The effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test

AbstractOBJECTIVESThe aim of this study is to demonstrate the effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test.BACKGROUNDPrevious studies evaluating the effect of resting ST segment depression on the diagnostic characteristics of exercise treadmill test have been conducted on relatively small patient groups and based only on visual electrocardiogram (ECG) analysis.METHODSA retrospective analysis of data collected prospectively was performed on consecutive patients referred for evaluation of chest pain. One thousand two hundred eighty-two patients without a prior myocardial infarction underwent standard exercise treadmill tests followed by coronary angiography, with coronary artery disease defined as a 50% narrowing in at least one major epicardial coronary artery. Sensitivity, specificity, predictive accuracy and area under the curve of the receiver operating characteristic (ROC) plots were calculated for patients with and without resting ST segment depression as determined by visual or computerized analysis of the baseline ECG.RESULTSSensitivity of the exercise treadmill test increased in 206 patients with resting ST segment depression determined by visual ECG analysis compared with patients without resting ST segment depression (77 ± 7% vs. 45 ± 4%) and specificity decreased (48 ± 12% vs. 84 ± 3%). With computerized analysis, sensitivity of the treadmill test increased in 349 patients with resting ST segment depression compared with patients without resting ST segment depression (71 ± 6% vs. 42 ± 4%) and specificity decreased (52 ± 9% vs. 87 ± 3%) (p < 0.0001 for all comparisons). There was no significant difference in the area under the curve of the ROC plots (0.66–0.69) or the predictive accuracy (62–68%) between the four subgroups.CONCLUSIONSThe diagnostic accuracy and high sensitivity of the exercise treadmill test in a large cohort of patients with resting ST segment depression and no prior myocardial infarction support the initial use of the test for diagnosis of coronary artery disease. The classification of resting ST segment depression by method of analysis (visual vs. computerized) did not affect the results

A randomized trial of the effects of 1 year of exercise training on computer-measured ST segment displacement in patients with coronary artery disease

As part of a randomized trial of the effects of 1 year of exercise training on patients with stable coronary artery disease, 48 patients who exercised and 59 control patients had computerized exercise electrocardiography performed initially and 1 year later. The patients who had exercise training as an intervention had a 9% increase in measured maximal oxygen consumption and significant decreases in heart rate at rest and during submaximal exercise. ST segment displacement was analyzed 60 ms after the end of the QRS complex in the three-dimensional X,Y and Z leads and utilizing the spatial amplitude derived from them. Statistical analysis by ttesting yielded no significant differences between the groups except for less ST segment displacement at a matched work load, but this could be explained by a lowered heart rate. Analysis of variance yielded some minor differences within clinical subgroups, particularly in the spatial analysis. Obvious changes in exercise-induced ST segment depression could not be demonstrated in this heterogeneous group of selected volunteers with coronary artery disease secondary to an exercise program

Evaluation of true maximal oxygen uptake based on a novel set of standardized criteria

In this study, criteria are used to identify whether a subject has elicited maximal oxygen uptake. We evaluated the validity of traditional maximal oxygen uptake criteria and propose a novel set of criteria. Twenty athletes completed a maximal oxygen uptake test, consisting of an incremental phase and a subsequent supramaximal phase to exhaustion (verification phase). Traditional and novel maximal oxygen uptake criteria were evaluated. Novel criteria were: oxygen uptake plateau defined as the difference between modelled and actual maximal oxygen uptake >50% of the regression slope of the individual oxygen uptake-workrate relationship; as in the first criterion, but for maximal verification oxygen uptake; and a difference of [less than or equal to]4 beats x [min.sup.-1] between maximal heart rate values in the 2 phases. Satisfying the traditional oxygen uptake plateau criterion was largely an artefact of the between-subject variation in the oxygen uptake-workrate relationship. Secondary criteria, supposedly an indicator of maximal effort, were often satisfied long before volitional exhaustion, even at intensities as low as 61% maximal oxygen uptake. No significant mean differences were observed between the incremental and verification phases for oxygen uptake (t = 0.4; p = 0.7) or heart rate (t = 0.8; p = 0.5). The novel oxygen uptake plateau criterion, maximal oxygen uptake verification criterion, and maximal heart rate verification criterion were satisfied by 17, 18, and 18 subjects, respectively. The small individual absolute differences in oxygen uptake between incremental and verification phases observed in most subjects provided additional confidence that maximal oxygen uptake was elicited. Current maximal oxygen uptake criteria were not valid and novel criteria should be further explored

Study protocol: a randomised controlled trial investigating the effect of exercise training on peripheral blood gene expression in patients with stable angina

Background: Exercise training has been shown to reduce angina and promote collateral vessel development in patients with coronary artery disease. However, the mechanism whereby exercise exerts these beneficial effects is unclear. There has been increasing interest in the use of whole genome peripheral blood gene expression in a wide range of conditions to attempt to identify both novel mechanisms of disease and transcriptional biomarkers. This protocol describes a study in which we will assess the effect of a structured exercise programme on peripheral blood gene expression in patients with stable angina, and correlate this with changes in angina level, anxiety, depression, and exercise capacity. Methods/Design: Sixty patients with stable angina will be recruited and randomised 1: 1 to exercise training or conventional care. Patients randomised to exercise training will attend an exercise physiology laboratory up to three times weekly for supervised aerobic interval training sessions of one hour in total duration. Patients will undergo assessments of angina, anxiety, depression, and peripheral blood gene expression at baseline, after six and twelve weeks of training, and twelve weeks after formal exercise training ceases. Discussion: This study will provide comprehensive data on the effect of exercise training on peripheral blood gene expression in patients with angina. By correlating this with improvement in angina status we will identify candidate peripheral blood transcriptional markers predictive of improvements in angina level in response to exercise training

Gender Differences in Ventricular Remodeling and Function in College Athletes, Insights from Lean Body Mass Scaling and Deformation Imaging

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International criteria for electrocardiographic interpretation in athletes: Consensus statement.

Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD