Application of exercise ECG stress test in the current high cost modern-era healthcare system

Abstract

Exercise electrocardiogram (ECG) tests boasts of being more widely available, less resource intensive, lower cost and absence of radiation. In the presence of a normal baseline ECG, an exercise ECG test is able to generate a reliable and reproducible result almost comparable to Technitium–99 m sestamibi perfusion imaging. Exercise ECG changes when combined with other clinical parameters obtained during the test has the potential to allow effective redistribution of scarce resources by excluding low risk patients with significant accuracy. As we look towards a future of rising healthcare costs, increased prevalence of cardiovascular disease and the need for proper allocation of limited resources; exercise ECG test offers low cost, vital and reliable disease interpretation.This article highlights the physiology of the exercise ECG test, patient selection, effective interpretation, describe previously reported scores and their clinical application in today’s clinical practice.

The Brazilian Society of Cardiology and Brazilian Society of Exercise and Sports Medicine Updated Guidelines for Sports and Exercise Cardiology - 2019

“…Such alterations have higher values when occurring concomitantly with chest pain or other manifestations that contribute to a diagnosis of myocardial ischemia. 49 ST-segment elevation ≥ 1 mm at 60 ms after J-point, when not observed in a Q-wave area (inactive zone), is very suggestive of subepicardial (or transmural) injury, 50 indicates ischemia and must be managed as such.…”

A computational investigation into rate-dependant vectorcardiogram changes due to specific fibrosis patterns in non-ischæmic dilated cardiomyopathy

“…The main benefit of the methodology proposed here is to perform non-invasive VCG analysis; however, it also requires both slow and fast sinus rhythm pacing. Increases in sinus heart rate, up to approximately 180bpm, may be achieved clinically using exercise testing, which is a commonly-used provocative stress test performed to assess different aspects of cardiac function [54] , [55] , [56] . Alternatively, heart rate may be elevated to similar levels using pharmacological means.…”

Arrhythmia Detection Algorithm using GoogLeNet and Generative Adversarial Network with Lifelog Signals

“…There are various electrocardiographic methods applied to an arrhythmia diagnosis, including 24-h electrocardiography and an exercise electrocardiogram, although all of them are cumbersome and take a long time to record [12][13][14]. Such measurements are not optimized for an arrhythmia diagnosis, which requires periodic checks of the heart condition.…”