginning of the A'wave), left atrial electromechanical delay, and interatrial electromechanical delay were observed to be significantly longer in the hypertensive response group to exercise stress test compared with the control group (74.0±6.3 vs. 68.8±5.7, p=0.003; 24.7±7.0 vs. 19.6±7.1, p=0.013; 36.8±8.5 vs. 30.6±6.6, p=0.003, respectively). Conclusions: Early detection of electromechanical delay non-invasively may be useful in this patient group in predicting the development of new AF risk. [ABSTRACT FROM AUTHOR]
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- 2023
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26. Blood pressure response to exercise in unaffected relatives of autosomal dominant polycystic kidney disease patients: an observational study.
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Yenigun, Ezgi Coskun, Turgut, Didem, Cevher, Simal Koksal, Yucel, Cigdem, Aypak, Cenk, and Dede, Fatih
- Abstract
Introduction: Hypertension is an early finding of autosomal dominant polycystic kidney disease (ADPKD) and is related to different mechanisms. Cyst expansion-related renin secretion or early endothelial dysfunctions are some of these hypotheses. In addition, the underlying genetic factor is thought to play a role in the inheritance of hypertension. The differential course of hypertension in ADPKD preoccupies that relatives of ADPKD patients may also be at risk for this underlying mechanisms with a genetically determined abnormal endothelial-vascular state. In this study, we aimed to evaluate blood pressure response to exercise as an initial vascular problem in unaffected and normotensive relatives of hypertensive ADPKD patients. Methods: This is an observational study including unaffected and normotensive relatives (siblings and children) of ADPKD patients (relative group) and healthy controls (control group) who performed an exercise stress test. A 6-lead electrocardiogram was recorded and blood pressure was measured automatically with a cuff worn on the right arm, immediately before the test and every 3 min during the exercise and the recovery phase. Participants continued the test until their age-specific target heart rate was reached or symptoms occurred that required discontinuation of the test. The highest blood pressure and pulse values during exercise were noted. In addition, as a marker for endothelial function, nitric oxide (NO) and asymmetric dimethylarginine (ADMA) levels were measured at baseline and post-exercise. Results: There were 24 participants in the relative group (16 female, mean age 38.45 years) and 30 participants in the control group (15 female, mean age 37.96 years). Two groups were similar in terms of age, gender, body mass index (BMI), smoking status, resting systolic blood pressure (SBP)/diastolic blood pressure (DBP) and biochemical parameters. Mean SBP and DBP were similar in both groups during 1st, 3rd and 9th minutes of exercise (1st minute: 136.25 ± 19.71 mmHg vs 140.36 ± 30.79 mmHg for SBP, p = 0.607, 84.05 ± 14.75 mmHg vs 82.60 ± 21.60 mmHg for DBP, p = 0.799; 3rd minute: 150.75 ± 30.39 mmHg vs 148.54 ± 27.30 mmHg for SBP, p = 0.801, 98.95 ± 26.92 mmHg vs 85.92 ± 17.93 mmHg for DBP, p = 0.062; 9th minute: 156.35 ± 30.84 mmHg vs 166.43 ± 31.90 mmHg for SBP, p = 0.300, 96.25 ± 21.99 mmHg vs 101.78 ± 33.11 mmHg for DBP, p = 0.529 for control and relatives, respectively). During the recovery phase, SBP decreased in both groups in 6th minute (119.85 ± 14.06 mmHg vs 122.86 ± 16.76 mmHg, p = 0.538 for control and relatives respectively); however, in the relatives of ADPKD patients DBP remained high at the end of the 6th minute (78.95 ± 11.29 mmHg vs 86.67 ± 9.81 mmHg p = 0.025 for control and relatives, respectively). Baseline and post-exercise NO and ADMA levels were similar in both groups (Baseline p = 0.214 and p = 0.818, post-exercise p = 0.652 and p = 0.918 for NO and ADMA, respectively). Conclusion: Abnormal blood pressure response to exercise was observed in unaffected normotensive relatives of ADPKD. Although its clinical significance needs to be demonstrated by additional research, it is an important finding that unaffected relatives of ADPKD may be at risk for an altered arterial vascular network. Furthermore, these data are the first to demonstrate that relatives of ADPKD patients may also be under risk with a genetically determined abnormal vascular state. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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27. Evaluation of Wrist-Worn Photoplethysmography Trackers with an Electrocardiogram in Patients with Ischemic Heart Disease: A Validation Study
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Ibrahim, Nur Syazwani, Rampal, Sanjay, Lee, Wan Ling, Pek, Eu Way, and Suhaimi, Anwar
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- 2024
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28. Heart rate response and recovery during exercise predict future delirium risk—A prospective cohort study in middle- to older-aged adults.
- Author
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Gao, Lei, Gaba, Arlen, Li, Peng, Saxena, Richa, Scheer, Frank A.J.L., Akeju, Oluwaseun, Rutter, Martin K., and Hu, Kun
- Subjects
HEART beat ,EXERCISE ,OLDER people - Abstract
• Heart rate response/recovery (HRR) to submaximal exercise predicted future delirium risk during hospitalization. • Lowest quartile for a HRR index was equivalent to being 6 years older, a current smoker, or having 3 or more additional cardiovascular risks compared to those in the highest quartile. • Findings were robust in subsets by age, sex, physical activity level, rate-control medications, but the risk from low HRR appeared greater in those with better baseline cognition. • Results were also consistent when only postoperative delirium was considered, and when dementia related cases were excluded. Delirium is a neurocognitive disorder characterized by an abrupt decline in attention, awareness, and cognition after surgical/illness-induced stressors on the brain. There is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and mortality. One common indicator for cardiovascular health is the heart rate response/recovery (HRR) to exercise, but how this relates to future delirium is unknown. Electrocardiogram data were examined in 38,740 middle- to older-aged UK Biobank participants (mean age = 58.1 years, range: 40–72 years; 47.3% males) who completed a standardized submaximal exercise stress test (15-s baseline, 6-min exercise, and 1-min recovery) and required hospitalization during follow-up. An HRR index was derived as the product of the heart rate (HR) responses during exercise (peak/resting HRs) and recovery (peak/recovery HRs) and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile, respectively. Associations between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a 2-year landmark analysis to minimize reverse causation. Sociodemographic factors, lifestyle factors/physical activity, cardiovascular risk, comorbidities, cognition, and maximal workload achieved were included as covariates. During a median follow-up period of 11 years, 348 participants (9/1000) newly developed delirium. Compared with the high HRR group (16/1000), the risk for delirium was almost doubled in those with low HRR (hazard ratio = 1.90, 95% confidence interval (95%CI): 1.30–2.79, p = 0.001) and average HRR (hazard ratio = 1.54, 95%CI: 1.07–2.22, p = 0.020)). Low HRR was equivalent to being 6 years older, a current smoker, or ≥3 additional cardiovascular disease risks. Results were robust in sensitivity analysis, but the risk appeared larger in those with better cognition and when only postoperative delirium was considered (n = 147; hazard ratio = 2.66, 95%CI: 1.46–4.85, p = 0.001). HRR during submaximal exercise is associated with future risk for delirium. Given that HRR is potentially modifiable, it may prove useful for neurological risk stratification alongside traditional cardiovascular risk factors. [Display omitted] [ABSTRACT FROM AUTHOR]
- Published
- 2023
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29. Unknown QRS Morphology Change at Peak Exercise
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Fabio M. Leonelli, MD, Daniel Sun, BS, Stephanie Gonzalez, BS, Rejoy Sabin Thomas, BS, and Maqsood A. Siddique, MD
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exercise stress test ,left septal fascicle block ,septal depolarization ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Electrocardiogram changes during stress tests are well standardized and understood. We present and explain a reversible QRS morphology change at peak exercise previously unreported. (Level of Difficulty: Intermediate.)
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- 2023
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30. Teaching Cases in Nuclear Oncology: Investigating the Heart in Cancer Patients
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Fox, Josef J., Strauss, H. William, Volterrani, Duccio, editor, Erba, Paola A., editor, Strauss, H. William, editor, Mariani, Giuliano, editor, and Larson, Steven M., editor
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- 2022
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31. Stress Testing (Treadmill, Echocardiography, SPECT, PET, and Cardiac MR)
- Author
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Al-Otaibi, Talal Khalid, Hauser, Thomas H., Bhargava, Ankit A., editor, Wells, Bryan J., editor, and Quintero, Pablo A., editor
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- 2022
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32. Benign Arrhythmias and Conduction Defects in Athletes
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Biffi, Alessandro, Palermi, Stefano, Serio, Alessandro, Murazzi, Eleonora, Sirico, Felice, Delise, Pietro, editor, and Zeppilli, Paolo, editor
- Published
- 2022
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33. Clinical Utility of the Humble Exercise ECG Stress Test.
- Author
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Beltrame, John F., La, Sarena, and Marathe, Jessica
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- *
BLOOD flow measurement , *ELECTROCARDIOGRAPHY , *MICROCIRCULATION disorders , *EXERCISE tests - Abstract
[Display omitted] [ABSTRACT FROM AUTHOR]
- Published
- 2024
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34. Surrogates of Muscle Mass on Cardiac MRI Correlate with Exercise Capacity in Patients with Fontan Circulation.
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Smith, Kevin L., Gordon, Emile B., Gunsaulus, Megan E., Christopher, Adam, Olivieri, Laura J., Tadros, Sameh S., Harris, Tyler, Saraf, Anita P., Kreutzer, Jacqueline, Feingold, Brian, and Alsaied, Tarek
- Subjects
- *
CARDIAC magnetic resonance imaging , *MUSCLE mass , *AEROBIC capacity , *MYOCARDIUM , *BODY surface area - Abstract
Background: Sarcopenia is an increasingly recognized marker of frailty in cardiac patients. Patients with a history of congenital heart disease and Fontan procedure have a higher risk of developing progressive muscle wasting. Our objective was to determine if we could use routine cardiac MRI (CMR) for the surveillance of muscle wasting. Methods: A retrospective study of all Fontan patients (n = 75) was conducted at our institution, with CMR performed from 2010 to 2022 and exercise stress testing performed within 12 months (4.3 ± 4.2 months). The skeletal muscle area (SMA) for the posterior paraspinal and anterior thoracic muscles were traced and indexed for body surface area (BSA). Patients were stratified by percentile into the upper and lower quartiles, and the two groups were compared. Multivariable regression was performed to control for sex and age. Results: There was a significant positive association of both anterior (r = 0.34, p = 0.039) and paraspinal (r = 0.43, p = 0.007) SMA to peak VO2. Similarly, paraspinal but not anterior SMA was negatively associated with the VE/VCO2 (r = –0.45, p = 0.006). The upper quartile group had significantly more males (18/19 vs. 8/20; p = 0.0003) and demonstrated a significantly higher peak VO2 (32.2 ± 8.5 vs. 23.8 ± 4.7, p = 0.009), a higher peak RER (1.2 ± 0.1 vs. 1.1 ± 0.04, p = 0.007), and a significantly lower VE/VCO2 (32.9 ± 3.6 vs. 40.2 ± 6.2, p = 0.006) compared to the lowest quartile. The association of SMA to VO2 peak and VE/VCO2 was redemonstrated after controlling for sex and age. Conclusion: Thoracic skeletal muscle area may be an effective surrogate of muscle mass and is correlated to several measures of cardiorespiratory fitness post-Fontan. CMR would be an effective tool for the surveillance of sarcopenia in post-Fontan patients given its accessibility and routine use in these patients. [ABSTRACT FROM AUTHOR]
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- 2023
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35. 运动负荷试验及其相关参数诊断冠心病的 准确性评价.
- Author
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赵蕊, 吴磊, 李广平, and 陈元禄
- Abstract
Objective To analyze the value of exercise stress test (EST) and its related parameters on diagnosing coronary heart disease (CHD), and to explore the influence of individual factors [such as age, sex and body mass index(BMI)] on its diagnostic accuracy. Methods We selected 439 patients who had performed treadmill or bicycle exercise test and coronary angiography (CAG). There were 318 CAG positive patients and 121 negative cases among those patients. The sensitivity and specificity of their EST results were observed. All the enrolled patients were grouped according to age, sex, BMI, the number of lesioned vessels, the lesioned vessels whether including the left main artery (LM) and(or) the proximal branch of the left anterior descending artery (LAD1), and the presence or absence of ventricular arrhythmias. The reference value of EST parameters on the definite diagnosis of CHD was analyzed in each group. Results The sensitivity and specificity of EST in diagnosing CHD is separately 81. 22% and 34. 71% . The true positive rate of the multi-branch coronary artery lesion group is significantly higher than that of the single-branch vascular lesion group (88. 12% vs. 73. 96%, P = 0. 011), however its false negative rate is lower than that of the single-branch vascular lesion group (11. 88% vs. 26. 04%, P = 0. 011). The true positive rate of the LM and(or) LAD1 lesion group does not vary significantly from that of the non-LM and(or) LAD1 lesion group (76. 92% vs. 86. 02%, P = 0. 103). In the EST true positive group, the peak heart rate (HR) during exercise, attainment rate of target HR, and HR recovery at 1 and 2 min after exercise are all lower than those in the false positive group (P < 0. 05). Among the true positive cases, the peak HR during exercise, attainment rate of target HR, and HR recovery at 1 and 2 min after exercise of the single-branch vascular lesion group are all higher than those of the multi-branch coronary artery lesion group (P < 0. 05). The incidence of ventricular arrhythmias of the true positive group is significantly higher than that of the false positive group (63. 06% vs. 18. 02%, P = 0. 048 ) and the false negative group ( 63. 06% vs. 7. 21%, P = 0. 046 ). Conclusion EST has some diagnostic value for CHD. For the elderly overweight males with abnormal peak HR during exercise, attainment rate of target HR, and HR recovery at 1 and 2 min after exercise, and with ventricular arrhythmias, positive EST results suggest further CAG examination. For the patients with high suspicion of CHD and negative EST results, the related individual factors should be comprehensive analyzed. [ABSTRACT FROM AUTHOR]
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- 2023
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36. Painful left bundle branch block syndrome: a case report.
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Mixich, Renee, Dubravčić, Nikolina Jurković, Pleša, Andrea, and Pejković, Senka
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- *
BUNDLE-branch block , *MEDICAL personnel , *ANGINA pectoris , *SYMPTOMS , *MYOCARDIAL ischemia , *CHEST pain - Abstract
Introduction: Left bundle branch block (LBBB) is a conduction abnormality of electrical impulses in the heart, clearly visible on an electrocardiogram (ECG). In this condition, the activation of the left ventricle is delayed, causing the left ventricle to contract later than the right ventricle.¹ Slow or absent conduction through the left bundle branch means that the left ventricle takes longer than normal to fully depolarize. This may be due to a damaged bundle branch that cannot conduct impulses, or it may represent intact conduction that is slower than normal. LBBB can be constant, present at all times, or intermittent, occurring, for example, only during an increased heart rate.² Painful LBBB syndrome is a condition where angina pectoris appears simultaneously with transient LBBB, without evidence of myocardial ischemia. The syndrome was first described in 1976 by Vieweg et al. A few years later, the authors reported a series of 7 patients with painful LBBB. In 2016, Shvilkin et al. described 4 new cases, along with 46 previously reported in the literature, establishing this clinical entity. Additionally, in 2013, two more cases were reported, one involving atypical chest pain and another in a young female. The leading theory for the origin of the pain is dyssynchronous ventricular contraction during LBBB. The asynchronous contraction of the right and left ventricles is thought to cause the pain, likely combined with small-vessel dysfunction or vasospasm. Case report: In this case report, we discuss a 32-year-old female patient with no prior history of cardiac disease who presented to a cardiologist with chest pain during minimal activity. Based on her medical history, she was referred for an exercise stress test. During the test, LBBB appeared after 90 seconds, accompanied by chest pain. The test was subsequently stopped, and the patient entered the recovery stage, during which she was monitored until the symptoms and ECG abnormalities resolved. LBBB disappeared by the 4th minute of recovery, and her chest pain also completely subsided. The patient was advised to engage in aerobic physical activity to improve conditioning, and a beta-blocker was introduced to her treatment plan. At the follow-up visit, the patient reported similar symptoms on only two occasions, both during intense exertion. A Holter ECG did not record any LBBB episodes. Conclusion: LBBB is a significant conduction abnormality that can lead to various clinical manifestations, including the painful LBBB syndrome. The case of the 32-year-old female patient illustrates the complex relationship between cardiac electrophysiology and chest pain. Effective management, including the use of beta-blockers and encouragement of aerobic activity, proved beneficial in her case. This highlights the need for increased awareness among healthcare providers regarding painful LBBB syndrome to ensure appropriate care and prevent potential complications. [ABSTRACT FROM AUTHOR]
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- 2024
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37. Prevalence and prognostic implications of hypertensive response to exercise in patients with hypertrophic cardiomyopathy
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Dai-Yin Lu, Ioannis Ventoulis, Hongyun Liu, Bereketeab Haileselassie, Iraklis Pozios, Hsin-Yueh Liang, Lars L. Sorensen, Marco Canepa, Nicole Bavaro, Susan Phillip, M. Roselle Abraham, and Theodore P. Abraham
- Subjects
Blood pressure ,Chronotropic response ,Exercise stress test ,Hypertension ,Hypertrophic cardiomyopathy ,Outcome ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objective: Hypertensive response to exercise (HRE) is observed in patients with hypertrophic cardiomyopathy (HCM) with normal resting blood pressure (BP). However, the prevalence or prognostic implications of HRE in HCM remain unclear. Methods: In this study, normotensive HCM subjects were enrolled. HRE was defined as systolic BP > 210 mmHg in men or >190 mmHg in women, or diastolic BP > 90 mmHg, or an increase in diastolic BP > 10 mmHg during treadmill exercise. All participants were followed for subsequent development of hypertension, atrial fibrillation (AF), heart failure (HF), sustained ventricular tachycardia/fibrillation (VT/VF), and all-cause death. Six hundred and eighty HCM patients were screened. Results: 347 patients had baseline hypertension, and 333 patients were baseline normotensive. 132 (40%) of the 333 patients had HRE. HRE was associated with female sex, lower body mass index and milder left ventricular outflow tract obstruction. Exercise duration and metabolic equivalents were similar between patients with or without HRE, but the HRE group had higher peak heart rate (HR), better chronotropic response and more rapid HR recovery. Conversely, non-HRE patients were more likely to exhibit chronotropic incompetence and hypotensive response to exercise. After a mean follow-up of 3.4 years, patients with and without HRE had similar risks of progression to hypertension, AF, HF, sustained VT/VF or death. Conclusion: HRE is common in normotensive HCM patients during exercise. HRE did not carry higher risks of future hypertension or cardiovascular adverse outcomes. Conversely, the absence of HRE was associated with chronotropic incompetence and hypotensive response to exercise.
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- 2023
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38. Determinants and Prognostic Value of Heart Rate Recovery in Short-Term Outcome of Percutaneous Coronary Intervention in Patients with and Without Type 2 Diabetes.
- Author
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Mahfouz, Ragab, Aldaydamony, Mohamed, El Zayat, Ahmed, and Alshaikha, Mustafa
- Subjects
- *
TYPE 2 diabetes treatment , *PERCUTANEOUS coronary intervention , *EXERCISE physiology , *ECHOCARDIOGRAPHY , *CORONARY angiography - Abstract
Background: Heart rate recovery (HRR) after exercise is an independent prognostic tool for cardiovascular (CV) morbidity and mortality. The aim of this study is to detect the determinants of HRR in ischemic heart disease patients undergoing PCI with and without Type II Diabetes (T2D) and to assess its short term prognostic value. Methods: We examined the correlation between HRR and Clinical, Laboratory, Echocardiography, stress test and coronary angiography data in our cohort (100 patients with positive exercise test and PCI within 90 days, age 49 ±10 years, 71 males, 50% with T2D). We followed them up for 6 months and tested how impaired HRR (IHRR) predicts CV morbidity and mortality and compared data between diabetics and non-diabetics. Results: HRR closely correlated with age, presence of T2D, resting HR, METs, Diastolic dysfunction, LA size and number of coronary lesions. A stepwise linear regression model revealed age, T2D, Resting HR and Diastolic dysfunction as predictors of IHRR. In diabetics HRR was strongly correlated with resting HR, METs, LA size and TG level. A stepwise linear regression model showed resting HR, LA size and TG level as predictors of IHRR. In non diabetics only resting HR was strongly correlated with HRR. Kaplan-Meier survival analysis showed IHRR predicted mortality. Cox regression models found that IHRR predicted arrhythmia and CV composite end point. In diabetics IHRR predicted CV composite end point but not in non diabetics. Conclusions: Age, T2D, Resting HR, and Diastolic dysfunction were determinants of HRR among PCI patients. In diabetics resting HR, LA size and TG level its determinants. In non diabetics resting HR was the only determinant. In patients with T2D IHRR predicted CV composite end point but did not predict mortality. In non diabetics IHRR did not predict any of the endpoints. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
39. Role zátěžového testu v posuzování způsobilosti u sportovce s náhodně zjištěnou dvoucípou aortální chlopní a přidruženou vadou.
- Author
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Pešová, Petra, Godula, Bogna Jiravská, Krausová, Darina, Sovová, Eliška, and Jiravský, Otakar
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AORTIC valve diseases ,MITRAL valve ,AORTIC valve ,SYSTOLIC blood pressure ,HEART valve diseases ,AORTIC valve insufficiency - Abstract
Copyright of Medicina Sportiva Bohemica et Slovaca is the property of Ceska spolecnost telovychovneho lekarstvi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2023
40. RELIABILITY OF STRESS EXERCISE TEST IN PATIENTS WITH PULMONARY ARTERIOVENOUS MALFORMATIONS.
- Author
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Yatish and Singh, Dhermendra Pratap
- Subjects
- *
EXERCISE tests , *ARTERIOVENOUS malformation , *CARDIOVASCULAR system , *OXYGEN saturation , *HEART beat - Abstract
Background: Pulmonary arteriovenous malformations lead a route for passing the emboli to the circulatory system and can be a reason for cerebrovascular accidents, attacks, and abscesses of the cerebral region. Aim: To evaluate and assess the reproducibility, reliability, and efficacy of a 6-minute walk test and exercise stress test in subjects with pulmonary arteriovenous malformations. Also, to assess if these tests can be used at follow-up revaluation and can replace echocardiography and CT (non-contrast) in asymptomatic children. Materials and Methods: In 20 subjects with PAVMs Exercise stress test and 6 minute walk test was done with continuous monitoring of ECG, heart rate, and oxygen saturation was done The study parameters were statistically evaluated and results were formulated regarding efficacy and reliability of 6 minute walk test and exercise stress test. They were baseline and after test heart rates and oxygen saturation. Differences in oxygen saturation recorded at baseline, and after test were also evaluated. Results: Except for the difference in the oxygen saturation, all other parameters including heart rate and oxygen saturation (baseline and after test) showed significant reproducibility with the p- value of 0.7429 for 6 minute walk test. For the exercise stress test, all the parameters showed a statistically significant reproducibility p-value <0.005. Conclusion: The study concludes that 6 minute walk test and exercise stress test are highly reproducible and can be used for follow-up revaluation replacing invasive techniques in subjects with pulmonary arteriovenous malformations. [ABSTRACT FROM AUTHOR]
- Published
- 2022
41. Exercise-induced change in circulating NT-proBNP could not distinguish between patients with and without coronary artery disease: the CADENCE study.
- Author
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Cwikiel, Joanna, Fagerland, Morten W., Wachtell, Kristian, Arnesen, Harald, Seljeflot, Ingebjørg, and Flaa, Arnljot
- Subjects
- *
CORONARY artery disease , *EXERCISE tests , *CORONARY angiography , *CORONARY arteries - Abstract
Objective. In patients with chest pain, exercise stress test has a moderate accuracy for coronary artery disease (CAD). Adding a reliable cardiac biomarker to the exercise test could potentially improve the precision of the test. We investigated circulating NT-proBNP levels before and during exercise stress test in patients with and without angiographically verified CAD. We hypothesized that NT-proBNP would give an additive diagnostic value to the exercise stress test. Methods. In patients presenting with symptoms of stable CAD, venous blood samples were taken at rest and within 5 min of termination of a maximal stress test on a bicycle ergometer. All study participants underwent coronary angiography. Significant CAD was defined as ≥75% stenosis in one or more segments of the coronary arteries. Results. Of the 297 participants, significant CAD was found in 111 (37%) patients. Resting levels of NT-proBNP were significantly higher in patients with CAD compared with patients without CAD (74.18 vs. 56.03 ng/L), p =.005. During exercise, NT-proBNP levels increased in the total population (p <.001). The rise was, however, not significantly different between the two groups (8.24 vs. 8.51 ng/L), p =.700. Combining resting NT-proBNP with positive exercise stress test was superior to exercise test alone in predicting CAD, AUC = 0.68 vs. 0.64. Conclusion. Exercise-induced change in circulating NT-proBNP could not distinguish between patients with or without CAD. However, resting levels of NT-proBNP were significantly higher in patients with CAD than those without CAD. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
42. Determinants and Prognostic Value of Heart rate Recovery in Short-term outcome of percutaneous coronary intervention in Patients with and without Type 2 Diabetes.
- Author
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Mahfouz, Ragab, Aldaydamony, Mohamed, El Zayat, Ahmed, and Alshaikha, Mustafa Ahmed
- Subjects
PERCUTANEOUS coronary intervention ,TYPE 2 diabetes complications ,CARDIOVASCULAR disease related mortality ,CORONARY angiography ,ECHOCARDIOGRAPHY ,HEART rate monitoring - Abstract
Background: Heart rate recovery (HRR) after exercise is an independent prognostic tool for cardiovascular (CV) morbidity and mortality. The aim of this study is to detect the determinants of HRR in ischemic heart di sease patients undergoing PCI with and without Type II Diabetes (T2D) and to assess its short term prognostic value. Methods: We examined the correlation between HRR and Clinical, Laboratory, Echocardiography, stress test and coronary angiography data in our cohort (100 patients with positive exercise test and PCI within 90 days, age 49 ±10 years, 71 males, 50% with T2D). We followed them up for 6 months and tested how impaired HRR (IHRR) predicts CV morbidity and mortality and compared data between diabetics and non diabetics. Results: HRR closely correlated with age, presence of T2D, resting HR, METs, Diastolic dysfunction, LA size and number of coronary lesions. A stepwise linear regression model revealed age, T2D, Resting HR and Diastolic dysfunction as predictors of IHRR. In diabetics HRR was strongly correlated with resting HR, METs, LA size and TG level. A stepwise linear regression model showed resting HR, LA size and TG level as predictors of IHRR. In non diabetics only resting HR was strongly correlated with HRR. Kaplan-Meier survival analysis showed IHRR predicted mortality. Cox regression models found that IHRR predicted arrhythmia and CV composite end point. In diabetics IHRR predicted CV composite end point but not in non-diabetics. Conclusion: Age, T2D, Resting HR, and Diastolic dysfunction were determinants of HRR among PCI patients. In diabetics resting HR, LA size and TG level its determinants. In non diabetics resting HR was the only determinant. In patients with T2D IHRR predicted CV composite end point but did not predict mortality. In non diabetics IHRR did not predict any of the endpoints. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
43. Comparison of master two-step exercise stress test versus six-min walk test in patients tested positive for SARS-CoV-2.
- Author
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Kumar, Ankit, Hegde, Naveen, Kumaravel, J, Mohindra, Ritin, Soni, Roop, Rathod, Ramya, Kumar, Mohan, Muthu, Valliappan, Gamad, Nanda, Patil, Amol, and Sharma, P
- Subjects
- *
RATE of perceived exertion , *EXERCISE tests , *DIASTOLIC blood pressure , *SYSTOLIC blood pressure , *COVID-19 , *PEARSON correlation (Statistics) - Abstract
Background and Aim: There has been a lack of uniformity on how to triage coronavirus disease 2019 (COVID-19) patients visiting the emergency units of hospitals. Triage tools are themselves spreading the pandemic in hospital areas. The present study compared a master two-step (M2ST) exercise stress test versus a 6-min walk test (6MWT) in COVID-19–positive patients visiting the emergency unit of a hospital. Materials and Methods: Thirty-nine patients underwent 6MWT followed by M2ST, while another set of 38 patients underwent M2ST followed by 6MWT in this randomized, crossover, open-label, and noninferiority study. The exercise tests assessed the change from baseline in SpO2, heart rate (HR), respiratory rate, blood pressure, exertion, and dyspnea on the modified-Borg scale. Results: Noninferiority was established for SpO2 (P < 0.05), systolic blood pressure (SBP; P < 0.001), and diastolic blood pressure (DBP; P < 0.05), but not for HR (P = 0.3) and respiratory rate (P = 0.6). The difference between the pretest and posttest (delta change) values for the parameters SpO2, respiratory rate, HR, SBP, and DBP correlated significantly (P < 0.001) with Pearson correlation coefficient (r = 0.764, 0.783, 0.473, 0.838, and 0.783, respectively). The delta change values of modified-Borg scale for dyspnea (P = 0.291) and exertion (P = 0.208) were statistically insignificant between the two exercise tests. However, the correlation between the tests was statistically significant (P < 0.001). Conclusion: M2ST, a timesaving, cost-effective, and easy to perform exercise stress test, has been identified as a reliable alternative for 6MWT. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
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44. Exercise Stress Testing Enhances Plasma Protein Carbonyl Levels in Patients With Asymptomatic Moderate-to-Severe Aortic Stenosis.
- Author
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Kopytek M, Kolasa-Trela R, Malinowski KP, Ząbczyk M, Natorska J, and Undas A
- Subjects
- Humans, Male, Female, Aged, Middle Aged, Oxidative Stress, Biomarkers blood, Aortic Valve Stenosis blood, Aortic Valve Stenosis physiopathology, Exercise Test methods, Protein Carbonylation
- Abstract
Background: Exercise stress test-induced hypofibrinolysis and changes in circulating levels of several interleukins have been observed in aortic stenosis (AS). However, it is unknown whether the pattern of exercise-induced changes in oxidative stress differs between AS patients and controls and if the differences are associated with changes in fibrinolysis and inflammation. Methods: We studied 32 asymptomatic patients with moderate-to-severe AS and 32 controls of similar age, sex, and body mass index. We assessed plasma protein carbonyl (PC) concentrations, a marker of oxidative stress, in relation to interleukin (IL)-10 and -6 levels and fibrinolysis capacity, expressed as plasma clot lysis time (CLT) at four time points: at baseline, at peak exercise, 1 and 24 h after a symptom-limited exercise test. Results: AS patients had 12.8% and 27% higher PC concentrations 1 and 24 h after exercise than controls (both p < 0.05), with no differences at baseline and peak exercise. In AS patients, PC concentration was 8.3% higher at peak exercise compared to baseline followed by further PC increase (+12.8% at 1 h and +20.5% at 24 h) compared to peak exercise (all p < 0.05). In controls, PC concentrations increased during exercise, reaching the highest values 1 h after exercise (+21.9%). In the AS group, PC concentrations at baseline correlated with AS severity measured as peak transvalvular velocity ( V
max : r = 0.49, p < 0.05), mean (PGmean : r = 0.42, p < 0.05), and maximal transvalvular pressure gradients (PGmax : r = 0.41, p < 0.05). PC concentrations correlated with IL-10 levels 1 h ( r = 0.37, p < 0.05) and 24 h ( r = 0.38, p < 0.05) post exercise in AS patients, whereas in controls only at baseline ( r = 0.42, p < 0.05). No associations between PC levels and IL-6 or CLT were observed at any time point. Conclusions: Our findings show that AS patients respond differently to exercise in terms of PC compared to controls, which suggests a novel effect of hemodynamic abnormalities in this disease on intensity of oxidative stress., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Magdalena Kopytek et al.)- Published
- 2024
- Full Text
- View/download PDF
45. Risk Factors Associated With Exaggerated Blood Pressure Response at the Time of Exercise Treadmill Stress Test.
- Author
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Katsi V, Ioakeimidis N, Dimitroglou Y, Vlachopoulos C, and Tsioufis K
- Subjects
- Humans, Middle Aged, Male, Female, Adult, Risk Factors, Aged, Prevalence, Retrospective Studies, Exercise Test, Hypertension epidemiology, Hypertension physiopathology, Hypertension diagnosis, Blood Pressure
- Abstract
Background: Exaggerated blood pressure response (EBPR) to exercise stress testing (EST) may be a marker of future hypertension and carry valuable information for the prediction of cardiovascular events. We sought to evaluate the clinical and resting EST parameters associated with an increased likelihood of EBPR., Methods: The records of 14,073 patients (mean age: 55 ± 11 years) without known cardiovascular disease who underwent a treadmill EST were analyzed., Results: The overall prevalence of arterial hypertension was 44%. A considerable proportion (24%) of patients exhibited EBPR. Multivariate analysis of the entire study population showed that middle-aged individuals (40-60 years old), resting systolic BP > 130 mmHg and/or diastolic BP > 80 mmHg, known arterial hypertension, current cigarette smoking, and family history of premature coronary artery disease are all independent risk factors for EBPR (all P < 0.001). Although the presence of arterial hypertension increased the likelihood of EBPR in the analysis of the entire population, the relevant association in subjects above 60 years old is statistically nonsignificant (P = 0.120). Notably, the pre-test systolic BP > 130 mmHg and/or diastolic BP > 80 mmHg level increased significantly the likelihood of manifesting EBPR in all age categories (<40, 40-60, and >60 years old) independent of hypertension presence and in all hypertensive patients independently of antihypertensive treatment intake (all P < 0.001)., Conclusions: Considering the diagnostic and prognostic utility of EBPR during treadmill EST the clinical and resting hemodynamic parameters that increase the likelihood of EBPR are targets for interventions and preventive measures to modify lifestyle risk behaviors and reduce hypertension and cardiovascular risk factors in the early stages., (© The Author(s) 2024. Published by Oxford University Press on behalf of American Journal of Hypertension, Ltd. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
- Published
- 2024
- Full Text
- View/download PDF
46. Electrocardiographic Characteristics of Brugada Syndrome Type I During Exercise Stress Test.
- Author
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Miná CPC, Lima NA, de Andrade AT, Pérez-Riera AR, and Rocha EA
- Abstract
Introduction: Brugada syndrome (BS) is a genetic channelopathy characterized by an increased risk of sudden cardiac death (SCD) in the absence of structural heart disease. Prognostic stratification is necessary to determine which patients are candidates for implantable cardioverter defibrillator (ICD). The present study aims to evaluate EKG changes during exercise stress tests in patients with BS and to identify any poor prognosis variables., Methods: This was an observational, case-control study. Three comparison groups were created: patients with Type 1 BS with or without prior arrhythmic events (BE and BNoE subgroups) and age- and sex-matched healthy individuals. Patients underwent EST and electrocardiographic variables were analyzed., Results: The study recruited 36 patients with type 1 BS, 12 with prior Event (BE) and 24 without (BNoE). Patients in the BE group, in all postexercise recordings, had lower heart rates, notably in the first minute. A significant difference was also observed in the HR drop in the recovery phase, with a greater drop in relation to maximum HR in the first minute in the group of patients who had events., Conclusion: BS patients with prior events had a lower capacity to increase heart rate at peak effort and a greater proportional drop in the recovery phase. No relationship was observed between the occurrence of arrhythmic events and ST-segment elevation during the exercise test., (© 2024 Wiley Periodicals LLC.)
- Published
- 2024
- Full Text
- View/download PDF
47. Adenosine-Induced Myocardial Ischemia in a Patient with Myocardial Bridge: A Case Report
- Author
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Bingqing Bai, Huan Ma, Lan Guo, Xueju Yu, Haochen Wang, Yuting Liu, Ha Yin, Fengyao Liu, and Qingshan Geng
- Subjects
adenosine stress test ,exercise stress test ,myocardial bridge ,myocardial ischemia ,open-chest surgery ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
The adenosine stress test and exercise stress test have been widely used in the diagnosis of coronary heart disease, which has high sensitivity and specificity for diagnosis of coronary heart disease. The myocardial bridge is a congenital dysplasia of the coronary artery which may cause severe myocardial ischemia, acute myocardial infarction, arrhythmia, and sudden death. Although drug therapy for this disease is clear and widely used, indication for open-chest surgery is still vague. This case shows a patient with long-term chest pain undergoing the coronary computed tomographic angiography in our hospital 1 month ago, which showed the mild myocardial bridge in the left anterior descending (LAD) branch. Then, she did the mental stress-induced myocardial ischemia and cardiopulmonary exercise test which the results were negative. After the informed consent, the patient took the adenosine stress test and severe angina occurred during the test. Later, coronary angiography showed that the myocardial bridge caused 70% contraction of the middle segment of the LAD branch. In the case of long-term ineffective drug treatment, the patient underwent a open-chest surgery called coronary artery myotomy and her chest discomfort eventually recovered. To a degree, adenosine stress test may be more sensitive than exercise stress test in predicting the severity of coronary artery stenosis. Moreover, we may provide a unique direction of indication for surgeons to operate open-chest surgery on the myocardial bridge.
- Published
- 2022
- Full Text
- View/download PDF
48. Influence of covid 19 on morphological and cardiovascular status of professional handball players
- Author
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Aleksandar Gadžić, Aleksandar Živković, and Tamara Stojmenović
- Subjects
covid 19 ,handball players ,exercise stress test ,cardiopulmonary performance ,Sports ,GV557-1198.995 - Abstract
Handball is one of the very popular sports games in the world. The current COVID 19 pandemic directly affects handball players in the training and competition processes from all age categories but professional players seem to be at a higher risk of contracting the disease. This study aimed to assess morphological and cardiovascular status of 20 participants, professional handball players who compete at elite competition rank, and therewith to adjust their training process and to test the differences between COVID 19 positive and COVID 19 negative participants. Testing included measurements of basic morphological parameters while the function of the cardiovascular system (CVS) was assessed at rest and effort - exercise stress test with Vita Maxima protocol. The results of t-test did not show a statistically significant difference in morphological and cardiovascular characteristics of participants who had COVID 19 infection (with a positive PCR test), who had symptoms of infection but no PCR test for the virus, and those who did not contract COVID 19.
- Published
- 2021
- Full Text
- View/download PDF
49. Significance of ‘recovery ST-segment depression’ in exercise stress test
- Author
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Rockey Katheria, MD, DM, Subramanyam K. Setty, MD,DM, B.S. Arun, MD, DM, DNB, Prabhavathi Bhat, MD,DM, DNB, H.V. Jagadeesh, MD,DM, and C.N. Manjunath, MD,DM
- Subjects
Exercise stress test ,Coronary artery disease ,ST-segment depression ,Recovery ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objective: To study the significance of ST-segment depression during ‘recovery’ compared to that ‘during stress’ and ‘both the phases’ in exercise stress test. Methods: Patients with positive exercise stress test who underwent coronary angiography (CAG) from 1st January 2017 to 31st December 2018 were studied. Patients were divided into 3 groups- Group A with ST-depression restricted to recovery phase, group B with ST-depression restricted to stress phase and group C with ST-depression seen both during exercise and recovery. All patients underwent CAG. Sensitivity, specificity, and predictive values of each of these groups in diagnosis of significant coronary artery disease (CAD) were analysed and compared. Results: Total 300 patients were studied. Mean age of the study population was 48.77 ± 7.94 years. 78.3% of patients with positive exercise stress test had significant CAD. 96% of patients in group A had significant CAD, which was higher than in group B (88.9%) & group C (70.1%). The specificity, positive predictive value and negative predictive value of ST-segment depression in group A (96.92%, 96% and 25.2% respectively) were higher than that of ST-depression in group B (89.23%, 88.89% and 24.47% respectively) and group C (13.85%, 70.05% and 7.96% respectively). Sensitivity and accuracy of ST-depression in group A were lower (20.43% and 37% respectively), compared to other 2 groups. Conclusion: Patient with ST-depression restricted to recovery phase had highest specificity, positive predictive value, and negative predictive value. However, accuracy was highest in group with both stress phase and exercise ST-segment depression.
- Published
- 2021
- Full Text
- View/download PDF
50. Correlation between impaired hemodynamic response and cardiopulmonary fitness in middle-aged type 2 diabetes mellitus patients: a case-control study.
- Author
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Xie, Jinjin, Yin, Lianhua, Huang, Jia, Xu, Ying, Chen, Yannan, Qin, Jiawei, Liu, Zhizhen, and Tao, Jing
- Subjects
- *
EXERCISE tests , *BLOOD pressure , *CASE-control method , *TYPE 2 diabetes , *EXERCISE , *RESEARCH funding - Abstract
Purpose: Impaired cardiorespiratory fitness (CRF) is a predictor of mortality in patients with type 2 diabetes mellitus (T2DM). It is still not known how the exercise hemodynamic response correlates with CRF. The purpose was to assess the correlation between hemodynamic changes and CRF in middle-aged patients with T2DM.Methods: After 1:1 matching by age and sex, 139 T2DM patients and 139 non-T2DM controls who completed the exercise treadmill test were included. Maximal aerobic capacity (VO2max), exercise-induced changes in heart rate (ΔHR), systolic blood pressure (ΔSBP), diastolic blood pressure (ΔDBP), and rate-pressure product (ΔRPP) were measured. HRR1 was calculated as the maximum heart rate minus the heart rate after 1 min of rest.Results: Compared to the control population, T2DM patients had decreased ΔHR (87 (77, 97) v 93 (84, 104) bpm, p < 0.05), ΔRPP (3833.64 ± 1670.34 v 4381.16 ± 1587.78 bpm∙mmHg, p < 0.05), HRR1 (21 (14, 27) v 21 (17, 27) bpm, p < 0.05), and VO2max (32.76 ± 5.63 v 34.68 ± 5.70 ml/kg/min, p < 0.05). Multiple linear regression analysis showed that ΔHR and HRR1, yielded a positive correlation with VO2max in T2DM patients (β = 0.325, P < 0.001; β = 0.173, P = 0.01).Conclusion: The presence of impaired hemodynamic response and VO2max in middle-aged T2DM patients and the association of impaired ΔHR, HRR1, and VO2max may indicate a physiological pathway of impaired CRF, and our results support the need for cardiorespiratory screening and individualized treatment of middle-aged T2DM patients. [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
- View/download PDF
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