SeminarExercise testing in clinical medicine
Section snippets
Diagnosis
Meta-analysis of trials has shown that the exercise test has a specificity of around 80% and a sensitivity of around 70% for obstructive coronary disease confirmed by angiography.4 However, many of these studies had methodological problems of limited challenge and work-up bias. The former takes place when patients already known to have coronary artery disease (eg, those with previous myocardial infarction) are used to challenge a diagnostic test. Work-up bias describes the situation in which
Prognosis and novel indications
The overriding paradigm in the diagnosis of cardiovascular disease over the past decades has been the presumptive identification of obstructive coronary disease in order to direct interventional angiography or bypass surgery. However, shortcomings in non-invasive tests such as the work-up bias mentioned above, combined with limitations fundamental to angiography16 have led some to suggest that the principal place for the exercise test is in the assessment of prognosis (table 2). The appropriate
Protocol
Experience and history show that the pervasiveness of an idea, method, or product relies only in part on its intrinsic quality. Rather more, the acceptance of an idea relies on its extrinsic survival potential, a complex attribute with temporal, logistical, and experiential dimensions.39 In applied exercise testing, these features are apparent in relation to the choice of treadmill protocol. When treadmill and cycle ergometer testing was first introduced into clinical practice, practitioners
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Cited by (138)
Stress testing before abdominal aortic aneurysm repair does not lead to a reduction in perioperative cardiac events
2021, Journal of Vascular SurgeryAdverse cardiac events after vascular surgery are prevalent despite negative results of preoperative stress testing
2020, Journal of Vascular SurgeryCitation Excerpt :These findings along with favorable outcomes for patients who underwent coronary revascularization were the foundation for algorithms for noninvasive cardiac testing before vascular procedures aimed at identifying patients at elevated cardiac risk.14,15 Based in part on this work, cardiac stress testing has become an integral evaluative test used by primary care physicians, cardiologists, and surgeons for risk stratification before surgery.4,5,9 There is consensus that cardiac stress testing represents a noninvasive and low-risk method to assess perioperative cardiac risk.5,8
Exercise testing: New guidelines
2019, Presse MedicaleClinical Utility of Pre-Exercise Stress Testing in People With Diabetes
2019, Canadian Journal of CardiologyCitation Excerpt :In fact, the review of more than 500 clinic charts allowed for a rich dataset on presence of comorbidities and insights into the clinical decisions and end outcomes of the referral to screening clinics. Although stress testing can be useful in exercise prescription and assessing long-term prognosis,30 concerns with costs, barriers, follow-up with expensive/invasive tests, and potential low yield suggest that it may be impractical to use stress testing to screen for CAD in all or most asymptomatic patients with diabetes who want to begin exercise programs. Based on our findings, we suggest that recommendations for stress testing before beginning an exercise program for all patients with diabetes are too broad.
High-sensitivity cardiac troponin T increases after stress echocardiography
2019, Clinical BiochemistryCitation Excerpt :The noninvasive evaluation of patients with CAD is frequently performed with stress testing, either with exercise or with pharmacologic agents such as dobutamine and imaging modalities such as echocardiography or myocardial perfusion imaging [3,4]. Stress echocardiography has high sensitivity and specificity to detect myocardial ischemia, manifested as new or worsening segmental wall motion abnormalities [5–9]. Cardiac troponin (cTn) is the standard biomarker for the diagnosis of myocardial infarction (MI) [10,11].
French Society of Cardiology guidelines on exercise tests (part 1): Methods and interpretation
2018, Archives of Cardiovascular Diseases