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Yield of downstream tests after exercise treadmill testing: a prospective cohort study.

ABSTRACT: The purpose of this study was to estimate the frequency and results of downstream testing after exercise treadmill tests (ETTs).The utility of additional diagnostic testing after ETT is not well characterized.We followed consecutive individuals without known coronary artery disease referred for clinical ETT at a large medical center. We measured the frequency and results of downstream imaging tests and invasive angiography within 6 months of ETT and the combined endpoint of survival free from cardiovascular death, myocardial infarction, and coronary revascularization.Among 3,656 consecutive subjects who were followed for a mean of 2.5 ± 1.1 years, 332 (9.0%) underwent noninvasive imaging and 84 (2.3%) were referred directly to invasive angiography after ETT. The combined endpoint occurred in 76 (2.2%) patients. The annual incidence of the combined endpoint after negative, inconclusive, and positive ETT was 0.2%, 1.3%, and 12.4%, respectively (p < 0.001). Rapid recovery of electrocardiography (ECG) changes during ETT was associated with negative downstream test results and excellent prognosis, whereas typical angina despite negative ECG was associated with positive downstream tests and adverse prognosis (p < 0.001). Younger age, female sex, higher metabolic equivalents of task achieved, and rapid recovery of ECG changes were predictors of negative downstream tests.Among patients referred for additional testing after ETT, the lowest yield was observed among individuals with rapid recovery of ECG changes or negative ETT, whereas the highest yield was observed among those with typical angina despite negative ECG or a positive ETT. These findings may be used to identify patients who are most and least likely to benefit from additional testing.

SUBMITTER: Christman MP

PROVIDER: S-EPMC4033667 | biostudies-literature | 2014 Apr

REPOSITORIES: biostudies-literature

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Yield of downstream tests after exercise treadmill testing: a prospective cohort study.

Christman Mitalee P MP Bittencourt Marcio Sommer MS Hulten Edward E Saksena Ekta E Hainer Jon J Skali Hicham H Kwong Raymond Y RY Forman Daniel E DE Dorbala Sharmila S O'Gara Patrick T PT Di Carli Marcelo F MF Blankstein Ron R

Journal of the American College of Cardiology 20140205 13

<h4>Objectives</h4>The purpose of this study was to estimate the frequency and results of downstream testing after exercise treadmill tests (ETTs).<h4>Background</h4>The utility of additional diagnostic testing after ETT is not well characterized.<h4>Methods</h4>We followed consecutive individuals without known coronary artery disease referred for clinical ETT at a large medical center. We measured the frequency and results of downstream imaging tests and invasive angiography within 6 months of ...[more]

PMID: 24509269

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Project description:BackgroundExercise capacity is seriously reduced after stroke. While cardiopulmonary assessment and intervention strategies have been validated for the mildly and moderately impaired populations post-stroke, there is a lack of effective concepts for stroke survivors suffering from severe motor limitations. This study investigated the test-retest reliability and repeatability of cardiopulmonary exercise testing (CPET) using feedback-controlled robotics-assisted treadmill exercise (FC-RATE) in severely motor impaired individuals early after stroke.Methods20 subjects (age 44-84 years, <6 month post-stroke) with severe motor limitations (Functional Ambulatory Classification 0-2) were selected for consecutive constant load testing (CLT) and incremental exercise testing (IET) within a powered exoskeleton, synchronised with a treadmill and a body weight support system. A manual human-in-the-loop feedback system was used to guide individual work rate levels. Outcome variables focussed on standard cardiopulmonary performance parameters. Relative and absolute test-retest reliability were assessed by intraclass correlation coefficients (ICC), standard error of the measurement (SEM), and minimal detectable change (MDC). Mean difference, limits of agreement, and coefficient of variation (CoV) were estimated to assess repeatability.ResultsPeak performance parameters during IET yielded good to excellent relative reliability: absolute peak oxygen uptake (ICC?=0.82), relative peak oxygen uptake (ICC?=0.72), peak work rate (ICC?=0.91), peak heart rate (ICC?=0.80), absolute gas exchange threshold (ICC?=0.91), relative gas exchange threshold (ICC?=0.88), oxygen cost of work (ICC?=0.87), oxygen pulse at peak oxygen uptake (ICC?=0.92), ventilation rate versus carbon dioxide output slope (ICC?=0.78). For these variables, SEM was 4-13%, MDC 12-36%, and CoV 0.10-0.36. CLT revealed high mean differences and insufficient test-retest reliability for all variables studied.ConclusionsThis study presents first evidence on reliability and repeatability for CPET in severely motor impaired individuals early after stroke using a feedback-controlled robotics-assisted treadmill. The results demonstrate good to excellent test-retest reliability and appropriate repeatability for the most important peak cardiopulmonary performance parameters. These findings have important implications for the design and implementation of cardiovascular exercise interventions in severely impaired populations. Future research needs to develop advanced control strategies to enable the true limit of functional exercise capacity to be reached and to further assess test-retest reliability and repeatability in larger samples.

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Yield of downstream tests after exercise treadmill testing: a prospective cohort study.

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Yield of downstream tests after exercise treadmill testing: a prospective cohort study.

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