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

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.

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

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.

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

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
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.

Elevated Blood Pressure in a High School Football Player: Case Presentation and Discussion

1990 ◽  
Vol 2 (4) ◽  
pp. 384-394
Author(s):  
Ted A Kaplan
Keyword(s):  
High School ◽  
Blood Pressure ◽  
Cardiovascular Response ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Football Player ◽  
Exercise Stress ◽  
Peak Exercise ◽  
Elevated Systolic Blood Pressure ◽  
Graded Exercise

A case is presented of an adolescent high school athlete found to have mildly elevated systolic blood pressure (BP) at the preseason group physical examination. As part of the evaluation to clear him for participation, a graded exercise stress test was performed. The test revealed a systolic BP at peak exercise of 260 mm Hg. The rationale for hygienic and pharmacologic management of this situation is discussed, and the results of this process are detailed. This patient was finally treated with nifedipine after unacceptable results with lisinopril, pindolol, and nonpharmacological approaches. The graded exercise test can be a valuable part of the evaluation of a hypertensive athlete. Besides revealing the occasional dangerous superelevation of BP, the test results can reveal the individual’s cardiovascular response to stress. This can provide insight into the etiology of and prognosis for the patient’s problem. Follow-up testing should be done after any treatment is provided.

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

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.

Abstract W P158: Underutilization of Guideline-Concordant Cardiac Screening among Patients with Cerebrovascular Disease

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jason J Sico ◽  
Fitsum Baye ◽  
Laura E Myers ◽  
John Concato ◽  
Linda S Williams ◽  
...  
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Stress Testing ◽  
Cerebrovascular Event ◽  
Stroke Patients ◽  
Cardiac Stress ◽  
Cardiac Screening ◽  
History Of ◽  
Mild Stroke ◽  
Cardiac Stress Testing

Introduction: Guidelines recommend the use of cardiac stress testing to screen for occult coronary heart disease (CHD) among patients with TIA and ischemic stroke who have a ‘high risk’ Framingham Risk score (FRS). It is unclear whether TIA/stroke patients regularly receive guideline-concordant cardiac stress testing. Methods: Administrative data from a sample of 10,923 Veterans from admitted to Veterans Health Administration (VHA) facilities with a TIA or mild stroke in fiscal year 2011 were analyzed. Patients were excluded (n=6947) on the basis of a history of CHD, receipt of cardiac stress testing within 18-months prior to cerebrovascular event, patients who died within 90 days of discharge or were discharged to hospice, and those with missing/unknown race. A FRS was calculated for each patient based on: age, gender, race, systolic blood pressure, blood pressure treatment (yes/no), diabetes, smoking status (smoker/non-smoker), and cholesterol (total and high-density lipoprotein). Patients with an FRS ≥20 were classified as ‘high risk’ of having CHD. Administrative data were used to identify whether cardiac stress testing was performed within 6-months after the cerebrovascular event. Results: Of the 3976 TIA/mild stroke patients, 53.9% (2322) had FRS ≥ 20. A higher proportion of patients with FRS ≥ 20 that received cardiac screening were younger, white men with diabetes and without a history of cancer, compared with patients with a FRS ≥ 20 that did not receive testing. Cardiac stress testing was not performed more frequently for ‘high risk’ (4.5%; 104/2322) versus ‘low/intermediate risk’ (4.7%; 77/1654) FRS (OR = 0.96; CI 95 :071-1.30). Conclusions: Guideline concordant cardiac screening is underutilized among patients with TIA and minor ischemic stroke. Additional research is required to: 1) better understand clinicians’ understanding of and approach to cardiac screening for patients with cerebrovascular disease at high risk for CHD; and 2) determine whether cardiac screening improves post-TIA/stroke outcomes.

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

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260718
Author(s):  
Kelsey Anderson ◽  
Chirag Bavishi ◽  
Dhaval Kolte ◽  
Reginald Gohh ◽  
James A. Arrighi ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Stress Testing ◽  
Stress Test ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Stress ◽  
Cardiac Stress Testing ◽  
Artery Disease ◽  
Test Result

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.

Abstract 200: Adherence to Guidelines: Are Ischemic Stroke Patients Receiving Guideline-Concordant Cardiac Stress Testing?

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jason Sico ◽  
Laura J Myers ◽  
Linda S Williams ◽  
Dawn M Bravata
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
High Risk ◽  
Stress Testing ◽  
Fiscal Year ◽  
Health Administration ◽  
Cardiac Events ◽  
Stroke Patients ◽  
Cardiac Stress ◽  
Cardiac Stress Testing

Introduction: Current guidelines recommend screening for coronary heart disease (CHD) using cardiac stress testing for ischemic stroke patients at ‘high risk’ of future cardiac events. However, it is unknown whether high risk stroke patients routinely receive guideline concordant cardiac stress testing. Methods: Medical records were abstracted for a sample of 3965 Veterans from 131 Veterans Health Administration (VHA) facilities who were admitted for a confirmed diagnosis of ischemic stroke (fiscal year 2007). Patients with a history of CHD, receipt of cardiac stress testing within 18-months prior to stroke event, and patients who died during the index hospitalization were excluded (n=1628). Framingham Risk Scores (FRS) were calculated on the basis of: age, gender, systolic blood pressure, blood pressure treatment (yes/no), smoking status (smoker/non-smoker), diabetes, total cholesterol, and high-density lipoprotein cholesterol. FRS ≥20 was used to define patients at “high-risk” of CHD. Administrative data were used to determine whether or not cardiac stress testing was performed within 6-months following discharge from the index stroke hospitalization. Logistic regression was used to assess whether cardiac stress testing was performed more frequently among high risk stroke patients. Results: Among 2337 stroke patients, 28% (n=664) had FRS≥20, and a total of 6% (n=140) had cardiac stress testing within 6-months of discharge. Cardiac stress testing was not more frequently performed among those with ‘high risk’ (5.6%) than those with ‘low risk’ (6.2%) FRS. High risk patients (FRS ≥20) were as likely to have received cardiac stress testing as those with low FRS (OR = 0.90; CI95: 0.61-1.32). Conclusions: Guideline concordant cardiac screening is underutilized among ischemic stroke patients without evidence of previous cardiac stress testing. Patients at the highest risk of future cardiac events were not more likely to receive cardiac stress testing than patients with lower risk. Additional research is required to identify potential barriers to CHD screening, and to determine whether outcomes are improved among patients who received CHD screening.

Abstract 12972: Reduction of Unnecessary Radiation Exposure for Cardiovascular Patients by Adoption of a Stress-First Protocol for Nuclear-Based Cardiac Stress Testing

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Robert J Russo ◽  
Jordan Allem ◽  
Heather S Costa ◽  
Patricia D Silva
Keyword(s):  
Radiation Exposure ◽  
Stress Testing ◽  
Stress Test ◽  
Total Radiation ◽  
Stress Tests ◽  
Cardiac Stress ◽  
Cardiovascular Patients ◽  
Cardiac Stress Testing ◽  
Nuclear Stress Testing ◽  
Unnecessary Radiation

Background: In 2010, the FDA issued the Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging. The purpose of this study was to determine the total radiation exposure for cardiovascular patients and the relative contribution of nuclear-based cardiac stress testing. Method: The electronic medical record was reviewed to identify all patients who underwent cardiac stress testing in 1 institution over a 10-year period. The type and number of all radiation-based diagnostic tests were identified, and a hospital-determined or published radiation dose was used to calculate each patient’s gender-specific total annualized radiation exposure expressed in mSv. Therapeutic radiation-based procedures were excluded. Results: Between 2003 and 2012, a total of 50,737 patients underwent 88,108 stress tests, 501,239 diagnostic radiology exams, and 17,194 diagnostic coronary angiograms, with 177,957 patient years of follow-up. Mean age at first stress test was 60±14 years, 56% of the patients were men, and the total number of stress tests per patient was 1.8±1.4 (range 1-18). When patients undergoing a nuclear-based stress test (PET-Rb/SPECT) at any time were compared to those who never had a nuclear-based stress test, 0.8±0.6 vs 0.7±0.4 total stress tests/year were performed, respectively (p<.001), with a total radiation exposure (including stress tests, all radiology exams, and diagnostic coronary angiography) of 16.2±18.5 vs. 6.0±15.5 mSv/patient-year (p<.001), and an aggregate total radiation exposure from diagnostic angiography of 16 vs. 11%. For patients undergoing a nuclear-based stress test at any time, the total aggregate radiation exposure from nuclear stress testing was 37% (for both men and women). If a stress-first/stress-only protocol was adopted, which would decrease isotope exposure by 75% as a result of administering only a single dose of isotope, using an institutional normal test rate of 57% over the study period, the aggregate radiation exposure from radiation-based testing dropped to 25% for the group. Conclusion: Adoption of a stress-first/stress-only protocol for nuclear-based cardiac stress tests results in a significant reduction in unnecessary radiation exposure for patients undergoing cardiac stress testing.

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