Transesophageal echocardiography: a new window on the heart and great vessels

TEE adds an exciting new dimension to the field of echocardiography. It has expanded the physician's ability to clearly examine cardiac structures and bloodflow; in many instances it has been the means by which rapid and lifesaving diagnoses have been made. The nurse collaborates with the physician during TEE by ensuring adequate preparation, remaining at the patient's bedside to assist with and monitor the effects of probe insertion and ensuring close observation and postprocedural follow up. The complication rate for TEE is negligible. Possibilities include routine pediatric use, biplane imaging and incorporation with exercise stress testing.

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Usefulness of Exercise Stress Testing for Prediction of Blood Pressure Trends

PEDIATRICS ◽

10.1542/peds.75.6.1071 ◽

1985 ◽

Vol 75 (6) ◽

pp. 1071-1075

Author(s):

David E. Fixler ◽

W. Pennock Laird ◽

Kent Dana

Keyword(s):

Blood Pressure ◽

Stress Testing ◽

Isometric Exercise ◽

Systolic Pressure ◽

Exercise Stress ◽

Female Adolescents ◽

Exercise Stress Testing ◽

Stress Tests ◽

Blood Pressures

The purpose of this study was to determine whether values of blood pressure during exercise help predict which adolescents are prone to maintain high blood pressure. Dynamic and isometric exercise stress tests were performed on 131 adolescents who had had systolic or diastolic pressures greater than the 95th percentile on three examinations the previous year. Follow-up blood pressures were measured 1 year after the stress testing, and outcomes were classified on the basis of the blood pressure status that year. Stepwise regression analysis was used to examine the association between earlier blood pressures and exercise pressures with outcome pressures. In both male and female adolescents, the average resting systolic pressure on the earlier survey was the best predictor of systolic pressure 2 years later. Blood pressures and heart rates during dynamic and isometric exercise did not significantly contribute to the models' prediction of future systolic or diastolic pressures. The data suggest that exercise stress testing is not a valid method for predicting youths whose blood pressures will remain elevated over the next 1 to 2 years.

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

CJEM ◽

10.1017/s1481803500015463 ◽

2007 ◽

Vol 9 (06) ◽

pp. 435-440 ◽

Cited By ~ 24

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.

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Gender differences in exercise stress testing protocol selection, exercise capacity, and prognostic value of METs

European Heart Journal ◽

10.1093/ehjci/ehaa946.3081 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Harb ◽

T.W Wang ◽

Y.W Wu ◽

M.V Menon ◽

L.C Cho ◽

...

Keyword(s):

Gender Differences ◽

Exercise Capacity ◽

Prognostic Value ◽

Stress Testing ◽

Exercise Stress ◽

Exercise Stress Testing ◽

Metabolic Equivalents ◽

Testing Protocols ◽

Gender Specific

Abstract Background Exercise capacity, as measured by metabolic equivalents of task [METs], varies with gender and is an independent predictor of mortality. We sought to investigate gender differences in the protocol selected, the estimated exercise capacity, and the prognostic value of METs. Purpose Investigate the gender differences in the protocol chosen (adjusting for age and comorbidities), the METs achieved (also adjusting for the protocol selected), and the predictive value of exercise capacity adjusted to METs achieved. Methods In a 25-year stress testing registry spanning from 1991 to 2015, we identified 120,705 patients who underwent exercise stress testing. Protocols were split into Bruce vs. non-Bruce. METs were estimated based on established gender-specific formulas (the St James Take Heart Project formula for women, and the Veterans Affairs cohort formula for men).The primary outcome was all-cause mortality. Results The mean age was 53.3±12.5 years, and 59% were male. Table 1 presents the baseline characteristics and exercise parameters. A total of 8426 death occurred over 8.7 years of mean follow-up duration. Females were more commonly referred for non-Bruce protocols [adjusted OR 2.6; 95% CI (2.5–2.7)] even after adjusting for age and comorbidities. Within the same protocol chosen, females achieved lower estimated METs [Beta −1.4; 95% CI (−1.43 to −1.37)]. Exercise capacity was inversely related to mortality in both genders and across protocols (figure 1), however, after adjusting for age, comorbidities, protocol chosen, and the number of METs achieved, the HR for death was significantly lower for women [adjusted HR=0.44; 95% CI (0.41–0.46)]. Conclusion After adjusting for age and comorbidities, women tend to be more commonly referred for non-Bruce protocols, achieve less estimated METs (after adjusting for the protocol chosen), and have half the mortality for the same METs achieved. Death vs. Exercise capacity by gender Funding Acknowledgement Type of funding source: None

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