Electrocardiographic exercise testing in adults: performance and interpretation. An expert opinion of the Polish Cardiac Society Working Group on Cardiac Rehabilitation and Exercise Physiology

Abstract

A b s t r a c tElectrocardiographic (ECG) exercise stress test has been a major diagnostic test in cardiology for several decades. Ongoing technological advances that have led to a wide use of imaging techniques and development of new guidelines have called for a revised and updated approach to the technique and interpretation of the ECG exercise testing. The present document outlines an expert opinion of the Polish Cardiac Society Working Group on Cardiac Rehabilitation and Exercise Physiology regarding the performance and interpretation of ECG exercise testing in adults. We discussed technical requirements and necessary equipment for the exercise testing laboratory as well as healthcare personnel competencies necessary to supervise ECG exercise testing and fully interpret test findings. Broad indications for ECG exercise testing include diagnostic assessment of coronary artery disease (CAD), including pre-test probability of CAD, evaluation of functional disease severity and risk stratification in patients with established CAD, assessment of response to treatment, evaluation of exercise-related symptoms and exercise capacity, patient evaluation before exercise training/cardiac rehabilitation, and risk stratification prior to non-cardiac surgery. ECG exercise testing is safe if indications and contraindications are observed, testing is appropriately monitored, and indications for test termination are clearly established. The exercise protocol should be adjusted to the expected exercise capacity of a patient so as to limit the duration of exercise to 8-12 min. Clinical, haemodynamic, and ECG response to exercise is evaluated during the test. The test report should include information about the exercise protocol used, reason for test termination, perceived exertion, presence/severity of anginal symptoms, peak exercise capacity or tolerated workload in relation to the predicted exercise capacity, heart rate response, and the presence or absence of ST-T changes. The test report should conclude with a summary including clinical and ECG assessment.

Application and optimization of the rate response function in dual-chamber pacemakers: Prospective, randomized, cross-over clinical trial study protocol

“…Furthermore, specific recommendations in the guidelines of the European Society of Cardiology on cardiac pacing and cardiac resynchronization therapy are limited [2,3]. Many studies rely on the electrocardiographic treadmill exercise test as an objective method of assessment of physical performance and progress in cardiac rehabilitation or for optimization of settings of implantable devices and cardiac [7,12,13]. Therefore, this study will deepen the research on the impact of the rate response function on physical performance in a homogeneous group of patients and will reveal which patients would benefit the most from rate-adapted pacing.…”

Maximising the Diagnostic Utility of the Exercise Treadmill Test

“…Multiple studies have found that this stratification is not often done by reque-sting doctors, resulting in many inappropriate ETTs and consequently, increased expenditure [4,5,9]. In order to minimize false negatives/positives, ETTs are recommended for individuals with an intermediate pretest probability [4,6,9,10]. It is not recommended that asymptomatic, very low or low risk patients be made to undergo this test [9].…”

“…The ETT is a useful, non-invasive test that is relatively cost effective [4,5]. Its use in diagnosis and prognostication requires that the test be done by a skilled individual [6] in order to maximise its rather low sensitivity of 67% [3,4]. Accurate interpretation is not solely dependent on ST segment changes during exercise, but other parameters like the presence of chest pain, heart rate at onset of symptoms (if any) and workload done at the end of the test [4,7,8].…”

Comprehensive cardiac rehabilitation as the keystone in the secondary prevention of cardiovascular disease

“…The exercise test is used to determine exercise intensity, exercise-related risk, as well as changes in exercise capacity after completing each phase of CR. It is also applied to determine workload for subsequent physical activity associated with work and leisure [16];…”