Health Evaluation for Hypertensive Population Using Exercise Testing and Health-related Quality of Life Questionnaire

Objectives This study aims to assess the impacts of hypertension on health-related quality of life (HRQOL), as well as cardiovascular functional status (CVFS). Methods An instrument was presented based on WHOQOL-BREF and SP-16 questionnaire and exercise testing. 57 normotensive and 76 hypertensive subjects aged 35-65 year-old participated the health survey using this instrument. Based on the exercise testing results of the two groups, a discriminate function was established and used to investigate cardiovascular risk factors for hypertensive population. Results The results showed that persons with hypertension rated significantly lower scores on physical health (i.e. limitation in performing daily activities and problems with work or mobility) than did normotensives (P < 0.01). The discriminant score obtained from the exercise testing results was capable of reflecting the impacts of hypertension on CVFS. Conclusions The method presented in this paper provides a more powerful tool to estimate the effects of health interventions and medical therapy for hypertensive population than just self-rated HRQOL questionnaire.

Dead Space Breathing in Patients with Malignancies: Determination by Cardiopulmonary Exercise Testing

Rationale: Patients with cancer commonly experience dyspnea originating from ventilatory, circulatory and musculoskeletal sources, and dyspnea is best determined by cardiopulmonary exercise testing (CPET). Objectives: In this retrospective pilot study, we evaluated patients with hematologic and solid malignancies by CPET to determine the primary source of their dyspnea. Methods: Subjects were exercised on a cycle ergometer with increasing workloads. Minute ventilation, heart rate, breathing reserve, oxygen uptake (V’O2), O2-pulse, ventilatory equivalents for carbon dioxide and oxygen (V’E/V’CO2 and V’E/V’O2, respectively) were measured at baseline and peak exercise. The slope and intercept for V’E/V’CO2 was computed for all subjects. Peak V’O2 4% predicted indicated a circulatory or ventilatory limitation. Results: Complete clinical and physiological data were available for 36 patients (M/F 20/16);32 (89%) exhibited ventilatory or circulatory limitation as shown by a reduced peak V’O2 and 10 subjects with normal physiologic data. The largest cohort comprised the pulmonary vascular group (n = 18) whose mean ± SD peak V’O2 was 61% ± 17% predicted. There were close associations between V’O2 and spirometric values. Peak V’E/V’O2 and V’E/V’CO2 were highest in the circulatory and ventilatory cohorts, consistent with increase in dead space breathing. The intercept of the V’E-V’CO2 relationship was lowest in patients with cardiovascular impairment. Conclusion: Dyspneic patients with malignancies exhibit dead space breathing, many exhibiting a circulatory source for exercise limitation with a prominent pulmonary vascular component. Potential factors include effects of chemo- and radiation therapy on cardiac function and pulmonary vascular endothelium.

Serum oxidizability potential of ischemic heart disease patients is associated with exercise test results and disease severity

AIM:To find out whether serum oxidizability potential correlates with exercise test(EXT) parameters and predicts their results in chronic ischemic heart disease(IHD) patients.METHODS:Oxidizability potential was determined in a group of chronic IHD patients who underwent a symptom limited EXT upon initiation of a cardiac rehabilitation program.The thermo-chemiluminescence(TCL) assay was used to assess serum oxidizability potential.This assay is based on heat-induced oxidation of serum,leading to the formation of electronically excited species in the form of unstable carbonyls,which further decompose into stable carbonyls and light energy(low chemiluminescence).Measured photons emission is represented by a kinetic curve which is described by its amplitude and slope(= ratio).We assessed the correlations of TCL ratio with exercise duration,metabolic equivalents(METS),maximal heart rate(mHR),maximal systolic BP,> 1 mm S-T depression,diabetes,hypertension,smoking,left ventricular ejection fraction(LVEF) > or < 40%,previous myocardial infarction,and aorto-coronary bypass surgery and compared to the TCL ratio measured in a group of healthy controls.RESULTS:A high TCL ratio(%) correlated well with METS(r = 0.84),with mHR(r = 0.79) and with exercise induced S-T segment shift(r = 0.87,P < 0.05).A lower serum oxidizability potential,expressed as a low TCL ratio,thus suggestive of a previous high oxidative stress,was found in IHD patients compared to healthy controls,and,in particular,in patients with low LVEF%.The TCL ratio(%) in IHD patients was 193 ± 21,compared to 215 ± 13 in controls(P < 0.05),and was 188 ± 14.7 in patients with LVEF < 40% as compared to 200 ± 11.9 in those with LVEF > 40%(P < 0.01).A trend for lower TCL ratio(%) was found in diabetic,hypertensive,and post-coronary bypass surgery patients.A paradoxically low TCL ratio(low oxidizability potential) was observed in patients without S-T depression compared to patients with S-T depression(189 ± 22 vs 201 ± 15,P = NS),due to the fact these patients had a much lower LVEF% and a lower exercise capacity.CONCLUSION:Serum oxidizability potential is associated with EXT parameters,results,and IHD severity.TCL ratio is an "easy-to-measure marker" that might be incorporated into risk assessment and prediction in chronic IHD patients.

TWO METHODS TO IMPROVE THE ACCURACY OF TREADMILL EXERCISE TESTING──ANALYSIS OF 147 CASESIN CONTRAST WITH CORONARY ANGIOGRAPHY

objective To study how to improve the accuracy of treadmill exercise testing(TET).Methods TET was performed before coronary angiography (CAG) for 147 subjects admitted into our departmentbecause of suspicion of angina or coronary artery disease (CAD), then: (1) Every subject was inquired about hissymptoms and physically examined in detail before the testing. Chest pain was divided into ischemic (ICP) ornon - ischemic (NICP) pattern. (2) Informations got from TET, like angina, ST segment depression, and SPB ratio,were analyzed in detail. Results (1) When the patients showed chest pain of ICP pattern and positive TETresults, the sensitivity of TET would be 95%, for patients with NICP chest pain, the negative result of TET meansthat their coronary arteries is normal with the accurate possibility of 98%. (2) By our new criteria of TET, thesensitivity and specificity of TET were 89% and 95% respectively, both higher than those in theliterature. Conclusion in this report, we found TET was more sensitive and accurate if we knew the symptomsprior, especially in detail the characteristics of chest pain, and consider different parameters in combination.

Significance of Q-Tc,Q-Tr and A Q-Tc during Treadmill Exercise Test in Predicting Coronary Artery Disease

Seventy-eight patients underwent coronary angiography and submaximal tre-admill exercise test to evaluate the Q-Tc,Q-Tr and ΔQ-Tc criteria for predicting co-ronary artery disease(CAD).The sensitivity,specificity,predicting value and correctdiagnostic rate of the Q-Tc and Q-Tr criteria were 84,76,83,81 percent and 69,88,89,77 percent,respectively,which had no significant differences when compared with ST de-pression.The Q-Tc had higher specificity(94%)than that of ST depression but less sen-sitivity(58%).These criteria could reflect the severity of coronary artery disease identi-fied with coronary angiography.Therefore,these criteria are usefel to interpret the resultsof stress test.

Evaluation of Treadmill Exercise Test Induced U-wave Inversion in Diagnosis of Coronary Artery Disease

U-wave changes during treadmill exercise test were compared between 34 patientswith CAD and 33 normal controls.All of them were confirmed by coronary angiographv.Tenpatients with CAD and 1 normal subject in this study showed U-wave inversion during exercisetest.Of the 10 patients,4 had significant stenosis in one-vessel and 6 in multi-vessel of the ma-jor coronary arteries.The sensitivity,specificity and predictive value of exercise-inducedU-wave inversion were 29％, 97％ and 91％,respectively.It is proposed that exercise inducedU-wave inversion is a reliable predictive index of CAD.

Predictive value of preoperative cardiopulmonary exercise testing on early outcomes of pulmonary valve replacement after repair of Tetralogy of Fallot

Objective Cardiopulmonary exercise testing(CPET)is helpful to identify right ventriclar(RV)dysfunction in patients with rapair of Tetralogy of Fallot(rTOF),but its predictive value on early outcomes of pulmonary valve replacement(PVR)of these patients is unclear when similar preoperative ventricular size and function in cardiovascular magnetic resonance(CMR)exist.The aim of this study is to evaluate whether CPET is useful to predict the early outcomes of rTOF patients after PVR.

Prognostic Value of Cardiopulmonary Exercise Test in Elderly Women with Heart Failure and Reduced or Preserved Ejection Fraction

The prognostic role of cardiopulmonary exercise test (CPET) in elderly women with chronic heart failure (HF) has not yet been clarified. We assessed the incremental value of CPET variables for risk stratification in female HF patients with preserved or reduced left ventricular ejection fraction (LVEF). We prospectively followed up 131 female HF outpatients aged 72 [interquartile range 62 - 77] years after a symptom limited CPET. 34% had ischemic heart disease and 14% permanent atrial fibrillation, 24% were in NYHA class III. LVEF was 50% [interquartile range 36 - 62], peak oxygen consumption was 11.3 [interquartile range 9.2 - 13.5] ml/kg/min;the slope of the regression line relating ventilation to CO2 output was 33.9 [interquartile range 30.3 - 44.9];40% of patients showed exercise oscillatory breathing during CPET. During a median follow-up of 18 months [interquartile range 8 - 54], overall 39 patients (29.7%) met the combined end-point of cardiovascular mortality or HF admission using a time-to-first event approach. Moderate to severe mitral regurgitation, slope, exercise oscillatory breathing were independently associated to cardiovascular mortality or HF admission. When CPET ventilatory variables were added to clinical and echocardiographic parameters, prediction of the combined point improved significantly (AUC 0.755 (95% CI 0.662 to 0.832) vs 0.634 (95% CI 0.536 to 0.725), p = 0.016). In conclusion, among elderly female HF patients the CPET derived parameters EOB and VE/VCO2 slope emerged as strong prognostic markers, with additive predictive value to clinical and echocardiographic parameters in patients with both reduced and preserved LVEF.

New Parameters of Cardiopulmonary Exercise Testing in Patients with Chronic Heart Failure: Practical Applications

Cardiopulmonary exercise testing (CPX) has become the cornerstone of risk stratification for heart failure patients. Peak oxygen consumption (VO2) was the first CPX variable to demonstrate prognostic value and is still the most frequently analyzed variable in clinical practice. More recently, several investigations have shown that ventilatory efficiency, typically expressed as the minute ventilation/carbon dioxide production (VE/VCO2) slope, is a strong prognostic marker in patient with HF. The majority of studies report the VE/VCO2 slope to be prognostically superior to peak VO2 which underscore the clinical importance of assessing ventilatory efficiency in HF patients. Other expressions of ventilatory inefficiency like exercise oscillatory breathing (EOB), oxygen uptake efficiency slope (OUES), end-tidal carbon dioxide pressure (PET CO2) at rest, and haemodynamic responses such as heart rate recovery (HRR) are strong predictors of outcomes in patients with heart failure (HF). So there is a need for simplified approaches that integrate the additive prognostic information from cardiopulmonary exercise testing.

Preoperative Exercise Testing Is a Better Predictor of Postoperative Complications than Pulmonary Function Testing for Patients with Lung Cancer

Objective: The aim of this preliminary study was to evaluate the feasibility of exercise testing (ET) for predicting postoperative complications in patients with impaired pulmonary function. Methods: Thirteen patients were prospectively enrolled. The enrollment criteria were FEV1.0% 8 by the Goddard classification or interstitial pneumonia on chest computed tomography. Patients underwent testing for pulmonary function, six-minute walking test (6MWT), and stair-climbing test (SCT). Postoperative cardiopulmonary complications (PCPCs) were recorded. Results: Four patients developed PCPCs. There were no significant differences between the patients with PCPCs (n = 4) and those without PCPCs (n = 9) for background data and PFT. The distances achieved in the 6MWT were 503 ± 72.7 m for patients without PCPCs and 369 ± 50.7 m for patients with PCPCs (p = 0.011). The SCT climbing heights were 20.4 ± 5.3 m for patients without PCPCs and 14.9 ± 4.0 m for patients with PCPCs (P = 0.187). Cut-off points, including a 6MFT distance of less than 400 m, SCT height lower than 15 m, and SCT climbing speed less than 8.5 m/min, were predictive of CPCP. Conclusions: Exercise testing is more feasible for predicting postoperative cardiopulmonary complications than stationary pulmonary function testing.

QRS Prolongation as an Indicator of Risk of lschemic Ventricular Arrhythmia in Treadmill Exercise Test

Objective:The clinical value of QRS prolngation as a indicator of risk ofischemic ventricular arthythmia induced by exercise in the patient withischemic heart disease.Methods:17 case patients with ventricular arthythmias were studiedbefore and after myocardial revascularization.These results werecompared with 19 control patients with no ventricular arrhythmia.Theresting and peak exercise electrocardiogram were examined with respectto QRS duration,ST-segment depression,and JT intervals.Result:The QRS duration at rest was similar in case and control patientsand increased significantly with exercise in both groups.However,theQRS prolongation was larger in the case group.In both groups,the QRSprolongation was associated with significant ST-segment depression.TheQRS prolongation】15msec predicted ischimia-related ventriculararrhythmia in 73% of the patients.After myocardial revascularization,there were no QRS prolongation with exercise in either group.Conclusion:QRS prolongation】14msec may be a useful indicator of riskof ischemic ventricular arrhythmia related to exercise in the patients withtschemie heart disease.

Myocardial perfusion imaging in patients with a recent, normal exercise test

AIM: To investigate the added value of myocardial perfusion scintigraphy imaging (MPI) in consecutive patients with suspected coronary artery disease (CAD) and a recent, normal exercise electrocardiography (ECG). METHODS: This study was a retrospective analysis of consecutive patients referred for MPI during a 2-year period from 2006-2007 at one clinic. All eligible patients were suspected of suffering from CAD, and had performed a satisfactory bicycle exercise test (i.e. , peak heart rate > 85% of the expected, age-predicted maximum) within 6 mo of referral, their exercise ECG was had no signs of ischemia, there was no exercise-limiting angina, and no cardiac events occurred between the exercise test and referral. The patients subsequently underwent a standard 2-d, stress-rest exercise MPI. Ischemia was defined based on visual scoring supported by quantitative segmental analysis (i.e. , sum of stress score > 3). The results of cardiac catheterizationwere analyzed, and clinical follow up was performed by review of electronic medical files. RESULTS: A total of 56 patients fulfilled the eligibility criteria. Most patients had a low or intermediate ATPⅢ pretest risk of CAD (6 patients had a high pre-test risk). The referral exercise test showed a mean Duke score of 5 (range: 2 to 11), which translated to a low postexercise risk in 66% and intermediate risk in 34%. A total of seven patients were reported with ischemia by MPI. Three of these patients had high ATPⅢ pre-test risk scores. Six of these seven patients underwent cardiac catheterization, which showed significant stenosis in one patient with a high pre-test risk of CAD, and indeterminate lesions in three patients (two of whom had high pre-test risk scores). With MPI as a gate keeper for catheterization, no significant, epicardial stenosis was observed in any of the 50 patients (0%, 95% confidence interval 0.0 to 7.1) with low to intermediate pre-test risk of CAD and a negative exercise test. No cardiac events occurred in any patients within a median follow up period of > 1200 d. CONCLUSION: The added diagnostic value of MPI in patients with low or intermediate risk of CAD and a recent, normal exercise test is marginal.

Increases in the incremental exercise mean response time across the steady state domain:Implications for exercise testing&prescription

We hypothesized that slowed oxygen uptake(VO_(2))kinetics for exercise transitions to higher power outputs(PO)within the steady state(SS)domain would increase the mean response time(MRT)with increasing exercise intensity during incremental exercise.Fourteen highly trained cyclists(mean±standard deviation[SD]);age(39±6)years[yr];and VO_(2) peak=(61±9)mL/kg/min performed a maximal,ramp incremental cycling test and on separate days,four 6-min bouts of cycling at 30%,45%,65%&75% of their incremental peak PO(Wpeak).SS trial data were used to calculate the MRT and verified by mono-exponential and linear curve fitting.When the ramp protocol attained the value from SS,the PO,in Watts(W),was converted to time(min)based on the ramp function W to quantify the incremental MRT(iMRT).Slope analyses for the VO_(2) responses of the SS versus incremental exercise data below the gas exchange threshold(GET)revealed a significant difference(p=0.003;[0.437±0.08]vs.[0.382±0.05]L·min^(-1)).There was a significant difference between the 45%Wpeak steady state VO_(2)(ss VO_(2))([3.08±0.30]L·min^(-1),respectively),and 30% Wpeak ss VO_(2)(2.26±0.24)(p<0.0001;[3.61±0.80]vs.[2.20±0.39]L·min^(-1))and between the iMRT for 45% and 30% Wpeak ss VO_(2) values([50.58±36.85]s vs.[32.20±43.28]s).These data indicate there is no single iMRT,which is consistent with slowed VO_(2) kinetics and an increasing VO_(2) deficit for higher exercise intensities within the SS domain.

Cardiopulmonary exercise testing in the evaluation of high risk patients with lung cancer

Background It is still unclear whether pulmonary function tests （PFTs） are sufficient for predicting perioperative risk,and whether all patients or only a subset of them need a cardiopulmonary exercise test （CPET） for further assessment.Thus, this study was designed to evaluate the CPET and compare the results of CPET and conventional PFTs to identify which parameters are more reliable and valuable in predicting perioperative risks for high risk patients with lung cancer.Methods From January 2005 to August 2008, 297 consecutive lung cancer patients underwent conventional PFTs （spirometry ＋ single-breath carbon monoxide diffusing capacity of the lungs （DLCOsb） for diffusion capacity） and CPET preoperatively. The correlation of postoperative cardiopulmonary complications with the parameters of PFT and CPET was retrospectively analyzed using the chi-square test, independent sample t test and binary Logistic regression analysis.Results Of the 297 patients, 78 did not receive operation due to advanced disease stage or poor cardiopulmonary function. The remaining 219 underwent different modes of operations. Twenty-one cases were excluded from this study due to exploration alone （15 cases） and operation-related complications （6 cases）. Thus, 198 cases were eligible for evaluation. Fifty of the 198 patients （25.2%） had postoperative cardiopulmonary complications. Three patients （1.5%）died of complications within 30 postoperative days. The patients were stratified into groups based on VO2max/pred respectively. The rate of postoperative cardiopulmonary complications was significantly higher in the group with cardiopulmonary complications were significantly correlated with age, comorbidities, and poor PFT and CPET results.used to stratify the patients＇ cardiopulmonary function status and to predict the risk of postoperative cardiopulmonary predicting perioperative risk. If available, cardiopulmonary exercise testing is strongly suggested for high-risk lung cancer patients in addition to conventional pulmonary function tests, and both should be combined to assess cardiopulmonary function status.

Limited value of recovery phase-limited ST segment depression of treadmill exercise test

Background Clinical meaning of recovery phase limited ST segment depression of a treadmill exercise test is controversial.The aim of this study was to re-assess the diagnostic and prognostic value of ST segment depression during the recovery phase with the active phase of a treadmill exercise test in suspected coronary artery disease patients.Methods Clinical,exercise and angiographic data were retrospectively collected from 602 patients in the study.Five hundred and seventy-six patients developed ST segment depression during the active phase of the treadmill exercise test （group 1） and 26 patients developed ST segment depression only during the recovery phase （group 2）.Results With similar major clinical features,the prevalence of significant coronary artery stenosis and average Gensini scores were lower in the recovery phase-limited depression patients （group 2 vs.group 1,50.0% vs.66.9%,P=0.031 and group 2 vs.group 1,1.5 vs.8.5,P=0.04）.At a median follow up of 50.9 months for 22 group 2 and 34.8 months for 438 group 1 patients,the prevalence of total cardiac events was higher in group 1 than in group 2 patients （RR 1.60,95% Cl 1.00-2.54,P=0.049）.Conclusion The present study provides preliminary evidence that the diagnostic and prognostic value of recovery phaselimited ST segment depression of treadmill exercise test is limited.

Reference value of long-time exercise test in the diagnosis of primary periodic paralysis

Background The long-time exercise test （ET） is used to diagnose the primary periodic paralyses （PPs）.However the reference values of ET are many and various.This study aimed to investigate the reference value of long-time ET in the diagnosis of PPs.Methods We recruited 108 healthy subjects,68 patients with PPs,and 72 patients with other diseases for the study.The procedure of ET was made on the basis of the McManis＆#39; method.Electrical responses were recorded from right abductor digiti minimi （ADM） muscle when stimulation of the ulnar nerve at the wrist.After the compound muscle action potential （CMAP） was monitored,subjects were then asked to contract the muscle as strongly as possible for 5 minutes.CMAPs were recorded for 2 seconds immediately after cessation of exercise,then every 5 minutes for 10 minutes,and finally every 10 minutes for 50 minutes.In general,the CMAP amplitudes will fall below the pre-exercise levels in an hour.The largest decrease was calculated and used as results of ET.Results The CMAP amplitude decreases had no significant differences between groups when the healthy adults were grouped according to age,gender,height,weight and test time.Decreases in PPs patients （57.76%） were significantly more than in healthy subjects （15.21%） and other disease patients （18.10%,P 〈0.001）.Receiver operating characteristic （ROC） curve analysis showed that the best threshold is 35.50%.Conclusions In the long-time exercise test,threshold of 35.50% for the CMAP amplitude decrease was identified for abnormal.The result is not influenced by age,gender,height,weight,and test time.About 7.4% of healthy subjects were abnormal in ET.

Research hotspots and trends of cardiopulmonary exercise test:Visualization analysis based on citespace

The study aims to grasp the hot spots and trends of global cardiopulmonary exercise research.Web of Science(WoS)core collection and Derwent Innovation Index database were retrieved to collect literature from 2002 to 2022 with Cardiopulmonary Exercise Test(CPET)as the retrieval theme.CiteSpace was used to conduct bibliometrics and visual analysis of 6679 pieces of literature in the web of science core collection database and 251 patent data in the Derwent Innovation Index database.The results show that:(1)the number of CPET theme research papers is increasing year by year,and the main research fields are cardiology,respiratory system,sports science,etc.;(2)The main research hot spots of CPET include exercise prescription,exercise and heart failure,COVID-19 cardiopulmonary rehabilitation and evaluation,etc.;(3)The development trend of CPET technology is majorly in the direction of intelligence,portability,individualization and the integration of Virtual Reality(VR)technology and evidence-based research of CPET guiding clinical decision-making.

QT hysteresis in long-QT syndrome children with exercise testing

Background Congenital long QT syndrome （LQTS） is an inherited ion channel disorder resulting in abnormal cardiac repolarization that can cause syncope and sudden death associated with a prolonged rate-corrected QT interval and polymorphic ventricular tachycardia. Several studies in adults showed that LQTS patients have altered QT adaptation to heart rate changes compared with normal subjects which forming a ＂hysteresis loop＂ in the QT-circle length plot. This study was to observe the QT interval changing during exercise testing in children long QT syndrome （LQTS） patients, explore the new diagnosis methods of LQTS. Methods The subjects were divided into 3 groups according to 1993 LQTS diagnostic criteria. Group 1： LQTS group （n=17） who scored 〉 or = 4 points indicating definite LQTS. Group 2： Middle group （n=16）, patients who have prolonged QT interval but scored 1.5 to 3.5. Group 3： Normal control group （n=18）. The average age of all study population is （12.3±5.8） years. No case had beta-adrenergic antagonists administration before exercise testing. All subjects were underwent tread mill exercise testing and electrocardiograph in whole exercise testing and recovery were recorded. QT and heart rate changing during whole exercise testing period were recorded. /kQT, the QT interval at 1, 2, 4, 6 minutes into recovery subtract from the QT interval at a similar heart rate during exercise, were calculated. Results In all three groups, QT intervals were shortening with the increasing of heart rate, but QTc had no significant change. ΔQT at 1 minute （（45±11） ms）, 2 minutes （（37±15） ms）, 4 minutes （（23±12） ms） into recovery in LQTS group were significantly greater than that of the other two groups （P〈0.05, P〈0.01, P〈0.01, respectively）. There was no ΔQT significant difference between middle group and normal control group at recovery time. During the recovery phase in LQTS group, the QT interval remained shortened despite a decelerating heart rate, forming a hysteresis ＂loop＂ in the curve relating the QT interval to the cycle length. Conclusions In children LQTS patients, there is significant QT hysteresis loop in the relation of QT interval with heart rate during recovery of exercise testing, which could be useful to the early diagnosis for LQTS.

Shortness of breath in clinical practice: A case for left atrial function and exercise stress testing for a comprehensive diastolic heart failure workup

The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.

2D and 3D Analysis of Magnetocardiographic Data in the Evaluation of the Ventricular Repolarization Changes under Exercise Stress Test in Patients with CAD

Objective: Non-invasive methods of evaluation of electrical activity of the heart are still the most important functional diagnostics methods in coronary artery disease (CAD) detection. It has been shown that magnetocardiography (MCG) appears to be rather sensitive in diagnostics of chronic CAD even in the patients at rest with unchanged ECG. The objective of present paper is to investigate the influence of non-invasive tests with a physical exerciseon MCG parameters in the patients with chronic CAD. Materials and Methods: In total, 10 patients were examined (mean age 41 ± 5 years) suffering from chronic stable angina (CAD). CAD was diagnosed by clinical evidences, bicycle ergometria positive data and coronary angiography (stenosis > 70% in at least onr main coronary angiography). The control group consisted of 14 healthy volunteers. MCG mapping was performed by means of a 7-channel SQUID-magnetometer installed in an unshielded room. The MCG examination was conducted twice, whilst patients were at rest and after exercise on the bicycle (in healthy persons it was conducted immediately after exercise and in the patients, after the ST depression and/or chest pain had disappeared). The homogeneity and electric motive force (EMF) direction disturbances on magnetic field distribution maps on an extent of ST-T interval have been evaluated. Results: Statistically significant differences between groups examined based both on 2D and 3D quantitative criteria were demonstrated. Conclusion: The application of a set of MCG criteria based on the analysis both of ventricular depolarization and repolarization will enable a greater degree of accuracy for the results of the exercise stress test, especially in doubtful cases.