The diagnostic value of exercise stress testing for cardiovascular disease is more than just st segment changes: A review

Abstract

Purpose: The objectives of this review were to: (1) identify the acute cardiovascular responses to aerobic exercise used in an exercise stress test (EST), (2) identify when and how to best conduct an EST including the stopping point, (3) identify conditions that would preclude an EST, (4) define the limiting signs and symptoms associated with an EST (5), discuss what data are needed as part of an EST and how to interpret EST data. Methods:We identify the cardiovascular responses to an EST and when an EST should or should not be used. Finally we analyze the components of an EST and potential sensitivities, significances and predictability of the changes in the outcome data that will provide diagnosis overt cardiovascular disease, and for purposes of exercise prescription and evaluation of rehabilitation effects in cardiac patients.Results: Although most of the focus for performing an EST traditionally has been on the diagnostic value to identify ST-segment abnormalities, an EST provides other valuable diagnostic and prognostic data including maximal oxygen consumption (predicted or measured), exercise capacity and fatigability, blood pressure and heart rate responses to exercise and recovery. Conclusions:This review identifies the most recent standards, and guidelines of EST, which include the acute physiological response of the cardiovascular system to aerobic exercise, the use of EST in evaluation of coronary artery disease, an updated diagnostic and prognostic variables of EST, and reporting of EST.

Association of carotid intima-media thickness with exercise tolerance test in type 2 diabetic patients

“…Sensitivity of ETT was estimated about 60% to 70%, and specificity about 60% to 80% in various studies. It has some degree of false positive and false negative results; however, it is an easy, inexpensive, and non-invasive method for evaluation of ischemic heart disease [ 32 , 33 ].…”

Power walking based outpatient cardiac rehabilitation in patients with post‐coronary angioplasty: Randomized control trial

“…ST80i Stress Testing System (PHILIPS) used for symptom‐limited exercise stress testing (EST) using Bruce protocol with three‐minute stages as tolerated to reach 85% of age predicted maximum heart rate, by cardiologist to measure METs. EST has high sensitivity, specificity and to interpret prognosis of coronary artery disease (Sharif & Always, 2016).…”

The Importance of Measurement for Quality Improvement: Submaximal Cardiac Stress Testing

“…A substantial number of clinical research studies have evaluated and determined an adequate level of exercise in most adults to produce ischemia. There are 3 cutoffs for adequate cardiac stress that the patient must meet: the patient must expend 5 metabolic equivalents (METs) of energy (a workload of about 6 min using the standard Bruce protocol for the treadmill), indicating moderate exercise sufficient to provoke ischemia; the heart rate must reach a level higher than 85% of the maximum predicted heart rate based on age (maximum predicted heart rate 5 220 -age); and the patient must have symptoms such as fatigue, shortness of breath, chest pain, or electrocardiogram changes indicative of ischemia (15,16). Basically, the patient must be markedly fatigued.…”