ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines).

Journal of the American College of Cardiology (Impact Factor: 15.34). 11/2002; 40(8):1531-40. DOI: 10.1161/01.CIR.0000034670.06526.15
Source: PubMed
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    ABSTRACT: Background. We tested the hypothesis that high intensity interval training (HIIT) would be more effective than moderate intensity continuous training (MIT) to improve newly emerged markers of cardiorespiratory fitness in coronary heart disease (CHD) patients, as the relationship between ventilation and carbon dioxide production (VE/VCO2 slope), oxygen uptake efficiency slope (OUES), and oxygen pulse (O2P). Methods. Seventy-one patients with optimized treatment were randomly assigned into HIIT (n = 23, age = 56 ± 12 years), MIT (n = 24, age = 62 ± 12 years), or nonexercise control group (CG) (n = 24, age = 64 ± 12 years). MIT performed 30 min of continuous aerobic exercise at 70-75% of maximal heart rate (HRmax), and HIIT performed 30 min sessions split in 2 min alternate bouts at 60%/90% HRmax (3 times/week for 16 weeks). Results. No differences among groups (before versus after) were found for VE/VCO2 slope or OUES (P > 0.05). After training the O2P slope increased in HIIT (22%, P < 0.05) but not in MIT (2%, P > 0.05), while decreased in CG (-20%, P < 0.05) becoming lower versus HIIT (P = 0.03). Conclusion. HIIT was more effective than MIT for improving O2P slope in CHD patients, while VE/VCO2 slope and OUES were similarly improved by aerobic training regimens versus controls.
    02/2015; 2015:1-8. DOI:10.1155/2015/192479
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    ABSTRACT: Myocardial computed tomography perfusion (CTP) using conventional single energy (SE) imaging is influenced by the presence of beam hardening artifacts (BHA), occasionally resembling perfusion defects and commonly observed at the left ventricular posterobasal wall (PB). We therefore sought to explore the ability of dual energy (DE) CTP to attenuate the presence of BHA. Consecutive patients without history of coronary artery disease who were referred for computed tomography coronary angiography (CTCA) due to atypical chest pain and a normal stress-rest SPECT and had absence or mild coronary atherosclerosis constituted the study population. The study group was acquired using DE and the control group using SE imaging. Demographical characteristics were similar between groups, as well as the heart rate and the effective radiation dose. Myocardial signal density (SD) levels were evaluated in 280 basal segments among the DE group (140 PB segments for each energy level from 40 to 100 keV; and 140 reference segments), and in 40 basal segments (at the same locations) among the SE group. Among the DE group, myocardial SD levels and myocardial SD ratio evaluated at the reference segment were higher at low energy levels, with significantly lower SD levels at increasing energy levels. Myocardial signal-to-noise ratio was not significantly influenced by the energy level applied, although 70 keV was identified as the energy level with the best overall signal-to-noise ratio. Significant differences were identified between the PB segment and the reference segment among the lower energy levels, whereas at ≥70 keV myocardial SD levels were similar. Compared to DE reconstructions at the best energy level (70 keV), SE acquisitions showed no significant differences overall regarding myocardial SD levels among the reference segments. BHA that influence the assessment of myocardial perfusion can be attenuated using DE at 70 keV or higher.
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    ABSTRACT: To investigate the association between analyses of submaximal treadmill exercise test (TMT) and long-term myocardial ischemia (Mis) and silent Mis in community-dwelling older adults, 898 Rancho Bernardo Study participants (mean age 55 years) without coronary heart disease underwent TMT and were followed up to 27 years. The main outcome measures are incidence of Mis and silent Mis. During follow-up, 97 Mis and 103 silent Mis events occurred. We measured ST change, inability to achieve target heart rate, abnormal heart rate recovery (HRR), and chronotropic incompetence (ChI). Each parameter was a significant predictor for Mis and silent Mis. An integrated scoring model was based on these 4 parameters and defined as sum of numbers of abnormal parameters. After multiple adjustments, an integrated scoring model independently predicted Mis and silent Mis. The incidence rates of abnormalities of parameters are 36.5% for 1 abnormality, 9.1% for 2 abnormalities, and 2.0% for 3 or 4 abnormalities. Compared with those with normal results, participants with 1 or 2 abnormalities had significantly increased risk for Mis (hazard ratio [HR] 1.79 or 2.34, respectively) and silent Mis (HR 1.80 or 2.64, respectively). Participants with 3 or more positive findings showed an even greater risk for Mis (HR 7.96 [3.02 to 21.00]) and silent Mis (HR 3.22 [0.76 to 13.60]). In conclusion, ST change, ChI, abnormal HRR, inability to achieve target heart rate, and integrated scoring model of TMT were independent predictors of long-term Mis and silent Mis in an asymptomatic middle-aged population. Management of ChI or abnormal HRR in an asymptomatic population may prevent future ischemic heart disease and thus improve the quality of life. Copyright © 2015 Elsevier Inc. All rights reserved.