ACC/AHA Guidelines for Exercise Testing: Executive Summary

Gibbons, Raymond J.; Balady, Gary J.; Beasley, John W.; FAAFP,; Bricker, J. Timothy; Duvernoy, Wolf F.C.; Froelicher, Victor F.; Mark, Daniel B.; Marwick, Thomas H.; McCallister, Ben D.; Thompson, Paul D; FACSM,; Winters, William L.; Yanowitz, Frank G.

doi:10.1161/01.cir.96.1.345

Cited by 379 publications

(259 citation statements)

References 0 publications

Supporting

Mentioning

241

Contrasting

Unclassified

Order By: Relevance

“…Increasing age, male sex, diabetes mellitus, dyslipidemia, hypertension, lower income status, increased serum creatinine, and smoking are all cardiovascular risk factors associated with a higher risk of developing obstructive CAD 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37. Presence of chronic obstructive pulmonary disease, peripheral vascular disease, and a Charlson comorbidity index score are all measures of comorbidity that may affect a clinician's decision‐making process with respect to choosing a suitable initial diagnostic test 38. Resting ECG abnormalities and Canadian Cardiovascular Society (CCS) angina symptoms are other important factors that may influence the decision regarding the optimal initial diagnostic test 2, 38, 39.…”

Section: Methodsmentioning

confidence: 99%

“…Presence of chronic obstructive pulmonary disease, peripheral vascular disease, and a Charlson comorbidity index score are all measures of comorbidity that may affect a clinician's decision‐making process with respect to choosing a suitable initial diagnostic test 38. Resting ECG abnormalities and Canadian Cardiovascular Society (CCS) angina symptoms are other important factors that may influence the decision regarding the optimal initial diagnostic test 2, 38, 39. Furthermore, each patient's risk was categorized as low (<10%), intermediate (10–20%), or high (>20%) based on a modified Framingham risk score, as described previously 11, 40.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Roifman

Wijeysundera

Austin

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundThe optimal initial noninvasive diagnostic testing strategy for stable coronary artery disease (CAD) is unknown. Although American guidelines recommend an exercise stress test as the first‐line test, European guidelines suggest that stress imaging (myocardial perfusion imaging or stress echocardiography) or coronary computed tomography angiography may be preferable. Understanding the relationship between the initial strategy and downstream yield of obstructive CAD and major adverse cardiac events may provide insight as to the optimal strategy.Methods and ResultsWe conducted a population‐based retrospective cohort study of adults in Ontario, Canada, using health administrative and clinical data. The relationship between the initial testing strategy and obstructive CAD on invasive angiography was examined. Patients were then followed from their angiogram onward to determine whether they developed a composite end point of major adverse cardiac events. After adjusting for covariates, patients with initial myocardial perfusion imaging (odds ratio: 0.92; 95% confidence interval, 0.85, 1.00), coronary computed tomography angiography (odds ratio: 1.51; 95% confidence interval, 0.91, 2.49), or stress echo (odds ratio: 0.95; 95% confidence interval, 0.84, 1.08) did not a have significantly different yield of obstructive CAD compared with those with an initial exercise stress test. Furthermore, there was no significant difference in downstream major adverse cardiac events after invasive angiography among the 4 initial testing strategies after adjusting for clinically relevant covariates.ConclusionsOur study found no evidence to suggest significant differences in either yield of obstructive CAD or downstream major adverse cardiac events in patients undergoing an initial noninvasive testing strategy with stress or anatomical imaging compared with those undergoing an initial exercise stress test.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Roifman

Wijeysundera

Austin

et al. 2017

JAHA

View full text Add to dashboard Cite

show abstract

“…V9O 2 ,peak V9O 2 ,peak has consistently demonstrated prognostic significance in CHF [223,224], with lower V9O 2 ,peak predicting higher mortality and the need for heart transplant. MANCINI et al [225] reported that V9O 2 ,peak .14 mL?min -1 ?kg -1 is associated with 94% survival at 1 yr and 84% survival at 2 yrs; while patients with V9O 2 ,peak f14 mL?min -1 ?kg -1 , who were rejected for transplant for noncardiac reasons, had survival rates at 1 and 2 yrs of 47% and 32%, respectively.…”

Section: V9o 2 Peak and Ventilatory Indicesmentioning

confidence: 95%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

537

390

View full text Add to dashboard Cite

Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.For symptom-limited incremental exercise, CPET indices, such as peak O 2 uptake (V9O 2 ), V9O 2 at lactate threshold, the slope of the ventilation-CO 2 output relationship and the presence of arterial O 2 desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) ''When should an evaluation of exercise intolerance be sought?''; 2) ''Which particular form of test should be asked for?''; and 3) ''What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?''

show abstract

“…Exercise electrocardiography has found wide acceptance for CAD identification because of its low cost. However, the sensitivity and specificity range from 65% to 80%, 1 and a substantial number of patients are unable to exercise because of comorbidities. Dobutamine stress echocardiography may be a solution, but its interpretation is largely operator dependent.…”

mentioning

confidence: 99%

Detection of Diastolic Abnormality by Dyssynchrony Imaging Correlation With Coronary Artery Disease in Patients Presenting With Visibly Normal Wall Motion

Onishi

Uematsu

Nanto

et al. 2009

Circ J

View full text Add to dashboard Cite

Background Post-systolic shortening (PSS) is a sensitive indicator of myocardial ischemia. Methods and ResultsWe have developed a tissue Doppler imaging technique that portrays PSS, and whether PSS correlates with coronary artery disease (CAD) was investigated in 186 patients presenting with chest pain and normal echocardiograms. Delays of the displacement peaks from end-systole were calculated in the apical views and displayed from green (0 ms) to red (≥100 ms): detection of diastolic abnormality by dyssynchrony imaging (DADI). CAD was judged positive by DADI when the left ventricular segments were color-coded red. Patients subsequently underwent thallium-201 myocardial perfusion single-photon emission computed tomography (n=150), coronary angiography (CAG, n=74), or both (n=37). CAD(-) was defined as negative scintigraphy test and/or no significant coronary artery stenosis by CAG. In 43 patients (23%), CAD(+) was confirmed by CAG as >75% diameter stenosis. DADI predicted CAD with sensitivity of 60%, specificity of 75%, predictive accuracy of 72%, positive predictive value of 42%, and negative predictive value of 86%. Among 74 patients who underwent CAG, sensitivity was best for the left anterior descending artery. Conclusions DADI detected the regional diastolic abnormality, which correlated with the presence of CAD in patients presenting with visibly normal wall motion. (Circ J 2009; 73: 125 -131)

show abstract

ACC/AHA Guidelines for Exercise Testing: Executive Summary

Cited by 379 publications

References 0 publications

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Recommendations on the use of exercise testing in clinical practice

Detection of Diastolic Abnormality by Dyssynchrony Imaging Correlation With Coronary Artery Disease in Patients Presenting With Visibly Normal Wall Motion

Contact Info

Product

Resources

About