Relation of abnormal cardiac stress testing with outcomes in patients undergoing renal transplantation

Cardiovascular risk stratification is often performed in patients considered for renal transplantation. In a single center, we sought to examine the association between abnormal stress testing with imaging and post-renal transplant major adverse cardiovascular events (MACE) using multivariable logistic regression. From January 2006 to May 2016 232 patients underwent renal transplantation and 59 (25%) had an abnormal stress test result. Compared to patients with a normal stress test, patients with an abnormal stress test had a higher prevalence of dyslipidemia, diabetes mellitus, obesity, coronary artery disease (CAD), and heart failure. Among those with an abnormal result, 45 (76%) had mild, 10 (17%) moderate, and 4 (7%) severe ischemia. In our cohort, 9 patients (3.9%) had MACE at 30-days post-transplant, 5 of whom had an abnormal stress test. The long-term MACE rate, at a median of 5 years, was 32%. After adjustment, diabetes (OR 2.37, 95% CI 1.12–5.00, p = 0.02), CAD (OR: 3.05, 95% CI 1.30–7.14, p = 0.01) and atrial fibrillation (OR: 5.86, 95% CI 1.86–18.44, p = 0.002) were independently associated with long-term MACE, but an abnormal stress test was not (OR: 0.83, 95% CI 0.37–1.92, p = 0.68). In conclusion, cardiac stress testing was not an independent predictor of long-term MACE among patients undergoing renal transplant.

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Comparison of Preoperative Assessment of Patient’s Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing

Anesthesiology Research and Practice ◽

10.1155/2018/5912726 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Adam S. Weinstein ◽

Martin I. Sigurdsson ◽

Angela M. Bader

Keyword(s):

Cardiac Failure ◽

Stress Testing ◽

Stress Test ◽

Preoperative Evaluation ◽

Preoperative Assessment ◽

Exercise Stress ◽

Cardiac Stress ◽

Metabolic Equivalents ◽

Cardiac Stress Testing ◽

Cardiac Stress Test

Background. Preoperative anesthetic evaluations of patients before surgery traditionally involves assessment of a patient’s functional capacity to estimate perioperative risk of cardiovascular complications and need for further workup. This is typically done by inquiring about the patient’s physical activity, with the goal of providing an estimate of the metabolic equivalents (METs) that the patient can perform without signs of myocardial ischemia or cardiac failure. We sought to compare estimates of patients’ METs between preoperative assessment by medical history with quantified assessment of METs via the exercise cardiac stress test. Methods. A single-center retrospective chart review from 12/1/2005 to 5/31/2015 was performed on 492 patients who had preoperative evaluations with a cardiac stress test ordered by a perioperative anesthesiologist. Of those, a total of 170 charts were identified as having a preoperative evaluation note and an exercise cardiac stress test. The METs of the patient estimated by history and the METs quantified by the exercise cardiac stress test were compared using a Bland–Altman plot and Cohen’s kappa. Results. Exercise cardiac stress test quantified METs were on average 3.3 METS higher than the METs estimated by the preoperative evaluation history. Only 9% of patients had lower METs quantified by the cardiac stress test than by history. Conclusions. The METs of a patient estimated by preoperative history often underestimates the METs measured by exercise stress testing. This demonstrates that the preoperative assessments of patients’ METs are often conservative which errs on the side of patient safety as it lowers the threshold for deciding to order further cardiac stress testing for screening for ischemia or cardiac failure.

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Blood pressure and risk of cognitive impairment. The role of vascular disease in neurodegeneration.

10.21203/rs.2.18666/v1 ◽

2019 ◽

Author(s):

Mar Carmona-Abellan ◽

Malwina Trzeciak ◽

Miriam Recio-Fernandez ◽

Beatriz Echeveste ◽

Laura Imaz ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Stress Testing ◽

Cardiovascular Response ◽

Stress Test ◽

Peak Exercise ◽

Cardiac Stress ◽

Cardiac Stress Testing

Abstract Background: Both cerebral vascular disorders and cognitive decline increase in incidence with age. The role of cerebral vascular disease and hemodynamic changes in the development of cognitive deficits is controversial. The objective of this study was to assess cardiovascular response during cardiac stress testing in neurologically asymptomatic individuals who developed cognitive impairment several years after the cardiac stress testing.Methods: This is a retrospective cohort study of patients who underwent cardiac stress testing between January 2001 and December 2010. Patients were followed up until May 2015 and we selected those who developed cognitive dysfunction including dementia, mild cognitive impairment and subjective cognitive decline, after the stress test. Heart rate and blood pressure both at rest and at peak exercise and the mean R-R interval at rest were recorded. For each patient who developed cognitive impairment, we selected one matched control who did not show cognitive decline by the end of the follow-up period.Results: From this cohort of 7224 patients, 371 developed cognitive impairment; of these, 186 (124 men) met the inclusion criteria and 186 of the other patients were selected as matched controls. During follow-up, cognitive impairment appeared 6.2 ± 4.7 years after the cardiac stress test. These patients who subsequently developed cognitive impairment had significantly lower at-rest systolic, diastolic and mean blood pressure than controls (p<0.05). Further, compared with controls, their maximum heart rate was significantly higher at peak exercise and both systolic and diastolic blood pressures increased significantly more during exercise. Conclusion: The results from this study suggest that differences in cardiovascular response to stress are present in the preclinical phase of cognitive decline, serving as a potential risk factor for cognitive impairment. These findings challenge the potential use of blood pressure and heart rate variability at rest and during cardiac stress assessment as a risk factor for cognitive impairment.

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Surviving a stressful MIBI scan

CJEM ◽

10.2310/8000.2013.130997 ◽

2013 ◽

Vol 15 (06) ◽

pp. 392-396 ◽

Cited By ~ 1

Author(s):

Robert Gooch ◽

Lisa Bryski ◽

Ewa Courvoisier-Grzywacz

Keyword(s):

Coronary Artery Disease ◽

Stress Testing ◽

Stress Test ◽

Pharmacologic Stress ◽

Test Laboratory ◽

Cardiac Monitoring ◽

Emergency Physicians ◽

Hemodynamic Stability ◽

Cardiac Stress ◽

Artery Disease

ABSTRACTDipyridamole/technetium sestamibi scans (more commonly known as MIBI scans, an acronym for methoxyisobutyl isonitrile) are used commonly for the diagnosis and risk stratification of coronary artery disease. Adverse events from MIBI scans are extremely rare. We present the case of a 64-year-old man who was successfully resuscitated after two asystolic episodes following dipyridamole infusion for a MIBI scan. The second asystolic episode occurred in the emergency department 40 minutes after the patient had been transferred from the Cardiac Stress Test Laboratory. To our knowledge, there are no previous reports of patients having two discrete asystolic episodes or an asystolic episode as delayed as we report after a MIBI scan. Our case illustrates why emergency physicians should be aware of the potential for asystole following MIBI scanning and why aminophylline, the antidote for dipyridamole, should be readily available in emergency departments that could see patients after pharmacologic stress testing. Patients who become asystolic following dipyridamole infusion likely require prolonged cardiac monitoring, given the potential for further episodes after periods of hemodynamic stability.

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

American Journal of Critical Care ◽

10.4037/ajcc1998.7.4.320 ◽

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.

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Abstract 126: Cardiac Stress Testing: Optimizing Outcomes Through Dual Physician-Patient Education

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.126 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Jelena Spyropoulos ◽

Catherine C Capparelli ◽

Deepak L Bhatt

Keyword(s):

Patient Education ◽

Stress Testing ◽

Stress Test ◽

Cardiac Stress ◽

Caregiver Education ◽

Coronary Arterial Disease ◽

Cardiac Stress Testing ◽

Physician Patient ◽

The Impact ◽

Post Assessment

Background: Even though cardiovascular (CV) tests, which are used to assess coronary arterial disease (CAD) are included in medical guidelines, cardiologists have limited ability to adequately perform appropriate testing modalities. In parallel, many patients have concerns or anxiety related to CV testing, and are not proactively educated on how to prepare for their procedure. Goals: To determine if an online parallel physician-patient education interventions could improve performance of cardiologists related to CV stress testing, and patient knowledge about the procedure. Methods: An online CME activity was developed as a 25-minute roundtable discussion with 3 leading experts on criteria for appropriate use of stress testing and preparing physicians to communicate the risks and benefits of testing modalities to their patients. The activity included a transcript of the discussion and a downloadable slide deck to reinforce key recommendations. Participant responses to questions were collected after the education (post-assessment) and compared with each user’s baseline data (pre-assessment) using a 2-tailed paired T-test to provide P values for assessing the impact of education. The CME activity also included a link to a patient/caregiver education module, developed in parallel to educate patients and their caregivers about cardiac stress testing. Patient/caregiver responses post-education compared to pre-education were also assessed to measure improvement in knowledge. Results: A total of 312 of cardiologists who participated in the CME activity and answered all pre- and post-assessment questions were included in the analysis. In addition, 3458 patients preparing for a stress test, 640 family members, 116 caregivers, and 3299 other participants interested in the topic of CV testing who completed the patient/caregiver education module and the pre- and post-education questions were included in the assessment. Post-education, significant improvements were observed (Table). Conclusion: This study demonstrated that both knowledge/competence of cardiologists on evidence-based practices as well as the understanding of patient/caregivers on CV testing can be improved using a dual approach to education.

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Coronary Artery Findings After Left-Sided Compared With Right-Sided Radiation Treatment for Early-Stage Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.08.6595 ◽

2007 ◽

Vol 25 (21) ◽

pp. 3031-3037 ◽

Cited By ~ 233

Author(s):

Candace R. Correa ◽

Harold I. Litt ◽

Wei-Ting Hwang ◽

Victor A. Ferrari ◽

Lawrence J. Solin ◽

...

Keyword(s):

Breast Cancer ◽

Coronary Artery ◽

Stress Testing ◽

Radiation Treatment ◽

Early Stage ◽

Breast Conservation ◽

Cardiac Stress ◽

Coronary Stenoses ◽

Cardiac Stress Testing ◽

Artery Disease

PurposeTo compare the incidence and distribution of coronary artery disease after left-sided versus right-sided irradiation in patients treated with breast conservation for early-stage breast cancer who subsequently underwent cardiac stress testing and/or catheterization for cardiovascular symptoms.Patients and MethodsThe medical records of 961 stage I-II breast cancer patients treated from 1977 to 1995 at the University of Pennsylvania with conventional tangential beam radiation treatment (RT) were screened for cardiac stress tests and catheterizations performed after RT. The results of these tests were analyzed by laterality of RT and compared with baseline cardiovascular risk.ResultsAt diagnosis, patients with left-sided and right-sided breast cancer had the same estimated 10-year risk (both 7%) of developing coronary artery disease. At a median time of 12 years post-RT (range, 2 to 24 years), 46 patients with left-sided and 36 patients with right-sided breast cancer (total, N = 82) had undergone cardiac stress testing. A statistically significant higher prevalence of stress test abnormalities was found among left (27 of 46; 59%) versus right-side irradiated patients (three of 36; 8%; P = .001). Furthermore, 19 of 27 of left-sided abnormalities (70%) were in the left anterior descending artery territory. Thirteen left-side irradiated patients also underwent cardiac catheterization revealing 12 of 13 with coronary stenoses (92%) and eight of 13 with coronary stenoses (62%) solely in the left anterior descending artery.ConclusionPatients treated with left-sided radiation as a component of breast conservation have an increased risk of late, radiation-associated coronary damage. Treatment with modern radiation techniques may reduce the risk of cardiac injury.

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Center-Related Variation in Cardiac Stress Testing in the 18 Months Prior to Renal Transplantation

JAMA Internal Medicine ◽

10.1001/jamainternmed.2019.0423 ◽

2019 ◽

Vol 179 (8) ◽

pp. 1135 ◽

Cited By ~ 2

Author(s):

Adam A. Shpigel ◽

Mohammed J. Saeed ◽

Eric Novak ◽

Tarek Alhamad ◽

Michael W. Rich ◽

...

Keyword(s):

Renal Transplantation ◽

Stress Testing ◽

Cardiac Stress ◽

Related Variation ◽

Cardiac Stress Testing

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Blood Pressure and Risk of Cognitive Impairment: The Role of Vascular Disease in Neurodegeneration

Brain Sciences ◽

10.3390/brainsci11030385 ◽

2021 ◽

Vol 11 (3) ◽

pp. 385

Author(s):

Mar Carmona-Abellan ◽

Malwina Trzeciak ◽

Miriam Recio Fernández ◽

Beatriz Echeveste ◽

Laura Imaz ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Stress Testing ◽

Cardiovascular Response ◽

Stress Test ◽

Peak Exercise ◽

Cardiac Stress ◽

Cardiac Stress Testing

(1) Background: Both cerebral vascular disorders and cognitive decline increase in incidence with age. The role of cerebral vascular disease and hemodynamic changes in the development of cognitive deficits is controversial. The objective of this study was to assess the cardiovascular response during cardiac stress testing in neurologically asymptomatic individuals who developed cognitive impairment several years after previous cardiac stress testing. (2) Methods: This was a retrospective cohort study of patients who underwent cardiac stress testing between January 2001 and December 2010. Patients were followed up until May 2015, and we selected those who developed cognitive dysfunction including dementia, mild cognitive impairment, and subjective cognitive decline, after the stress test. Heart rate and blood pressure both at rest and at peak exercise, and the mean R-R interval at rest were recorded. For each patient who developed cognitive impairment, we selected one matched control who did not show cognitive decline by the end of the follow-up period. (3) Results: From the cohort of 7224 patients, 371 developed cognitive impairment; of these, 186 (124 men) met the inclusion criteria, and 186 of the other patients were selected as matched controls. During follow-up, cognitive impairment appeared 6.2 ± 4.7 years after the cardiac stress test. These patients who had subsequently developed cognitive impairment had significantly lower at-rest systolic, diastolic, and mean blood pressure than controls (p < 0.05). Further, compared with controls, their maximum heart rate was significantly higher at peak exercise. (4) Conclusion: The results from this study suggest that differences in cardiovascular response to stress might be present in individuals who develop cognitive decline. These findings challenge the possibility of assessing blood pressure and heart rate variability at rest and during cardiac stress as potential risk factors associated with cognitive impairment.

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Absent or Mild Coronary Calcium Predicts Low-Risk Stress Test Results and Outcomes in Patients Considered for Flecainide Therapy

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/10742484211046671 ◽

2021 ◽

pp. 107424842110466

Author(s):

Jeffrey L. Anderson ◽

Stacey Knight ◽

Raymond O. McCubrey ◽

Heidi T. May ◽

Steve Mason ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Stress Testing ◽

Stress Test ◽

Clinical Information ◽

Major Adverse Cardiovascular Events ◽

Quantitative Ct ◽

Flow Reserve ◽

History Of ◽

Artery Disease

Background: Flecainide is a useful antiarrhythmic for atrial fibrillation (AF). However, because of ventricular proarrhythmia risk, a history of myocardial infarction (MI) or coronary artery disease (CAD) is a flecainide exclusion, and stress testing is used to exclude ischemia. We assessed whether absent/mild coronary artery calcium (CAC) can supplement or avoid the need for stress testing. Methods: We assessed ischemic burden using regadenoson Rb-82 PET/CT in 1372 AF patients ≥50 years old without symptoms or signs of clinical CAD. CAC was determined qualitatively by low dose attenuation computed tomography (CT) (n = 816) or by quantitative CT (n = 556). Ischemic burden and clinical outcomes were compared by CAC burden. Results: Patients with CAC absent or mild (n = 766, 57.2%) were younger, more frequently female, and had higher BMI but lower rates of diabetes, hypertension, and dyslipidemia. Average ischemic burden was lower in CAC-absent/mild patients, and CAC-absent/mild patients showed greater coronary flow reserve, had fewer referrals for coronary angiography, and less often had obstructive CAD. Revascularization at 90 days was lower, and the rate of longer-term major adverse cardiovascular events was favorable. Conclusions: An easily administered, inexpensive, low radiation CAC scan can identify a subset of flecainide candidates with a low ischemic burden on PET stress testing that rarely needs coronary angiography/intervention and has favorable outcomes. Absent or mild CAC-burden combined with other clinical information may avoid or complement routine stress testing. However, additional, ideally randomized and multicenter trials are indicated to confirm these findings before replacing stress testing with CAC screening in selecting patients for flecainide therapy in clinical practice.

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