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• Arm exercise stress testing: diagnostic options in stable coronary artery disease

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  Arm exercise stress testing: diagnostic options in stable coronary artery disease

  Author(s)

  Rahul Bahl & Pascal Meierl

  Date

  2016-05-13

  Source

  Open Heart V3(1) 2016

  Diagnostic and prognostic testing in coronary artery disease (CAD) is a rapidly expanding field and now includes a range of functional tests, imaging modalities and combinations of the two (stress imaging). For patients suspected of having occlusive CAD, current European Society of Cardiology and National Institute for Health and Clinical Excellence guidance1 2 recommends an approach where the probability of obstructive disease and the risk of future events are estimated to determine the next steps. Those at low-risk on the basis of history, examination and basic investigations do not need further assessment, while those at high-risk can proceed directly to treatment, including invasive angiography, if needed. However, for intermediate risk patients, there are a number of options.

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• Diagnosis of Functionally Significant Coronary Stenosis with Exercise CT Myocardial Perfusion Imaging

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  Diagnosis of Functionally Significant Coronary Stenosis with Exercise CT Myocardial Perfusion Imaging

  Author(s)

  Michel Habis, MD, Said Ghostine, MD, Adela Rohnean, MD, André Capderou, MD, PhD, Jean-François Paul, MD

  Date

  2014-11-19

  Source

  RSNA Publications Online

  Purpose

  To assess the feasibility of exercise perfusion computed tomography (CT) in patients suspected of having hemodynamically significant coronary stenosis.
  Materials and Methods

  This study had institutional review board approval, and all patients gave informed consent. Thirty-two consecutive patients (26 men [mean age, 63 years] and six women [mean age, 71 years]) with 55 coronary stenoses of at least 50% underwent coronary CT angiography (one stenosis in 13 patients, two stenoses in 15 patients, and three stenoses in four patients). CT myocardial perfusion imaging was performed within 1 minute after patients performed supine exercise on an ergometer secured to the CT table. The pressure-rate product was computed to assess level of exercise. The myocardial enhancement ratio between stenotic and normally perfused territories was determined for each stenosis. Fractional flow reserve less than 0.8, as measured during invasive coronary angiography, was the reference for defining significant stenoses. Receiver operating characteristic curves were constructed to determine the myocardial enhancement ratio cutoff value.
  Results

  In the per-patient analysis, a myocardial enhancement ratio cutoff of 0.8 performed best for identifying functionally significant stenosis: Sensitivity was 95% (21 of 22 patients), specificity was 90% (nine of 10 patients), positive predictive value was 95% (21 of 22 patients), negative predictive value was 90% (nine of 10 patients), and accuracy was 94% (30 of 32 patients). Corresponding values in the per-stenosis analysis were 97% (29 of 30 stenoses), 96% (23 of 24 stenoses), 97% (29 of 30 stenoses), 96% (23 of 24 stenoses), and 96% (52 of 54 stenoses), respectively.
  Conclusion

  Exercise CT myocardial perfusion imaging is feasible and accurate for assessment of the functional significance of coronary stenosis.

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• Experimental Protocol of a Three-minute, All-out Arm Crank Exercise Test in Spinal-cord Injured and Able-bodied Individuals (video article)

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  Experimental Protocol of a Three-minute, All-out Arm Crank Exercise Test in Spinal-cord Injured and Able-bodied Individuals (video article)

  Author(s)

  Joelle L. Flueck1

  Date

  2017-08-06

  Source

  Journal of Visualized Experiments

  Reliable exercise protocols are required to test changes in exercise performance in elite athletes. Performance improvements in these athletes may be small; therefore, sensitive tools are fundamental to exercise physiology. There are currently many exercise tests that allow for the examination of exercise capacity in able-bodied athletes, with protocols mainly for lower-body or whole-body exercise. There is a trend to test athletes in a sport-specific setting that closely resembles the actions that the participants are used to performing. Only a few protocols test short-term, high-intensity exercise capacity in participants with an impairment of the lower body. Most of these protocols are very sportspecific and are not applicable to a wide range of athletes. One well-known test protocol is the 30 s Wingate test, which is well-established in cycling and in arm crank exercise testing. This test analyzes high-intensity exercise performance over a 30 s time duration. In order to monitor exercise performance over a longer duration, a different method was modified for application to the upper body. The 3 min, all-out arm crank ergometer test allows athletes to be tested in a manner specific to 1,500 m wheelchair racing (in terms of exercise duration), as well as to upper body exercises such as rowing or hand-cycling. In order to increase the reliability with identical test conditions, it is crucial to precisely replicate settings such as the resistance (i.e., torque factor) and the position of the participants (i.e., the height of the crank, the distance between the crank and the participant, and the fixation of the participant). Another important issue concerns the beginning of the exercise test. Fixed revolutions per minute are required to standardize the test conditions for the start of the exercise test. This exercise protocol shows the importance of accurate operations to reproduce identical test conditions and settings.

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• Impact of Percutaneous Revascularization on Exercise Hemodynamics in Patients With Stable Coronary Disease

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  Impact of Percutaneous Revascularization on Exercise Hemodynamics in Patients With Stable Coronary Disease

  Author(s)

  Cook CM, Ahmad Y, Howard JP, et al

  Date

  2018-08-28

  Source

  Journal of the American College of Cardiology

  BACKGROUND:
  Recently, the therapeutic benefits of percutaneous coronary intervention (PCI) have been challenged in patients with stable coronary artery disease (SCD).

  OBJECTIVES:
  The authors examined the impact of PCI on exercise responses in the coronary circulation, the microcirculation, and systemic hemodynamics in patients with SCD.

  METHODS:
  A total of 21 patients (mean age 60.3 ± 8.4 years) with SCD and single-vessel coronary stenosis underwent cardiac catheterization. Pre-PCI, patients exercised on a supine ergometer until rate-limiting angina or exhaustion. Simultaneous trans-stenotic coronary pressure-flow measurements were made throughout exercise. Post-PCI, this process was repeated. Physiological parameters, rate-limiting symptoms, and exercise performance were compared between pre-PCI and post-PCI exercise cycles.

  RESULTS:
  PCI reduced ischemia as documented by fractional flow reserve value (pre-PCI 0.59 ± 0.18 to post-PCI 0.91 ± 0.07), instantaneous wave-free ratio value (pre-PCI 0.61 ± 0.27 to post-PCI 0.96 ± 0.05) and coronary flow reserve value (pre-PCI 1.7 ± 0.7 to post-PCI 3.1 ± 1.0; p < 0.001 for all). PCI increased peak-exercise average peak coronary flow velocity (p < 0.0001), coronary perfusion pressure (distal coronary pressure; p < 0.0001), systolic blood pressure (p = 0.01), accelerating wave energy (p < 0.001), and myocardial workload (rate-pressure product; p < 0.01). These changes observed immediately following PCI resulted from the abolition of stenosis resistance (p < 0.0001). PCI was also associated with an immediate improvement in exercise time (+67 s; 95% confidence interval: 31 to 102 s; p < 0.0001) and a reduction in rate-limiting angina symptoms (81% reduction in rate-limiting angina symptoms post-PCI; p < 0.001).

  CONCLUSIONS:
  In patients with SCD and severe single-vessel stenosis, objective physiological responses to exercise immediately normalize following PCI. This is seen in the coronary circulation, the microcirculation, and systemic hemodynamics.

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• The effects of arm crank ergometry, cycle ergometry and treadmill walking on postural sway in healthy older females.

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  The effects of arm crank ergometry, cycle ergometry and treadmill walking on postural sway in healthy older females.

  Author(s)

  Hill MW, Oxford SW, Duncan MJ, Price MJ

  Date

  2014-10-13

  Source

  Gait & Posture 41 (2015) 252–257

  A B S T R A C T
  Older adults are increasingly being encouraged to exercise but this may lead to muscle fatigue, which can
  adversely affect postural stability. Few studies have investigated the effects of upper body exercise on
  postural sway in groups at risk of falling, such as the elderly. The purpose of this study was to compare
  the effects arm crank ergometry (ACE), cycle ergometry (CE) and treadmill walking (TM) on postural
  sway in healthy older females. In addition, this study sought to determine the time necessary to recover
  postural control after exercise. A total of nine healthy older females participated in this study.
  Participants stood on a force platform to assess postural sway which was measured by displacement of
  the centre of pressure before and after six separate exercise trials. Each participant completed three
  incremental exercise tests to 85% of individual’s theoretical maximal heart rate (HRMAX) for ACE, CE and
  TM. Subsequent tests involved 20-min of ACE, CE and TM exercise at a relative workload corresponding
  to 50% of each individual’s predetermined heart rate reserve (HRE). Post fatigue effects and postural
  control recovery were measured at different times after exercise (1, 3, 5, 10, 15 and 30-min). None of the
  participants exhibited impaired postural stability after ACE. In contrast, CE and TM elicited significant
  post exercise balance impairments, which lasted for 10 min post exercise. We provide evidence of an
  exercise mode which does not elicit post exercise balance impairments. Older adults should exercise
  caution immediately following exercise engaging the lower limbs to avoid fall risk.

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• Validity and Reliability of Skill-Related Fitness Tests for Wheelchair-Using Youth With Spina Bifida.

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  Validity and Reliability of Skill-Related Fitness Tests for Wheelchair-Using Youth With Spina Bifida.

  Author(s)

  Manon A. Bloemen, MSc; Tim Takken, PhD; Frank J. Backx, PhD; Marleen Vos, MSc; Cas L. Kruitwagen, MSc; Janke F. de Groot, PhD

  Date

  2017-06-01

  Source

  Archives of Physical Medicine and Rehabilitation 2017;98:1097-103

  Abstract
  Objectives: To determine content validity of the Muscle Power Sprint Test (MPST), and construct validity and reliability of the MPST, 10
  5
  Meter Sprint Test (10
  5MST), slalom test, and One Stroke Push Test (1SPT) in wheelchair-using youth with spina bifida (SB).
  Design: Clinimetric study.
  Setting: Rehabilitation centers, SB outpatient services, and private practices.
  Participants: A convenience sample of children and adolescents (NZ53; 32 boys, 21 girls; age range, 5e19y) with SB who use a manual
  wheelchair. Participants were recruited through rehabilitation centers, SB outpatient services, pediatric physical therapists, and the BOSK
  (Association of Physically Disabled Persons and their Parents).
  Interventions: Not applicable.
  Main Outcome Measures: Construct validity of the MPST was determined by comparing results with the arm-cranking Wingate Anaerobic Test
  (WAnT) using paired t tests and Pearson correlation coefficients, while content validity was assessed using time-based criteria for anaerobic
  testing. Construct validity of the 10
  5MST, slalom test, and 1SPT was analyzed by hypothesis testing using Pearson correlation coefficients and
  multiple regression. For reliability, intraclass correlation coefficients (ICCs) and smallest detectable changes (SDCs) were calculated.
  Results: For the MPST, the mean  SD exercise time of 4 sprints was 28.16.6 seconds. Correlations between the MPSTand arm-crankingWAnT
  were high (r>.72, P<.01). Excellent correlations were found between the 10
  5MSTand slalom test (rZ.93, P<.01), while correlations between the
  10
  5MSTor slalom test and MPSTand 1SPTwere moderate (rZ.56 to.70; rZ.56, P<.01). The variation of the 1SPTwas explained for 38% by
  wheelchair mass (bZ.489) and total upper muscle strength (bZ.420). All ICCs were excellent (ICCs>.95), but the SDCs varied widely.
  Conclusions: The MPST is a valid and reliable test in wheelchair-using youth with SB for measuring anaerobic performance. The 10
  5MST and
  slalom test are valid and reliable for measuring agility. For the 1SPT, both validity and reliability are questionable.

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