Wolff–Parkinson–White syndrome: a single exercise stress test might be misleading

2016 ◽  
Vol 27 (4) ◽  
pp. 804-807 ◽  
Author(s):  
Arash Salavitabar ◽  
Eric S. Silver ◽  
Leonardo Liberman
Keyword(s):  
High Risk ◽  
Sudden Death ◽  
Risk Stratification ◽  
Stress Testing ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
White Syndrome ◽  
Complex Process ◽  
Wolff Parkinson White Syndrome

AbstractRisk stratification of patients with Wolff–Parkinson–White syndrome for sudden death is a complex process, particularly in understanding the utility of the repeat exercise stress test. We report a case of an 18-year-old patient who was found to have a high-risk pathway by both invasive and exercise stress testing after an initial exercise stress test showing beat-to-beat loss of pre-excitation.

scholarly journals A Method for Predicting the Main Indicators of Cardiopulmonary Stress Testing for Patients with Chronic Heart Failure

2020 ◽  
Vol 23 (1) ◽  
pp. 96-104
Author(s):  
A. S. Krasichkov ◽  
E. Mbazumutima ◽  
F. Shikama ◽  
E. M. Nifontov
Keyword(s):  
Heart Failure ◽  
Oxygen Consumption ◽  
Chronic Heart Failure ◽  
Stress Testing ◽  
Stress Test ◽  
Significant Risk ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Peak Oxygen Consumption ◽  
Prognostic Information

Introduction. Cardiopulmonary stress test provides significant diagnostic and prognostic information of the condition of patients with cardiovascular and pulmonary diseases. There is a serious problem, that final phase of stress testing is a physically difficult exercise for a person. There is a significant risk of occurrence and development of pathological conditions of the patient's cardiovascular system. One of the solutions is the development of methods for assessing the biological parameters of the patients at the end of a load protocol based on data from the initial stages of the test.Aim. Development of a method for finding an estimate of the maximum heart rate (HR) and of the peak oxygen consumption (OC) for the patients with chronic heart failure at the end of a cardiorespiratory exercise stress test, based on the results of the study obtained at the first initial stages of the test.Materials and methods. For the study, 149 anonymized records of rhythmograms and data of changes in the oxygen consumption of the patients with chronic heart failure were used. The patients underwent a cardiopulmonary stress test by a bicycle ergometer using step-by-step load protocol (the load power increase at each stage was 10 W, the duration of the load stage was 1 min)Results. Based on the analysis of the data obtained, a method for assessing the peak values of HR and of PC of the patients with chronic heart failure was developed.Conclusion. The relative error of the proposed estimate of the HR peak in most cases was no more than 10 %, which allows it to be used for practical purposes. It was established that when performing 70 % of the stress protocol, the error of the proposed estimate of the OC peak in most cases did not exceed 20 %. More research is needed to improve the accuracy of the assessment for using in medical applications aimed to the modernization of methods and equipment for stress testing of the patients.

scholarly journals Emergency department patient compliance with follow-up for outpatient exercise stress testing: a randomized controlled trial

CJEM ◽  
2007 ◽  
Vol 9 (06) ◽  
pp. 435-440 ◽  
Author(s):  
Doug Richards ◽  
Nazanin Meshkat ◽  
Jaqueline Chu ◽  
Kevin Eva ◽  
Andrew Worster
Keyword(s):  
Chest Pain ◽  
Stress Testing ◽  
Stress Test ◽  
Intervention Group ◽  
Exercise Stress Test ◽  
Low Risk ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Control Group

ABSTRACTIntroduction:Numerous patients are assessed in the emergency department (ED) for chest pain suggestive of acute coronary syndrome (ACS) and subsequently discharged if found to be at low risk. Exercise stress testing is frequently advised as a follow-up investigation for low-risk patients; however, compliance with such recommendations is poorly understood. We sought to determine if compliance with follow-up for exercise stress testing is higher in patients for whom the investigation is ordered at the time of ED discharge, compared with patients who are advised to arrange testing through their family physician (FP).Methods:Low-risk chest pain patients being discharged from the ED for outpatient exercise stress test and FP follow-up were randomized into 2 groups. ED staff ordered an exercise stress test for the intervention group, and the control group was advised to contact their FP to arrange testing. The primary outcome was completion of an exercise stress test at 30 days, confirmed through both patient contact and stress test results. Patients were unaware that our primary interest was their compliance with the exercise stress testing recommendations.Results:Two-hundred and thirty-one patients were enrolled and baseline characteristics were similar between the 2 groups. Completion of an exercise stress test at 30 days occurred in 87 out of 120 (72.5%) patients in the intervention group and 60 out of 107 (56.1%) patients in the control group. The difference in compliance rates (16.4%) between the 2 groups was statistically significant (χ2= 6.69,p< 0.001) with a relative risk of 1.29 (95% confidence interval 1.18–1.40), and the results remained significant after a “worst case” sensitivity analysis involving 4 control group cases lost to follow-up. When subjects were contacted by telephone 30 days after the ED visit, 60% of those who were noncompliant patients felt they did not have a heart problem and that further testing was unnecessary.Conclusion:When ED staff order an outpatient exercise stress test following investigation for potential ACS, patients are more likely to complete the test if it is booked for them before ED discharge. After discharge, many low-risk chest pain patients feel they are not at risk and do not return to their FP for further testing in a timely manner as advised. Changing to a strategy of ED booking of exercise stress testing may help earlier identification of patients with coronary heart disease.

The ECG in cardiac stress testing: a valuable, but unappreciated source of clues

1998 ◽  
Vol 7 (4) ◽  
pp. 320-327
Author(s):  
LG Futterman ◽  
L Lemberg
Keyword(s):  
Emergency Department ◽  
Clinical Features ◽  
Stress Testing ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Accurate Diagnosis ◽  
Exercise Stress ◽  
Cardiac Stress ◽  
Cardiac Stress Testing ◽  
Ecg Abnormalities

The ECG exercise stress test is a very potent aid to the clinical diagnosis of CAD. Thorough knowledge of the ECG abnormalities and clinical features related to the stress test are required for an accurate diagnosis. The ECG exercise stress test is not a substitute for clinical acumen. Proper evaluation of the stress test is a clinical art of the skilled clinician. ECG exercise stress testing can be done efficiently and effectively by trained emergency department physicians. As a result, the diagnosis of CAD can be greatly accelerated.

Abstract 17409: Improved Diagnosis of Coronary Artery Disease Using Cardiac CT Compared With Exercise Stress Testing in an Urban Public Hospital Patient Population

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Johnny Wu ◽  
Ivan Rudenko ◽  
Chandana Shekar ◽  
Suraj Dahal ◽  
April Kinninger ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Public Hospital ◽  
Stress Testing ◽  
Cardiac Ct ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Exercise Stress Testing

Introduction: Heart disease remains the leading cause of death in the United States, with the disease burden particularly high in various racial and ethnic groups. In serving an underserved population comprised largely of Hispanic and African American individuals, it is crucial for an urban public hospital to diagnose heart disease in a resource-efficient and cost-effective manner. The greater positive predictive value of cardiac CT relative to exercise stress testing presents the opportunity for such hospitals to optimize resource utilization in identifying patients with coronary artery disease (CAD). Hypothesis: The positive predictive value of cardiac CT in diagnosing CAD is greater than that of exercise stress testing in the patient population served by an urban public hospital. Methods: Patients at Harbor-UCLA Medical Center (Torrance, California) were identified for inclusion in this observational study on the basis of a positive (i.e., abnormal) exercise stress test result or a positive cardiac CT result, during the period between January 2015 and September 2019. These patients were subsequently referred for invasive coronary artery angiography, with the diagnosis of obstructive CAD established by an indication for revascularization via percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Data were analyzed using a two-tailed Z-test for two proportions. Results: Seventy-six catheterization laboratory results were analyzed. Fifteen subjects with an abnormal exercise stress test result, out of a total of 41 (36.6%), had an indication for PCI or CABG. Twenty-five cardiac CT imaging subjects, out of a total of 35 (71.4%), had an indication for PCI or CABG. The proportion of positive cardiac CT results with an indication for PCI or CABG was significantly higher than the abnormal exercise stress test proportion (p=0.0024). Conclusions: Among urban public hospital patients who were referred for invasive coronary artery angiography, it was determined that cardiac CT provides a greater positive predictive value in the diagnosis of obstructive CAD than exercise stress testing. This result may help guide the optimal allocation of diagnostic resources in an urban public hospital.

Use of electrophysiologic testing to assess risk in children with Wolff-Parkinson-White syndrome

2002 ◽  
Vol 12 (3) ◽  
pp. 248-252 ◽  
Author(s):  
Anne M. Dubin ◽  
Kathryn K. Collins ◽  
Nancy Chiesa ◽  
Debra Hanisch ◽  
George F. Van Hare
Keyword(s):  
Radiofrequency Ablation ◽  
Sudden Death ◽  
Risk Stratification ◽  
Supraventricular Tachycardia ◽  
Accessory Pathway ◽  
White Syndrome ◽  
Asymptomatic Children ◽  
Asymptomatic Patients ◽  
Electrophysiologic Studies ◽  
Wolff Parkinson White Syndrome

In adults with Wolff-Parkinson-White syndrome, the likelihood of sudden death can be estimated based upon the presence or absence of symptoms. Comparable data in children do not exist. To date, therefore, invasive risk stratification has been used to guide management regarding radiofrequency ablation in symptomatic children. As the safety of electrophysiology study and radiofrequency ablation in children has improved, asymptomatic patients have been referred more commonly for invasive risk stratification. We sought to compare the findings from electrophysiologic studies in symptomatic children with Wolff-Parkinson-White syndrome to the findings in asymptomatic children with Wolff-Parkinson-White pattern on their electrocardiogram. Thus, we compared the findings from electrophysiologic studies carried out in patients seen at Stanford University and University of California, San Francisco, from April 1999 to February 2001 with a preexcitation pattern on their electrocardiogram. The patients were divided into three groups: 23 asymptomatic patients studied for risk stratification, 19 patients who presented with syncope, and 77 patients presenting with documented supraventricular tachycardia. Data were collected for commonly accepted invasive criterions for stratification of risk: an effective refractory period of the accessory pathway less than 270 ms, multiple pathways, septal location of pathway, and inducibility of supraventricular tachycardia. Groups were compared by chisquare. No differences were found between the groups for any of the variables. These data suggest that risk factors for sudden death, developed in studies of adult patients, are not clearly applicable to children. Further studies are needed better to define the indications for study and ablation in children.

scholarly journals Asymptomatic severe aortic stenosis: what is the current role of exercise stress test and NT-proBNP in patient risk stratification

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
I Campos ◽  
J Pereira ◽  
N Salome ◽  
VH Pereira ◽  
C Oliveira ◽  
...  
Keyword(s):  
Adverse Event ◽  
Aortic Stenosis ◽  
Risk Stratification ◽  
Stress Test ◽  
Exercise Stress Test ◽  
The Elderly ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Aortic Valve Area

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Aortic stenosis (AS) is prevalent in the elderly population. When severe and the patient is symptomatic or left ventricular dysfunction arises, the prognosis deteriorates and valve replacement (AVR) is recommended. During the asymptomatic phase regular clinical evaluation is advised to detect early onset of symptoms and/or signs of myocardial maladaptation. Due to the inherent difficulties in the evaluation of symptoms, especially in the elderly, as well as the change in prognosis when symptoms appear (even if not perceived), it is crucial to evaluate the behavior of patients with effort and signs of myocardial injury. Methods An observational and retrospective study that included 74 patients followed at the Cardiology Service by severe AS (aortic valve area ≤ 1cm2 and/or aortic transvalvular mean gradient ≥40mmHg), who underwent exercise stress test (EST) and NT-proBNP evaluation for risk stratification. The outcome studied was hospitalization for heart failure (HF), or referral to SV, or death during the follow-up period. Independent predictors were obtained using multivariate Cox regression. Results Non-progression or decrease in systolic blood pressure (SBP) in EST is the only independent predictor of a short-term adverse event (p = 0.025). This parameter, NT-proBNP levels and interventricular septal thickness (IVS) were independent predictors of a medium (two (p = 0.025; p = 0.014; p = <0.001), three (p = 0.015; p = 0.007; p = 0.001) and four years (p = 0.007; p = 0.049; p = 0.005)) and a long term adverse event (p = 0.006; p = 0.028; p = 0.005). Conclusion In asymptomatic patients with severe AS, no progression or decrease in SBP in EST, increased NT-proBNP levels and thickness of IVS were independent predictors of hospitalization for HF, need for VS or death in short, medium and long term.

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