French Society of Cardiology guidelines on exercise tests (part 1): Methods and interpretation

Abstract

The exercise test is still a key examination in cardiology, used for the diagnosis of myocardial ischemia, as well as for the clinical evaluation of other heart diseases. The cardiopulmonary exercise test can further define functional capacity and prognosis for any given cardiac pathology. These new guidelines focus on methods, interpretation and indications for an exercise test or cardiopulmonary exercise test, as summarized below. The safety rules associated with the exercise test must be strictly observed. Interpretation of exercise tests and cardiopulmonary exercise tests must be multivariable. Functional capacity is a strong predictor of all-cause mortality and cardiovascular events. Chest pain, ST-segment changes and an abnormal ST/heart rate index constitute the first findings in favor of myocardial ischemia, mostly related to significant coronary artery disease. Chronotropic incompetence, abnormal heart rate recovery, QRS changes (such as enlargement or axial deviations) and the use of scores (based on the presence of various risk factors) must also be considered in exercise test interpretation for a coronary artery disease diagnosis. Arrhythmias or conduction disorders arising during the exercise test must be considered in the assessment of prognosis, in addition to a decrease or low increase in blood pressure during the exercise phase. When performing a cardiopulmonary exercise test, peak oxygen uptake and the volume of expired gas/carbon dioxide output slope are the two main variables used to evaluate prognosis.

Is Continuous ECG Recording on Heart Rate Monitors the Most Expected Function by Endurance Athletes, Coaches, and Doctors?

“…The trouble-free use of HRMs in everyday life makes them a candidate for use as professional equipment that requires special handling skills and professional knowledge for results interpretation (e.g., Holter ECG). It seems that it will only be a matter of time before HRMs will be able to record a 12-lead ECG with the possibility of assessing any ECG features, including the ST segment, which will be extremely important for the diagnosis of exercise ischemia in a classic exercise test [ 31 ]. Other data, such as measuring the QT interval or identifying the origin of ventricular beats, will become automatic information related to these recordings.…”

Case Report: When Exercise Went Wrong

“…Throughout the years, many international professional guidelines clearly stated the set-up requirement of exercise stress testing lab, indication and contraindication, termination criteria of EST in order to safeguard the patient [3,4,6]. Although EST remained as a safe procedure in both young and elderly patient, however, vigorous physical activity can also transiently and acutely increase the risk of sudden cardiac death and acute myocardial infarction in susceptible individuals [6,7].…”

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“…The trouble-free use of HRMs in everyday life makes them a candidate for use as professional equipment that requires special handling skills and professional knowledge for result interpretation (e.g., Holter ECG). It seems that it will only be a matter of time before HRMs will be able to record a 12-lead ECG with the possibility of assessing all ECG features, including the ST segment, which will be extremely important for the diagnosis of exercise ischaemia in a classic exercise test [27]. Other data, such as measuring the QT interval or identifying the origin of ventricular beats, will become automatic information related to these recordings.…”