The impact of novel exercise criteria and indices for the diagnostic and prognostic ability of exercise testing

Michaelides, Andreas; Tousoulis, Dimitris; Raftopoulos, Leonidas; Antoniades, Charalambos; Tsiachris, Dimitris; Stefanadis, Christodoulos

doi:10.1016/j.ijcard.2010.02.033

Cited by 12 publications

(13 citation statements)

References 40 publications

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“…Patients reaching an age‐specific target HR (220 beats per minute minus age in years) were encouraged to exercise to exhaustion. A 15‐lead ECG analysis system, including the right precordial leads 21 (GE CaseT‐2000 Series, Milwaukee, WI) was used. The ECG was recorded continuously and the BP was measured every minute at rest, during exercise, and for up to the tenth minute of recovery.…”

Section: Methodsmentioning

confidence: 99%

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The Interplay of Exercise Heart Rate and Blood Pressure as a Predictor of Coronary Artery Disease and Arterial Hypertension

Michaelides

Liakos

Vyssoulis

et al. 2012

J of Clinical Hypertension

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2Delayed blood pressure (BP) and heart rate (HR) decline at recovery post-exercise are independent predictors of incident coronary artery disease (CAD). Delayed BP recovery and exaggerated BP response to exercise are independent predictors of future arterial hypertension (AH). This study sought to examine whether the combination of two exercise parameters provides additional prognostic value than each variable alone. A total of 830 non-CAD patients (374 normotensive) were followed for new-onset CAD and ⁄ or AH for 5 years after diagnostic exercise testing (ET). At the end of follow-up, patients without overt CAD underwent a second ET. Stress imaging modalities and coronary angiography, where appropriate, ruled out CAD. New-onset CAD was detected in 110 participants (13.3%) whereas AH was detected in 41 former normotensives (11.0%). The adjusted (for confounders) relative risk (RR) of CAD in abnormal BP and HR recovery patients was 1.95 (95% confidence interval [CI], 1.28-2.98; P=.011) compared with delayed BP and normal HR recovery patients and 1.71 (95% CI, 1.08-2.75; P=.014) compared with normal BP and delayed HR recovery patients. The adjusted RR of AH in normotensives with abnormal BP recovery and response was 2.18 (95% CI, 1.03-4.72; P=.047) compared with delayed BP recovery and normal BP response patients and 2.48 (95% CI, 1.14-4.97; P=.038) compared with normal BP recovery and exaggerated BP response individuals. In conclusion, the combination of two independent exercise predictors is an even stronger CAD ⁄ AH predictor than its components. J Clin Hypertens (Greenwich). 2013; 15:162-170. Ó2012 Wiley Periodicals, Inc. Electrocardiographic (ECG) exercise testing (ET)remains a valuable tool for cardiovascular risk assessment.1 Although many clinicians typically think of ET only as a measure of ST-segment changes that may reflect ischemia, non-ECG parameters have emerged as stronger independent predictors of coronary artery disease (CAD). 1-4Markers reflecting autonomic nervous system dysfunction can predict cardiovascular events, future arterial hypertension (AH), and mortality. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The delayed fall in heart rate (HR) immediately after exercise (delayed HR recovery) has been associated with CAD and death.1-11 The insufficient decline in blood pressure (BP) during recovery has been reported as a predictor of CAD, new-onset AH, and mortality.12-16 The exaggerated BP response to exercise has been related to the risk of future AH. [16][17][18][19] A prospective study aiming to synthesize the clinical importance and evaluate the prognostic value of the combination of the aforementioned non-ECG exercise parameters was conducted. Its purpose was to test the hypothesis that the combination of two established prognostic markers provides an additional predictive value than each variable alone. Specifically, the relative risk (RR) for incident CAD according to HR and BP recovery (one or both abnormal) as well as the RR for new-onset hypertension according ...

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Section: Methodsmentioning

confidence: 99%

“…Based on the exercise‐induced changes in Q‐, R‐ and S‐wave amplitudes, the QRS score was calculated. The calculating formula has been previously reported 21 …”

Section: Methodsmentioning

confidence: 99%

The Interplay of Exercise Heart Rate and Blood Pressure as a Predictor of Coronary Artery Disease and Arterial Hypertension

Michaelides

Liakos

Vyssoulis

et al. 2012

J of Clinical Hypertension

Self Cite

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show abstract

“…[115][116][117] Beyond the ST Segment Because the surface ECG reflects uncancelled summation of individual action potentials in the heart, and because demand-induced ischemia affects action potentials beyond alterations in plateau phase and resting membrane potential, it is reasonable to expect changes in the exercise ECG that extend beyond the ST segment, either alone or as modified for HR behavior. 116,118 Several changes in the ECG during exercise-induced ischemia have been proposed as markers for obstructive CAD. Even though these findings are not used in routine test interpretation, they are described briefly in the P-Wave Abnormalities.…”

Section: St-segment Normalizationmentioning

confidence: 99%

“…An index based on exercise-induced changes in amplitudes of Q, R, and S waves was introduced as the Athens QRS score 89 and has been related to the extent of CAD and to the anatomic extent of myocardial ischemia. 118,132 The QRS score has been separately shown to complement ST-segment depression criteria for the detection of CAD.…”

Section: Qrsmentioning

confidence: 99%

Exercise Standards for Testing and Training

Fletcher¹,

Ades²,

Kligfield³

et al. 2013

Circulation

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760

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“…18 These variables include exercise capacity, chronotropic response, heart rate recovery, blood pressure response, and scores such as the Athens QRS score and the Duke Treadmill Score. 19,20 However, among the various parameters and scores introduced as prognostic markers by the exercise test, one of the most important is the functional capacity assessed as metabolic equivalents (METS). 21 In the current issue of the Journal, Padala et al 22 present data obtained analyzing retrospectively 14,849 consecutive patients (3,654 diabetics and 11,195 non-diabetics) undergoing exercise stress, combined exercise and pharmacologic stress, and pharmacologic stress MPS from 1995 to 2005 at a single tertiary care center.…”

Section: Prognostic Value Of Exercise Level In Diabetic Patientsmentioning

confidence: 99%