scholarly journals The Response of Circulating Leptin Levels to Exercise Stress Testing in Subjects Diagnosed with Metabolic Syndrome

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Dana Pop ◽  
Alexandra Dădârlat ◽  
Gyorgy Bodizs ◽  
Liana Stanca ◽  
Dumitru Zdrenghea
Keyword(s):  
Metabolic Syndrome ◽  
Stress Testing ◽  
Stress Test ◽  
False Negative ◽  
Test Group ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
True Negative ◽  
Negative Test ◽  
Group 2

Aim. To assess the plasma leptin responses after exercise stress testing in patients with metabolic syndrome (MS). Material and Methods. We investigated 67 patients with MS, with mean age of 55±7 years. They underwent exercise stress testing on cycloergometer. The lot was divided into three groups: group 1—10 patients with a true positive test, group 2—18 patients with a true negative test, and group 3—39 patients with a false negative test. Leptin levels were measured using the ELISA method. Results. Leptin levels decreased after effort in patients with MS (9.42±11.08 ng/mL before and 8.18±11.5 ng/mL after the exercise stress test, P=0.0005, r=0.874). In groups 1 (8.98±9.09 at rest versus 5.98±8.73 ng/mL after the exercise test, P=0.002) and 3 (8.6±10.53 at rest versus 6.91 ± 9.07 ng/mL, P=0.0005), lower leptin levels were recorded immediately after exercise testing. Leptin levels were not significantly lower in group 2 before effort (9.49±11.36 ng/ml) and after (9.46±13.81 ng/mL). We found no correlation between leptinemia and exercise stress testing parameters, regardless of group. Conclusion. Our research showed that short-term exercise lowers leptin levels in coronary patients, without a relationship between its parameters and leptin values.

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.

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.

scholarly journals Diagnostic value of electrocardiogram stress testing in patients with metabolic syndrome

2015 ◽  
Vol 21 (1) ◽  
pp. 9-15
Author(s):  
Jolita Badarienė ◽  
Jelena Čelutkienė ◽  
Dovilė Petrikonytė ◽  
Jūratė Balsytė ◽  
Egidija Rinkūnienė ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Chest Pain ◽  
Stress Testing ◽  
Diagnostic Value ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Asymptomatic Patients ◽  
Lumen Narrowing ◽  
Design And Methods ◽  
Electrocardiogram Ecg

SummaryObjectives:The aim of this study was to assess the diagnostic value of exercise stress testing to detect coronary heart disease (CHD) in the group of patients with metabolic syndrome.Design and methods: 2803 patients without prior diagnosis of CHD and identified metabolic syndrome were investigated. Subjects underwent electrocardiogram (ECG) stress testing and, depending on the results, coronary angiography and/or coronary computed tomography angiography to detect hemodynamically significant stenosis. CHD was confirmed, if lumen narrowing ≥ 50% of coronary arteries was found.Results: Exercise stress testing was interpreted as positive in 12% patients (71.7% women and 28.3% men). CHD was diagnosed in 45 patients (1.6%), 23 of them had positive exercise stress testing. ECG stress testing was more frequently positive in patients, who had typical/atypical anginal chest pain, dyspnea and/or non-anginal chest pain, in comparison to asymptomatic patients (16.6% vs 8.9%, p <0.001). CHD was more often diagnosed in symptomatic patients compared to patients with no symptoms (6.1% vs 0.7%, p < 0.001, women 5.3% vs 0.6%, p < 0.001, men respectively 8% vs 0.8%, p < 0.001).Conclusions: Diagnostic value of exercise stress testing for detecting CHD is limited in population with metabolic syndrome. CHD was more prevalent in patients with chest pain or dyspnea than in asymptomatic patients.

Abstract 11773: Liver Transplant Candidates: To Stress or Not to Stress?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ahmed Ibrahim ◽  
Andres Schuster ◽  
M Chadi Alraies ◽  
Abraham Sonny ◽  
Jacek B Cywinski ◽  
...  
Keyword(s):  
Stress Testing ◽  
Beta Blockers ◽  
Stress Test ◽  
Demographic Data ◽  
False Negative ◽  
Cleveland Clinic ◽  
Dobutamine Stress ◽  
Heart Catheterization ◽  
True Negative ◽  
Nuclear Stress Testing

Background: The prevalence of coronary artery disease (CAD) in patients with end stage liver disease (ESLD) and the incidence of acute coronary syndromes (ACS) post liver transplantation (LT) remain controversial. Current AHA/ACC guidelines recommend non-invasive stress testing (NIST) for risk stratification of LT recipients based on conventional cardiovascular risk factors (CVRF). The aim of our study was to define the role of NIST in the pre-transplant evaluation of ESLD patients. Methods: We retrospectively reviewed the data of 366 patients who were referred to the Cleveland Clinic LT center between the years 2006 and 2008. We collected demographic data, CVRF, NIST, left heart catheterization (LHC) results, incidence of ACS and death. Results: In our study population, the mean age was 56±8 years, 68% were males, 83% Caucasian, 34% diabetic, 36% hypertensive, 22% smokers, 17% had hyperlipidemia, 11% known CAD, and 14% had family history of premature CAD; overall, 70% of the patients had at least 3 CVRF. Mean platelet count was 104±70 k/uL, mean INR 1.4 ±0.4, total cholesterol (TC) 143±45 mg/dL and 42% were on beta blockers (BB). A total of 270 patients underwent NIST with dobutamine stress echocardiography (DSE) or nuclear stress testing. DSE was diagnostic in 76% of the cases and nuclear stress test was performed in 52% of the patients with a non-diagnostic DSE. From the patients with diagnostic NIST, 40 underwent LHC. There were 5 true positive, 22 true negative, 8 false positive, and 5 false negative results giving NIST a negative predictive value of 81%. After a median follow-up of 6.2 years [IQR 3.4 to 6.7], 264 patients were transplanted, 9 patients developed an ACS and only one of them within the first year of LT. ACS was the cause of death in one patient which occurred more than 3 years from LT. All of these patients had a prior negative NIST. There were no ACS in the non-transplanted group. Conclusions: In our ESLD population, NIST had a limited role in the CV risk assessment of LT candidates. This is probably secondary to the low incidence of ACS which could be explained by inherent ESLD factors like thrombocytopenia, low TC, and elevated INR.

Abstract 70: Exercise Stress Testing Modality after Percutaneous Coronary Intervention - Choice of Modality and Implications for Resource Use: Retrospective Analysis using the NCDR®

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Jerome Federspiel ◽  
Daniel W Mudrick ◽  
Bimal R Shah ◽  
Sally C Stearns ◽  
Frederick A Masoudi ◽  
...  
Keyword(s):  
Geographic Variation ◽  
Stress Testing ◽  
Stress Test ◽  
Test Procedure ◽  
Temporal Trends ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Stress Tests ◽  
Stress Imaging ◽  
Exercise Tests

OBJECTIVES: Exercise stress testing is frequently performed post PCI, but the choices amongst the modalities available (ECG-only, nuclear, or echocardiography) and consequences of such choices are not well characterized. We evaluated temporal trends and geographic variation in the choice of exercise testing modality post PCI, as well as associations between modality choice and procedure use after testing. METHODS: CathPCI Registry® data were linked with identifiable Medicare claims to capture stress testing use between 60 and 365 days after PCI and procedures within 90 days after testing. Testing rates and modality used were modeled based on patient, procedure, and PCI facility factors, calendar quarter, and Census Divisions using Poisson and logistic regression. Post stress test/procedure use was assessed using Gray's test. RESULTS: In 286,099 patients, the overall stress testing rate after PCI was 53.1 per 100 person-years. The rate declined from 59.5 in Q1 2006 to 47.2 in Q4 2008 (p<0.001), but the proportion of all stress tests performed with exercise and the proportion of all exercise tests performed with each modality changed little. After statistical adjustment, the proportion of exercise test recipients receiving ECG-only testing (vs. any stress imaging) varied from 8.7%-21.1% across divisions (p<0.001). Among exercise stress imaging recipients, the proportion receiving echocardiography (vs. nuclear) varied from 9.1%-31.2% across divisions (p<0.001). Rates of post-test procedure use varied among modalities; exercise ECG-only testing was associated with more subsequent stress testing (14.6% vs. 1.9%; p<0.001), but less catheterization (8.4% vs. 15.3%; p<0.001) than imaging-based tests. CONCLUSIONS: Modest reductions in stress testing after PCI occurring between 2006 and 2008 cannot be ascribed to trends in use of any single modality. Additional research should assess whether this trend represents better patient selection for testing or administrative policies (e.g., restricted access for patients with legitimate testing needs). Geographic variation in utilization of exercise stress modalities and differences in downstream procedure use among modalities suggest a need to identify optimal use of the different test modalities.

Exercise stress test in apparently healthy individuals − where to place the finish line? The Ferrari corporate wellness programme experience

2019 ◽  
Vol 26 (7) ◽  
pp. 731-738 ◽  
Author(s):  
Felice Sirico ◽  
Fredrick Fernando ◽  
Fernando Di Paolo ◽  
Paolo Emilio Adami ◽  
Maria Grazia Signorello ◽  
...  
Keyword(s):  
Stress Testing ◽  
Healthy Adult ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Peak Exercise ◽  
Ecg Changes ◽  
Volitional Exhaustion ◽  
Apparently Healthy

Aims The aim of our study was to assess the clinical significance of the exercise stress testing endpoints, namely 85% of maximal theoretical heart rate (MTHR), metabolic equivalent of task, and rating of perceived exertion (RPE), and their relation to electrocardiographic (ECG) changes in a healthy adult population. Methods A cross-sectional study was conducted on 408 males and 52 females (mean age 39.4 ± 8.6 years) who performed the maximal cycle ergometer exercise stress test until volitional exhaustion, reporting the RPE score at 85% of MTHR and at peak exercise. Metabolic equivalents of task were indirectly calculated from the maximum workload and compared with the predicted values. Sitting torso-lead ECG and blood pressure were recorded at rest, during exercise and during recovery. Results Of 460 participants, 73% exceeded 85% of MTHR. The RPE score represented the overall most significant endpoint of exercise stress testing, with the median value of 17 at peak exercise. ECG events were detected in 23/124 (18.5%) who reached ≤ 85% of MTHR and in 61/336 (18.2%) who achieved >85% of MTHR ( p = 0.92). In the latter group, 54% of ECG changes occurred at < 85% of MTHR and 46% at > 85% of MTHR ( p = 0.51). If the exercise stress testing had been interrupted at ≤ 85% of MTHR, almost half of the ECG events would have remained undetected and 35% of the cardiovascular abnormalities observed at the diagnostic follow-up would have remained undiagnosed. Conclusion Terminating exercise stress testing before volitional exhaustion and an RPE score of 17 limits the test accuracy and reduces the possibility to detect cardiovascular abnormalities in apparently healthy adult populations.

Abstract 14062: Accuracy of Exercise Induced St- Elevation in Lead Avr in the Diagnosis of Significant Left Main or Proximal Left Anterior Descending Artery Stenosis: A Systematic Review

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kirtipal S Bhatia ◽  
Subrat Das ◽  
Nirupama Krishnamurthi ◽  
Devika Aggarwal ◽  
vardhmaan jain ◽  
...  
Keyword(s):  
Stress Testing ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Left Main ◽  
Mesh Terms ◽  
Lead Avr ◽  
St Elevation ◽  
Exercise Induced

Introduction: ST-segment changes during exercise stress testing are diagnostic of myocardial ischemia in patients with suspected coronary artery disease (CAD). Recent studies have shown that exercise-induced ST-elevation in aVR is associated with significant stenosis of the left main (LM) and proximal left anterior descending (pLAD) arteries Methods: Search of electronic databases (Embase, Medline, and Web of Science) using MeSH terms and keywords for exercise stress test, lead aVR and CAD was performed from inception through December 2019. 2 reviewers independently screened results in 2 stages: title/abstract followed by full text. Included studies had adult patients who underwent exercise stress testing and reported the performance of ST-elevation >1 mm in lead aVR for diagnosing significant LM or pLAD disease. Significant disease was defined as luminal narrowing >50% and >70% for LM and pLAD respectively. Pooled sensitivity, specificity, likelihood ratios (LR) and diagnostic odds ratios were calculated using a bivariate model, and a summary receiver operator curve (SROC) was constructed. Results: We included 6 studies with 1128 patients. The pooled sensitivity was 0.8 (95% CI 0.36-0.97; I 2 =94.7) and pooled specificity was 0.78 (95% CI 0.56-0.90; I 2 =97.8). Overall calculated positive LR was 3.56 (95% CI 2.34-5.4) and negative LR was 0.26 (95% CI 0.07-1.01). The pooled diagnostic odds ratio was 13.5 (95% CI 4.8-38.5). Hierarchical SROC curve showed an area under the curve of 0.84 (95% CI 0.81-0.87) (Figure 1). Conclusions: Our analysis showed moderate sensitivity and specificity of exercise-induced aVR ST-elevation for diagnosing significant LM or pLAD disease. The heterogeneity among studies was high, likely due to differences in patient selection. In conclusion, ST-elevation in aVR during exercise stress test increases the likelihood of having LM or pLAD disease. Large studies are needed to substantiate this finding.

scholarly journals Does Cardiac Exercise Stress Testing Still Exist?

2018 ◽  
Vol 1 (3) ◽  
pp. 116-121
Author(s):  
Abuosa Ahmed ◽  
◽  
AlRahimi Jamilah ◽  
Almouaalamy Nabil ◽  
◽  
...  
Keyword(s):  
Stress Testing ◽  
Low Cost ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Treadmill Testing ◽  
Testing Practice ◽  
Exercise Treadmill ◽  
Exercise Treadmill Testing

Exercise Treadmill Testing to identify CAD is now a widely available and relatively low-cost examination that has been used for more than 60 years. The use of the ETT has expanded to include testing for functional capacity, chronotropic incompetence, assess the effects of therapy and also useful for risk stratification of patients with known CAD. The test sensitivity ranges from 61% to 73%, as reported by various analysts, and Specificity ranges from 59% to 81%, depending on the study or article referenced. Due to the various criteria set for the exercise stress test interpretation and reporting, we have outlined the criteria needed to support high quality exercise stress testing practice throughout Health facilities.

Respiratory arrest after treadmill exercise stress testing

1984 ◽  
Vol 75 (5) ◽  
pp. 241-248
Author(s):  
Ibrahim Jawad ◽  
Vithal Kinhal ◽  
Harisios Boudoulas
Keyword(s):  
Stress Testing ◽  
Treadmill Exercise ◽  
Respiratory Arrest ◽  
Exercise Stress ◽  
Exercise Stress Testing
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