Contribution of Stress Testing to the Management of Ischemic Heart Disease in Mali

Introduction: Exercise stress testing (on a treadmill or ergometer bicycle) is an important test in cardiology for diagnosing myocardial ischemia. This test in Mali is still in its beginning compared to other countries in the sub-region. The lack of data in Mali prompted this study, which aimed to evaluate the indications of this activity and its diagnostic contribution to cardiology in Mali. Materials and Methods: This was a retrospective, descriptive study. The study was conducted at the “TOUCAM” medical clinic in Kati based on the analysis of stress test reports between January 2016 and August 2022. Result: During the study period, we documented 73 patients who underwent exercise testing on a bicycle ergometer for suspected coronary heart disease. The mean age of our patients was 47.5 ± 13.8 years (14 and 79 years). Males accounted for the majority (78.1%). The sex ratio is 3.5. More than half of our patients were overweight or obese (77.1%). Hypertension and diabetes affected 52.1% and 25.8% of patients, respectively. 20.8% of patients had coronary artery disease. renin-angiotensin-aldosterone system blockers (56.8%) and beta-blockers (51.3%). The main indications were chest pain (63.0%) and ischemia detection (15.1%). A modified STEEP protocol was used. The majority of our patients (71.2%) achieved at least 85% of their maximum theoretical heart rate. The main reason for the termination of the study was fatigue (57.3%). The average duration was 11.3 ± 4.2 minutes. 24.7% thought the stress tests were positive and 17.8% thought they were controversial. Conclusion: This study demonstrates the importance of stress testing in the diagnosis and treatment of ischemic heart disease, especially in settings where we have very limited access to coronary angiography.

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.

Preoperative nuclear stress testing in the very old patient population

BACKGROUND Elderly patients awaiting moderate to high-risk surgery may undergo nuclear stress testing(NST)in order to evaluate their cardiovascular risk.The prognostic utility of such testing in the very elderly(≥85 years)has yet to be fully evaluated.Octogenarians and nonogenarians frequently have a number of concurrent conditions including a high rate of coronary disease,and therefore the prognostic value of NST for their preoperative risk assessment has been questioned.Our evaluation assesses the ability of nuclear stress testing to predict peri-operative cardiac outcomes in this patient population.AIM To investigate the ability of NST to predict peri-operative cardiac outcomes in elderly patients awaiting moderate to high-risk surgery.METHODS Patients≥85 years undergoing pre-operative NST were retrospectively evaluated.Patients undergoing low-risk surgery were excluded.Major adverse cardiac events(MACE)were considered any adverse event that occurred prior to discharge and included acute heart failure,arrhythmia,acute myocardial infarction,unstable angina,or death.Associations between patient risk factors,MACE,and the obtained results of the pre-operative stress testing,ejection fraction(<40%or≥40%),summed stress score(≤8,≥9),and the summed difference score(≤0,>0)were analyzed.RESULTS A total of 69 patients(mean age 88±2.6 years,31 males)underwent nuclear stress testing prior to surgery.There were 41(60%)patients found to have an abnormal NST.Sixteen(23%)patients were noted to experience post-operative MACE.No significant associations between risk factors and MACE were noted.Patients with an abnormal NST and/or a summed stress score≥9 weresignificantly(P<0.01)more likely to develop peri-operative MACE.CONCLUSION Indicated preoperative NST is useful to assess pre-operative risk in elderly patients≥85 years undergoing moderate to high-risk surgery.

The Extension Rate of the Medial Collateral Ligament of the Knee Joint during the Valgus Stress Test: Two Case Reports

This study aimed to evaluate the influence of measuring the length of the medial collateral ligament (MCL) to compare the MCL burden when the knee joint is placed under valgus stress in the open and closed and closed kinetic chain. Two examiners conducted the examination. The MCL length was measured using ultrasonography. Two subjects were measured in unload bearing and load-bearing positions, with and without valgus stress test at the knee joint extension and 30° flexion, under eight different measurement conditions. The MCL of the subject was delineated in the longitudinal direction using an ultrasound system. The attachment points of the medial femoral and tibial condyle of the MCL were identified, and the ligament length was measured. The MCL rate before and after the valgus stress test in the loading and unloading positions was calculated. The MCL length increased by an average of 8.9% when the external stress test was performed in the non-weight bearing and knee extension positions and by an average of 17.0% when external stress was applied in the non-weight bearing and knee flexion positions. The MCL length increased by an average of 12.2% when the external stress test was performed in the load-bearing and knee extension positions and an average of 8.9% when the valgus stress test was applied in load-bearing and knee flexion positions. In conclusion, the effect of valgus stress on the MCL differs between load-bearing and non-load-bearing positions. It is considered that the dynamic stabilization mechanism works in the knee joint flexion position in the load position and works simultaneously as the static stabilization mechanism, which limits the knee joint valgus and reduces the extension rate of MCL. Therefore, this study reconsiders the shifting of traditional therapy from open kinetic chain to close kinetic chain.

Determination of the Thermal Expansion Coefficient of Concrete at Early Ages by Using Temperature-stress Testing Machine

By using the uptodate temperatuer-stress testing machine, the thermal expansion coefficient of concrete at early ages was studied and indicative conclusions were achieved ： temperature rising due to hydration heat is not directly correlated with cracking, but the temperature and stress evolation process should be taken into consideration in the same time. Proper chemical admixtures and mineral cornpasitions can improve the mechanical properties of concrete such as thermal expansion coefficient, which is very indicative in practice.

Autonomic Function in Individuals with Slow Heart Rate Response following an Exercise Stress Test

Objective: To examine the autonomic function using HRV measures in apparently healthy individuals undergoing exercise stress test (EST) and demonstrating slow HRR response. Methods: HRV was measured with 12 lead ECGs during graded EST and analyzed via a post-processing method. Autonomic function was determined by Power Spectral Analysis of the very low frequency (VLF), low frequency (LF), high frequency (HF), and the ratio of LF/HF. We correlated HRV indices with resting, exercise, and recovery data. Results: No differences were found in anthropometric measurements, peak EST HR, and METS between individuals with slow HRR (below 18 b/min) compared with controls (HRR > 18 b/min). Only the VLF component of the HRV indices was statistically different (p = 0.03) at one-minute post-exercise compared with controls. Additionally, a significant correlation between HRR and resting LF and HF indices was found in the individuals with slow HRR but not in the controls. Conclusion: In apparently healthy individuals with slow HRR post-EST, autonomic function did not demonstrate any differences at any phase of the EST, including at one minute of recovery. However, a significant correlation was found between resting LF and HF powers and HRR in individuals with slow vagal reactivation post-exercise. The clinical and prognostic implications of such observation deserve further investigation.

Ministries Design Exchange Rate Stress Test for Labor-Intensive Industries

China’s Ministry of Commerce(MOFCOM)and the Ministry of Industry and Information Technology(MIIT)have designed a stress-test for China’s labor-intensive industries,

Methodology to Evaluate Fatigue Damage of High-Speed Train Welded Bogie Frames Based on On-Track Dynamic Stress Test Data

The current method of estimating the fatigue life of railway structures is to calculating the equivalent stress amplitude based on the measured stress data. However, the random of the measured data is not considered. In this paper, a new method was established to compute the equivalent stress amplitude to evaluate the fatigue damage based on the measurable randomness, since the equivalent stress is the key parameter for assessment of structure fatigue life and load derivation. The equivalent stress amplitude of a high-speed train welded bogie frame was found to obey normal distribution under uniform operation route that verified by on-track dynamic stress data, and the proposed model is, in effect, an improved version of the mathematical model used to calculate the equivalent stress amplitude. The data of a long-term, on-track dynamic stress test program was analyzed to find that the normal distribution parameters of equivalent stress amplitude values differ across different operation route. Thus, the fatigue damage of the high-speed train welded bogie frame can be evaluated by the proposed method if the running schedule of the train is known a priori. The results also showed that the equivalent stress amplitude of the region connected to the power system is more random than in other regions of the bogie frame.

Acoustic cardiography to improve detection of coronary artery disease with stress testing

AIM:To assess if performance of 12-lead exercise tolerance testing(ETT) can be improved by simultaneous acoustic cardiography and to compare the diagnostic performances of electrocardiography(ECG) during ETT and acoustic cardiography for detection or exclusion of angiographically proven coronary artery disease(CAD).METHODS:We conducted an explorative study with retrospective data analysis using a convenience sample of consecutive patients(n = 59,mean age:62 years) from an outpatient clinic in Switzerland,who were referred for ETT by their general practitioner on suspicion of CAD,and in whom,coronary angiography was carried out.Measurements included sensitivity,specificity,likelihood ratios and receiver operating characteristic curves.A standard,symptom-limited,12-lead ECG exercise tolerance test was performed by independent persons with simultaneous acoustic cardiography and subsequent cardiac angiography for determination of significant CAD.RESULTS:Thirty-four of the 59 adult subjects(58%) had a final diagnosis of CAD by angiography,and in 25 subjects,CAD was excluded by angiography.Sensitivity/specificity of ST segment depression in the group was 29%/92%,whereas the most powerful acoustic cardiographic parameter was the strength of the fourth heart sound(S4),with corresponding sensitivity/specificity of 53%/92%.The disjunctive combination of the S4 and ST depression had sensitivity/specificity of 68%/84%.CONCLUSION:In this preliminary pilot study,the use of acoustic cardiography alone during ETT or disjunctively with ST depression has been shown to be a simple and convenient method for the detection of CAD,which was superior to ST depression on the standardized ECG.

Use of Plastic Correction Formula to Improve Accuracy of Welding Residual Stress Test with Blind-Hole Method

The blind-hole method is the most widely used approach to experimentally determine the distribution of residual stress. This paper aims to improve test accuracy of welding residual stress and conducts an experimental study on the strain release factors involved when using the blind-hole method for Q235 and Q345, two steels commonly used in building structures. The ranges of strain release factors A and B in the elastic stage, the effects of strain release factors on residual stress calculated values, and the plastic corrected strain release factors are analyzed considering of the effect of plastic deformation around the blind hole on measurement accuracy. Finally, a simplified calculation formula to determine strain release factors is proposed for use with the blind-hole method. Results show that in the elastic stage, strain release factor A for Q235 and Q345 ranges from-0.399 to-0.525 and strain release factor B from-0.791 to-0.960. Changing the strain release factors A and B shows that calculated residual tensile stress varies in relation to a decrease in both factor values. However, there is a increase in calculated residual compressive stress with a decrease in the strain release factor A value, but there is an decrease with a decrease in strain release factor B value. Calculated residual stress applied to elastic strain release factors is compared with that applied to amended plastic strain release factors for Q235 steel. The maximum deviation between calculated residual stress and test stress is reduced from 21.1 to 1.0%,and for Q345 steel from 26.5 to 1.2%. It is thus evident that the plastic correction formula proposed in this paper can be used in calculations when conducting a residual stress test.

The Study of Electromagnetic Stress Testing Method on Oil-Gas Pipelines Based on WT

This paper proposes an effective method for early diagnosis (stress concentrating) of the oil-gas pipeline. Based on the principle of electromagnetic induction Faraday, we have designed and realized the nondestructive testing system for stress concentration area of ferromagnetic materials by means of the research of metal materials inverse magnetostrictive effect mechanism. The system changes the influence degree of the stress in ferromagnetic materials’ magnetic conductance to the corresponding voltage array by using discrete wavelet analysis method to process the data, in which not only the measuring accuracy is improved, but also the stress concentration is more directly reflected. The experiments confirm that the electromagnetic stress testing method is feasible and valid.

A recoverable stress testing algorithm for compression and encryption cards

This study proposes a recoverable stress testing algorithm (RSTA) for such special devices as compression/decom-pression card and encryption/decryption card. It uses a chaos function to generate a random sequence, and then, according to the random sequence, generates an effective command sequence. The dispatch of command obeys a special schedule strategy we designed for such devices, i.e., the commands are sent according to the command sequence, and the complete commands are put in a buffer for further result check. RSTA is used to test the HIFN compression acceleration card SAICHI-1000. Test results show that RSTA can make the card work continuously and adequately.

Research on Stress Testing of OSPF Protocol Implementation

The stability and robustness of routing protocol implementations (RPI) in a router are becoming more and more important with the growth of Internet scale. A novel approach named stress testing is proposed to test the properties of RPI. Compared with some traditional test techniques, stress testing is remarkably necessary to inspect and analyze RPI. The test environment is proposed and the test process of OSPF RPI is illustrated by a stochastic Petri Net model with large-scale route simulation and OSPF protocol emulation. Based on this model, the integrated performance tester (IP-TEST) is designed and developed, with which we test a CISCO2600 router. With mathematical methods, we find that the computational complexity of OSPF implementation in this router is O((lnN) 4)to the number of its routing table entries. This experiment shows that this technique can inspect the stability, the computational complexity and the scalability of RPI. Furthermore, it can also be widely used with other routing protocols, such as RIP and BGP.

Current Techniques and Practices for Myocardial Stress Testing—A Comparative Survey between Malta and International Nuclear Medicine Centres

Objectives: The study compared cardiac scintigraphy stress scanning practices applied in a National Maltese Nuclear Medicine centre and in international centres. This was achieved through the design of an online survey which investigated participant knowledge of stress testing, and current procedural practice. Methods: An online survey comprising 12 questions was prepared using Survey Monkey. Professional Nuclear Medicine groups such as the Medical-Physics-Engineering community and Virtual Radiopharmacy were targeted. Access to the survey remained open for eight months during which a periodic reminder was sent to optimise the response rate. Forty-three members responded from across Europe and Australasia. Chi-square tests and comparisons between multiple responses using IBM SPSS 20 were used to evaluate the results. Information related to Maltese practice was collated separately for review and comparative purposes. Results: The online survey participants comprised United Kingdom [72%], other European countries [18%] and Australasia [9%]. The majority of respondents [n = 39] reported pharmacological stress testing as being performed either alone or in conjunction with exercise stress testing as the preferred option. Most participants [60%] were aware of local stress test protocols but had limited knowledge in relation to guidelines designed for cases where patients were not suitable for pharmacological stress testing. Conclusion: The survey provided information about procedures within participating centres for scintigraphic cardiac stress scanning. Differences were identified with regards to the preferred radiopharmaceutical tracers and procedural protocols. Further investigation of examination techniques is warranted, with the aim of increasing standardisation of protocol compliance and the application of more suitable practice.

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.

An Experimental Study on Constant Current Load Test of Reinforced Concrete based on 3D Paraffin Isolation

Aiming at the complex corrosion degradation factors of reinforced concrete and clearing the deterioration mechanism in the constant stress state,a new type of constant current accelerated corrosion method in the saline soil environment was developed.The three-dimensional paraffin isolation specimens and the three-dimensional penetration specimens were taken as the research objects,and the Cl−content and AC impedance Bode diagram were measured.The macro morphology and micro analysis were also used to evaluate the corrosion degradation laws of the two groups of specimens.A constant current three-factor system accelerated model was established for the current acceleration factor,chloride ion,and sulfate ion acceleration factor.The experimental results show that,in the constant stress test of the saline soil environmental conditions,the paraffin isolation layer can effectively isolate corrosive chloride ions,which is a brand-new research method of single factor variable control in the constant stress test.According to the basic corrosion data,the law of constant current acceleration test is summarized and divided into five corrosion degradation stages,and each stage has significant changes in the accelerated corrosion efficiency.The corrosion degradation of a constant stress test is the combined effect of constant current,positive and negative penetration of chloride ions and sulfate ions.

Experimental study on temperature stress calculation and temperature control optimization of concrete based on early age parameters

Temperature control curve is the key to achieving temperature control and crack prevention of high concrete dam during construction,and its rationality depends on the accurate measurement of temperature stress.With the simulation testing machine for the temperature stress,in the present study,we carried out the deformation process tests of concrete under three temperature curves:convex,straight and concave.Besides,we not only measured the early-age elastic modulus,creep parameters and stress process,but also proposed the preferred type.The results show that at early age,higher temperature always leads to greater elastic modulus and smaller creep.However,the traditional indoor experiments have underestimated the elastic modulus and creep development at early age,which makes the calculated value of temperature stress too small,thus increasing the cracking risk.In this study,the stress values of the three curves calculated based on the strain and early-age parameters are in good agreement with the temperature stress measured by the temperature stress testing machine,which verifies the method accuracy.When the temperature changes along the concave curve,the law of stress development is in consistent with that of strength.Under this condition,the stress fluctuation is small and the crack prevention safety of the concave type is higher,so the concave type is better.The test results provide a reliable basis and support for temperature control curve design and optimization of concrete dams.

Mechanical properties of high-strength concrete subjected to high temperature by stressed test

Recently, the effects of high temperature on compressive strength and elastic modulus of high strength concrete were experimentally investigated. The present study is aimed to study the effect of elevated temperatures ranging from 20 ℃ to 700 ℃ on the material mechanical properties of high-strength concrete of 40, 60 and 80 MPa grade. During the strength test, the specimens are subjected to a 25% of ultimate compressive strength at room temperature and sustained during heating, and when the target temperature is reached, the specimens are loaded to failure. The tests were conducted at various temperatures (20-700 ℃) for concretes made with W/B ratios of 46%, 32% and 25%, respectively. The results show that the relative values of compressive strength and elastic modulus decrease with increasing compressive strength grade of specimen.

Nondestructive Testing and Characterization of Residual Stress Field Using an Ultrasonic Method

To address the difficulty in testing and calibrating the stress gradient in the depth direction of mechanical components, a new technology of nondestructive testing and characterization of the residual stress gradient field by ultrasonic method is proposed based on acoustoelasticity theory. By carrying out theoretical analysis, the sensitivity coefficients of different types of ultrasonic are obtained by taking the low carbon steel（12%C） as a research object. By fixing the interval distance between sending and receiving transducers, the mathematical expressions of the change of stress and the variation of time are established. To design one sending-one receiving and oblique incidence ultrasonic detection probes, according to Snell law, the critically refracted longitudinal wave（LCR wave） is excited at a certain depth of the fixed distance of the tested components. Then, the relationship between the depth of LCR wave detection and the center frequency of the probe in Q235 steel is obtained through experimental study. To detect the stress gradient in the depth direction, a stress gradient LCR wave detection model is established, through which the stress gradient formula is derived by the relationship between center frequency and detecting depth. A C-shaped stress specimen of Q235 steel is designed to conduct stress loading tests, and the stress is measured with the five group probes at different center frequencies. The accuracy of ultrasonic testing is verified by X-ray stress analyzer. The stress value of each specific depth is calculated using the stress gradient formula. Accordingly, the ultrasonic characterization of residual stress field is realized. Characterization results show that the stress gradient distribution is consistent with the simulation in ANSYS. The new technology can be widely applied in the detection of the residual stress gradient field caused by mechanical processing, such as welding and shot peening.

Optimal Design of Multiple Stresses Accelerated Life Test Plan Based on Transforming the Multiple Stresses to Single Stress

For planning optimum multiple stresses accelerated life test plans, a commonly followed guiding principle is that all parameters of the life-stress relationship should be estimated, and the number of the stress level combinations must be no less than the number of parameters of the life-stress relationship. However, the general objective of an accelerated life test（ALT） is to assess thep-th quantile of the product life distribution under normal stress. For this objective,estimating all model parameters is not necessary, and this will increase the cost of test. Based on the theoretical conclusion that the stress level combinations of the optimum multiple stresses ALT plan locate on a straight line through the origin of coordinate, it is proposed that a design idea of planning the optimum multiple stresses ALT plan through transforming the problem of designing an optimum multiple stresses ALT plan to designing an optimum single stress ALT plan. Moreover, a method of planning the optimum multiple stresses ALT plan which can avoid estimating all model parameters is established. An example shows that, the proposed plan which only has two stress level combinations could achieve an accuracy no less than the traditional plan, and save the test time and cost on one stress level combination at least; when the actual product life is less than the design value, even the deviation of the model initial parameters value is up to 20%, the variance of the estimation of thep-th quantile of the proposed plan is still smaller than the traditional plans approximately 25%. A design method is provided for planning the optimum multiple stresses ALT which uses the statistical optimum degenerate test plan as the optimum multiple stresses accelerated life test plan.