Abstract P442: Apparently Healthy Fit Asymptomatic Adults Are Not Immune To Sub-clinical Atherosclerosis

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Robert Scales ◽  
Kathryn A Cornella ◽  
Mohan Vardhini ◽  
Cengiz Akalan ◽  
Qing Wu ◽  
...  
Keyword(s):  
Stress Test ◽  
Exercise Stress Test ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Exercise Stress ◽  
Prior History ◽  
Carotid Artery Plaque ◽  
History Of ◽  
And Gender ◽  
Apparently Healthy

Evidence suggests that cardiovascular (CV) fitness below the 20 th percentile for age and gender is associated with increased cardiac death and all cause mortality. This study assessed the association between CV fitness and sub-clinical atherosclerosis (SCA) in a self-selected group of participants in a cardiology-based prevention program. The study involved a single visit observation of participants. 240 apparently healthy asymptomatic adults <65 years (69% male) received a maximal graded exercise stress test and a carotid intima-media thickness (CIMT) evaluation with B-mode ultrasound. CV fitness was classified based on age-gender norms (very poor=1-19 th , poor=20-39 th , fair=40-59 th , good=60-79 th , excellent/superior=80-100 th percentile). CIMT was used to define CV health based on age-gender-race norms. SCA was considered present when there was non-occlusive carotid artery plaque (>1.5mm and >50% of the surrounding intima-media) or CIMT >75 th percentile. Anyone with a prior history of clinically apparent atherosclerosis or diabetes was excluded from the study. The mean age of participants was 50 yrs (SD= 8.7). 113 participants (47%) had excellent/superior CV fitness. 41 (17%) were classified good, 36 (15%) fair, 20 (8%) poor and 30 (12%) very poor. 69 (61%) participants with excellent/superior CV fitness had advanced atherosclerosis (plaque=43%; n=49 or CIMT >75 th percentile=l7%; n=20). In the good classification there were 26 (64%) with plaque (49%; n=20) or CIMT >75 th percentile (15%; n=6). There were 23 (63%) in the fair classification with plaque (44%; n=16) or CIMT >75 th percentile (19%; n=7), 11 (55%) in the poor classification with plaque (45%; n=9) or CIMT >75 th percentile (10%; n=2) and 17 (56%) in the very poor classification with plaque (53%; n=16) or CIMT >75 th percentile (3%; n=1). 58 (24%) of the total number of participants were classified with superior CV fitness (95-100 th percentile); of which 36 (62%) had SCA (plaque=45%; n=26 or CIMT >75 th percentile=17%; n=10). In this self-selected population, CIMT testing detected evidence of SCA across all age-gender fitness classifications, which included very fit individuals. Further investigation is needed to identify other factors that may be associated with increased CV risk in apparently healthy fit asymptomatic adults.

P6259Unfavourable vascular risk profile of smokers with testosterone deficiency

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Ioakeimidis ◽  
C Vlachopoulos ◽  
C Georgakopoulos ◽  
A Angelis ◽  
D Terentes-Printzios ◽  
...  
Keyword(s):  
Cigarette Smoking ◽  
Vascular Function ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Exercise Stress ◽  
Total Testosterone ◽  
Testosterone Deficiency ◽  
Smoking Intensity

Abstract Purpose Testosterone deficiency and cigarette smoking are both associated with increased cardiovascular (CV) mortality risk. We examined whether vascular function and structure parameters are significantly impaired in smokers with low testosterone levels. Methods Carotid intima media thickness (cIMT) and aortic pulse wave velocity (aPWV) were measured in a total of 690 patients (mean 58±7 yrs) without manifest CV/atherosclerotic disease. All patients underwent exercise stress test (and coronary angiography) to reveal coronary artery disease (CAD). Plasma total testosterone (TT) levels were measured in all patients. Results Participants were divided into four subgroups according to smoking (yes/no) and measured low or normal TT levels (low TT<3.5 ng/ml). The subgroups had similar prevalence of hypertension and smoking and comparable LDL-C levels. The mean age of patients with low TT was greater than that of subjects with normal TT (P<0.05). Aortic PWV was significantly higher in smokers with low TT compared to smokers with normal TT (P=0.01) and non-smokers with either low TT (P=0.005) or normal TT (P<0.001) (left plot). Similarly, cIMT was significantly higher in smokers with low TT compared to smokers with normal TT (P=0.01) and non-smokers with either low TT (P=0.005) or normal TT (P<0.001) (right plot). All associations remained statistically significant after adjustment for age. Among smokers with low TT both aPWV and cIMT significantly increased with increasing cigarette smoking intensity (all P<0.05), whereas the associations between smoking intensity and either aPWV or cIMT were not significant among smokers with normal TT concentration (all P=NS). Interestingly, the prevalence of angiographically documented CAD was significantly higher among smokers with low TT (18%) compared to the CAD prevalence of the three other subgroups (overall P<0.001). TT level, smoking and vascular profile Conclusions Carotid IMT and aortic PWV are significantly increased and the prevalence of angiographically documented CAD is greater in smokers with testosterone deficiency. Further studies should be conducted to evaluate how much of the unfavorable effect of both cigarette smoking and testosterone deficiency on coronary atherosclerotic burden is mediated by their associations with function and structure changes in the vascular wall.

scholarly journals CAC: An Under-Utilized Tool for Screening of ASCVD in Diabetes

2020 ◽  
pp. 1-6
Author(s):  
Dharmendra Panchal ◽  
Dharmendra Panchal ◽  
Sanjeev Phatak ◽  
Banshi Saboo ◽  
Rutul Goklani ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Financial Burden ◽  
Stress Test ◽  
Ankle Brachial Index ◽  
Nuclear Imaging ◽  
Calcium Score ◽  
Exercise Stress Test ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Exercise Stress

Diabetes Mellitus is the silent killer of the 21st century affecting 425 million people all over the world. The situation is worse in south east Asia particularly India where the prevalence is increasing at a rapid pace. The overall prevalence of diabetes in all 15 states of India was 7.3%. Coronary artery disease (CAD) contributes the highest in morbidity, mortality and financial burden of diabetes. Observational studies and RCTs report the prevalence of silent myocardial ischaemia in asymptomatic DM as 22%. There are many ways to estimate cardiovascular risk in asymptomatic diabetes people like clinical risk score, various biomarkers and other modalities like exercise stress test, echocardiography, Ankle Brachial Index (ABI), Carotid Intima Media Thickness (CIMT), Coronary Artery Calcium Score (CAC), CT angiography, Cardiac MRI, Nuclear Imaging etc. In this article we tried to review various modalities and their usefulness in screening asymptomatic ASCVD. Out of all available modalities CAC score is found to be very cost effectiveness and sensitive way to predict ASCVD. Still CAC is an underutilized modality to screen asymptomatic ASCVD in diabetes people.

scholarly journals Chest Pain and Exercise Induced Ischemia with Angiographically Insignificant Coronary Arterial Disease: Clinical Presentation and Follow-Up

1970 ◽  
Vol 6 (1) ◽  
pp. 27-31
Author(s):  
Md Khurshed Ahmed ◽  
Mohammad Salman ◽  
Md Ashraf Uddin Sultan ◽  
Md Abu Siddique ◽  
KMHS Sirajul Haque ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Chest Pain ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Coronary Angiogram ◽  
Ecg Changes ◽  
History Of

Angiography of patients with typical chest pain reveals normal epicardial coronary arteries in about 15-20%. ECG changes suggestive of myocardial ischemia during exercise also can be demonstrated in this subset of the patients. Total 58 patients (42 females) with mean age 42±7 years who were undergoing coronary angiogram in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2005 to December 2009 were evaluated. The patients were recruited on the basis of presence of history of chest pain, with normal resting ECG and ischemia like ECG changes during exercise stress test. 32.8% patients had hypertension and 15.5% were diabetics, 19.0% had dyslipidemia and 6.9% had family history of ischemic heart disease. All the patients were having positive exercise stress test. Angiographic findings showed luminal irregularities in 29.3% patients, 15.5% patients had luminal stenosis less than 30% and rest had normal coronary angiogram. Follow up of the patients after one and six months of angiogram was done. After one month 63.8% patients remained symptomatic and after six months 63.3% patients remained symptomatic despite maximum medical management. The pathophysiology and appropriate management of this subset of the patients still remained a challenge for physicians. Optimum management of cardiovascular risk factors is very important issue in this group of patients.Key words: Angiography; Epicardial coronary arteries; Exercise stress test; Cardiovascular risk factors. DOI: 10.3329/uhj.v6i1.7187University Heart Journal Vol.6(1) 2010 pp.27-31

Bizarre electrocardiographic changes during occlusion of a congenital coronary arteriovenous fistula

2012 ◽  
Vol 23 (2) ◽  
pp. 295-298 ◽  
Author(s):  
Ramazan Akdemir ◽  
Ekrem Yeter ◽  
Harun Kilic ◽  
Murat Yucel
Keyword(s):  
Chest Pain ◽  
Arteriovenous Fistula ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Exercise Stress ◽  
Coronary Arteriovenous Fistula ◽  
St Segment ◽  
History Of ◽  
Electrocardiographic Changes ◽  
Electrocardiographic Recordings

AbstractA 38-year-old man who had a history of percutaneous coronary artery coil occlusion was admitted to our hospital with chest pain and shortness of breath. His complaint was chest pain, which is typical. ST depressions were observed during the treadmill exercise stress test. Coronary angiography demonstrated the persistence of a coronary arteriovenous fistula and coils in the fistula. Primarily, additional coil placement inside the arteriovenous fistula was decided as the mode of treatment. The coil was first placed inside the arteriovenous fistula and then an attempt was made to detach it. However, it was unsuccessful after four trials and electrical detachment of more than 3 minutes. Finally, a 2.5 × 18-millimetre graft stent was deployed at 20 atmospheric pressure. Electrocardiographic recordings showed bizarre ST segment changes during the electrical detachment of the coil. In this report, we discuss the concealed bizarre electrocardiographic changes that were seen during coronary arteriovenous fistula occlusion.

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.

scholarly journals Dizziness in an avid cyclist: an unusual presentation of a common problem

2021 ◽  
Vol 5 (12) ◽  
Author(s):  
Aish Sinha ◽  
Ozan M Demir ◽  
Howard Ellis ◽  
Divaka Perera
Keyword(s):  
Stress Test ◽  
Obstructive Coronary Artery Disease ◽  
Exercise Stress Test ◽  
Coronary Intervention ◽  
Exercise Stress ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Wide Range ◽  
Artery Disease ◽  
And Gender

Abstract Background Presyncope and syncope are common presentations with a wide range of differential diagnoses; when it occurs primarily on exertion, a cardiovascular cause is more likely. Structural abnormalities and primary rhythm disturbances are the usual culprits in these patients. Case summary A 75-year-old gentleman presented with a history of progressive exertional presyncope. His investigations demonstrated normal cardiac structure, function, and rhythm. He underwent an exercise stress test, which demonstrated a significant reduction in peak blood pressure with equivocal electrocardiogram changes and absence of ischaemic symptoms. In view of his age and gender, a computerized tomography coronary angiogram (CTCA) was organized to exclude obstructive coronary artery disease (CAD). Intriguingly, the CTCA demonstrated a severe proximal left anterior descending (LAD) artery stenosis. This stenosis was confirmed to be functionally significant using invasive coronary physiology and was treated with percutaneous coronary intervention. At follow-up, there was no recurrence of exertional presyncope and the patient was continuing to return to his baseline function. Conclusion Presyncope and/or syncope as the sole manifestation of obstructive CAD, in the presence of normal ventricular function and valves, has rarely been reported. Myocardial ischaemia-mediated presyncope and/or syncope may be secondary to numerous mechanisms, which are described in this case report. Revascularization of the functionally significant proximal LAD stenosis resulted in cessation of exertional presyncope in our patient. The long-term outcome of revascularization in patients with presyncope and syncope needs to be further investigated.

scholarly journals Cardiac Rehabilitation and Physical Performance in Patients after Myocardial Infarction: Preliminary Research

2021 ◽  
Vol 10 (11) ◽  
pp. 2253
Author(s):  
Agnieszka Grochulska ◽  
Sebastian Glowinski ◽  
Aleksandra Bryndal
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
Physical Performance ◽  
Stress Test ◽  
Maximal Oxygen Consumption ◽  
Exercise Stress Test ◽  
Health Condition ◽  
Exercise Stress ◽  
Test Time ◽  
Before And After

(1) Background: Cardiovascular diseases, in particular, myocardial infarction (MI), are the main threats to human health in modern times. Cardiac rehabilitation (CR), and especially increased physical activity, significantly prevent the consequences of MI. The aim of this study was to assess physical performance in patients after MI before and after CR. (2) Methods: 126 patients after MI were examined. They were admitted to the cardiac rehabilitation ward twice: in the 3rd month after MI, and then in the 6th month after the last rehabilitation session. CR lasted 20 treatment days (4 weeks with 5 treatment days and 2 days’ break). The exercise stress test on the treadmill and a 6-minute walk test (6MWT) were used to assess physical performance. Patients were assigned to an appropriate rehabilitation model due to their health condition. (3) Results: In the studied group, the exercise stress test time and the metabolic equivalent of task (MET), the maximal oxygen consumption (VO2max), and 6MWT score increased significantly (p = 0.0001) at two time-points of observation. (4) Conclusion: CR significantly improves physical performance in patients after MI.

scholarly journals P1398 Echocardiographic continuous monitoring of exercise stress test using probe fixation device

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
K Wdowiak-Okrojek ◽  
P Wejner-Mik ◽  
Z Bednarkiewicz ◽  
P Lipiec ◽  
J D Kasprzak
Keyword(s):  
Image Quality ◽  
Physical Exercise ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Bicycle Ergometer ◽  
Exercise Stress ◽  
Fixation Device ◽  
The Mean ◽  
First Time

Abstract Background Stress echocardiography (SE) plays an important role among methods of noninvasive diagnosis of ischemic disease. Despite the advantages of physical exercise as the most physiologic stressor, it is difficult (bicycle ergometer) or impossible (treadmill) to obtain and maintain the acoustic window during the exercise. Recently, an innovative probe fixation device was introduced and a research plan was developed to assess the feasibility of external probe fixation during exercise echocardiography on a supine bicycle and upright treadmill exercise for the first time. Methods 37 subjects (36 men, mean age 39 ± 16 years, 21 healthy volunteers, 16 patients with suspected coronary artery disease) were included in this study. This preliminary testing stage included mostly men due to more problematic probe fixation in women. All subjects underwent a submaximal exercise stress test on a treadmill (17/37) or bicycle ergometer (11/37). Both sector and matrix probes were used. We assessed semi-quantitatively the quality of acquired apical views at each stage – the four-point grading system was used (0-no view, 1-suboptimal quality, 2-optimal quality, 3-very good quality), 2-3 sufficient for diagnosis. Results The mean time required for careful positioning of the probe and image optimization was 12 ± 3 min and shortened from 13,7 to 11,1 minutes (mean) in first vs second half of the cohort documenting learning curve. At baseline, 9 patients had at least one apical view of quality precluding reliable analysis. Those patients were excluded from further assessment. During stress, 17 patients maintained the optimal or very good quality of all apical views, whereas in 11 patients the quality significantly decreased during the stress test and required probe repositioning. The mean image quality score at baseline was 2,61 ± 0,48 and 2,25 ± 0,6 after exercise. Expectedly, good image quality was easier to obtain and maintain in the supine position (score 2,74 ± 0,44) points as compared with upright position (score 2,25 ± 0,57). Conclusion This preliminary, unique experience with external probe fixation device indicates that continuous acquisition and monitoring of echocardiographic images is feasible during physical exercise, and for the first time ever - also on the treadmill. This feasibility data stem from almost exclusively male patients and the estimated rate of sufficient image quality throughout the entire test is currently around 60%. We are hoping, that gaining more experience with the product could increase the success rate on exercise tests. Abstract P1398 Figure. Treadmill and ergometer stress test

Sign in / Sign up

Export Citation Format

Share Document