جستجوی مقالات مرتبط با کلیدواژه « exercise test » در نشریات گروه « پزشکی »

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Cardiogoniometry (CGM) is a noninvasive technique for quantitative three‑dimensional vectorial analysis of myocardial depolarization and repolarization. We describe a method of surface electrophysiological cardiac assessment using CGM performed at rest to detect variables helpful in identifying coronary artery disease (CAD) and interplaying factors in patients who underwent coronary artery bypass graft (CABG).

In this study, all patients with CAD undergoing CABG were enrolled. Echocardiography, CGM, and electrocardiography (ECG) were obtained before surgery and a month later. The ECG and CGM alterations were compared before and after CABG and the accuracy of those two methods was evaluated.

In this study, 50 patients were enrolled, of which 33 (66%) were male versus 17 (44%) female, with a mean age of 39.12 ± 60 years. The mean ejection fraction before and after surgery was 44.3 ± 7.9% (range: 20–55) and 40.9 ± 12.5% (20–50), respectively. Before surgery, all patients had sinus rhythm, five cases had left bundle‑branch block (LBBB), and one case was with right bundle‑branch block (RBBB). Subsequently, after surgery, five cases had LBBB, and two cases were found to have RBBB. The rate of postoperation bleeding was 20%. There was no significant change in echocardiographic characteristics before and after operation (P = 0.81); likewise, no significant change was seen in ECG criteria before and after operation (P = 0.96). A significant correlation was seen regarding CGM characteristics before and after CABG (P = 0.003).

A significant association was seen regarding CGM characteristics before and after undergoing an operation. In addition, the specificity and sensitivity of the CGM and ECG before and after operation improved well.

 Exercise stress test (EST) is commonly performed to diagnose cardiovascular diseases. Patients undergoing EST usually experience anxiety and stress mainly because they lack knowledge about the test.

 The present double-blinded randomized controlled trial aimed to compare the effects of education via face-to-face, interactive multimedia, and short messaging service (SMS) methods on anxiety level (main outcome) and vital signs (secondary outcomes) in candidates for EST.

 Candidates of EST with moderate to severe anxiety were allocated randomly (block size of 6) to receive education via the face-to-face routine method (control, n = 47), multimedia (n = 48), or SMS (n = 49). The educational content was similar in the groups and focused on EST methods, preparations, and potential adverse effects. Anxiety was assessed at baseline and one week after education. The patients’ blood pressure and pulse rate were measured at baseline, before, and after the EST.

 One-hundred-forty-four patients completed the study. The post-intervention anxiety reduced significantly in the SMS group compared to the control group (P < 0.001, Cohen’s d = -1.09) and in the SMS group compared to the multimedia group (P < 0.001, Cohen’s d = -0.83). The anxiety score was not significantly different between the multimedia and control groups (P = 0.454, Cohen’s d = -0.26), although within-group comparison showed a significant decrease in the multimedia and SMS groups. Patients who received education via SMS also experienced lower pulse rates than those in the control group.

 Because of the effectiveness of education via SMS in decreasing patients’ anxiety scores, we recommend using this method to prevent anxiety before EST, especially in developing and low-income countries.

Iron-induced cardiomyopathy is the main cause of heart failure in patients with beta-thalassemia major (β-TM). Early diagnosis and timely cardiac iron overload (IO) therapy can improve patients’ prognosis.

This study evaluated the value of exercise test parameters and high-sensitivity C-reactive protein (hs-CRP) in detecting cardiac IO in patients with β-TM.

Forty β-TM patients (age range:18 – 48) were enrolled in this cross-sectional study. Serum hs-CRP was measured using ELISA. Echocardiography and exercise treadmill tests were performed. Cardiac IO was determined using cardiac T2* (CT2*) magnetic resonance imaging, and patients were divided into abnormal (CT2* < 20 ms; n = 22) and normal (CT2* > 20 ms; n = 18) groups. Statistical analyses were conducted using SPSS software. The Mann-Whitney U-test was used to assess differences between the groups. The correlations of variables were evaluated using Pearson’s or Spearman’s correlation analysis. Receiver operator characteristic (ROC) curves were drawn to calculate the optimum cutoff for each test.

We found a significantly higher level of hs-CRP (P = 0.011) and lower levels of the chronotropic index (CI) (P = 0.009) and heart rate recovery (HRR) at minutes 2 – 5 (P < 0.01) in the patients with abnormal CT2*. CT2* was inversely correlated with hs-CRP (r = -0.381, P = 0.022) and positively correlated with the CI (r = 0.346, P = 0.031) and HRR at minute 4 (HRR4) (r = 0.456, P = 0.005). ROC curve data showed diagnostic values of CI (AUC = 0.80, P = 0.005), HRR4 (AUC = 0.786, P = 0.008), and hs-CRP (0.711, P = 0.033) in predicting the severity of IO. These tests showed high sensitivity (CI = 84.6%, HRR4 = 84.6%, and hs-CRP = 85.7%) but low specificity (CI = 70.6%, HRR4 = 41.2%, and hs-CRP = 53.3%) in detecting the severity of cardiac IO.

We found that hs-CRP, CI, and HRRs were significantly associated with the severity of cardiac IO. Despite high sensitivity, these markers showed poor specificity in predicting cardiac iron deposition in β-TM patients.

Since hyperthyroidism could be associated with right ventricular dysfunction, this study intended to investigate right ventricular (RV) function using strain echocardiography in hyperthyroid patients both at rest and in maximum-stress conditions.  This cross-sectional study was conducted at Rajaie Cardiovascular Medical and Research Center, Tehran, Iran, from January 2019 to January 2020. All study participants completed a maximum treadmill exercise test, as well as a complete two-dimensional echocardiogram at rest and the peak of stress test. The data were analyzed using SPSS statistical software. The independent samples t test and Mann–Whitney U test were used for numerical, and the Chi square test was used for nominal variables. P<0.05 was considered statistically significant.  The final analysis included 52 participants (26 subjects in each group). In a maximal stress situation, we found that among the RV function indices, RV global longitudinal strain (P=0.0001), systolic strain rate (P=0.0001), diastolic strain rate (P=0.0002), and tricuspid annular plane systolic excursion (P=0.019) were reduced significantly in the hyperthyroid patients compared to the control group. There was also a linear correlation between RV size and thyroid stimulating hormone (TSH) level (P=0.009, r=0.36). Moreover, we found a negative linear correlation between TSH level with maximum stress RV strain and diastolic strain rate (P<0.001). The findings of the present study revealed a significant change in RV function indices among hyperthyroid patients. Therefore, it highlights the necessity of early diagnosis and treatment of hyperthyroidism, as well as RV function evaluation in these patients.

Nowadays, cardiovascular disease, including coronary artery disease, is the leading cause of death around the world. Duke Treadmill Score (DTS) is used as a prognostic score for patients suspected of coronary artery disease. Investigating the Relationship between DTS and syntax score (SxScore) as an indicator of complexity and severity of coronary artery disease in patients with intermediate and high Duke Score. This cross-sectional study was conducted at the exercise test unit of Heshmat Hospital in Rasht from September 2017 to December 2018. Among 1033 patients that passed exercise cardiac stress testing (EST), 118 patients who had positive exercise testing for CAD were enrolled. Coronary angiography was performed, and SxScore, a marker of CAD complexity, was determined. The relationship between DTS and SxScore was then evaluated. The data were analyzed by SPSS version 21. The risk of positive EST raised age more than 61 years (OR=1.072; 95%; CI=1.046-1.099), Hypertension (OR=3.235; 95%; CI=2.097-4.992), Hyperlipidemia (OR=2.109; 95%; CI=1.371-3.242) and Diabetes Mellitus (OR=2.15; CI=1.22-3.14). The presence of the following factors reduced positive EST: female (OR=0.377;95%; CI=0.133-1.068), retired (OR=0.128;95%; CI=0.045-0.361). The results of the present study showed that there was no significant difference between the degree of coronary artery involvement based on syntax with Duke scores (P=0.328). Although both DTS and Syntax scores are useful in evaluating coronary artery disease, there isn't a significant relationship between these scores, and they don't coincide. In other words, we cannot use DTS to predict the Syntax score.

Type 2 diabetes is a chronic disease with an increase in microvascular risks such as retinopathy and neuropathy. According to cardiac neuropathy in diabetic patients and the high prevalence of diabetes, the current study is designed to evaluate heart rate recovery and exercise capacity in diabetic versus healthy individuals. . This clinical study was performed on 228 patients. The age, sex, weight, BMI, educational level, duration of disease, history of other medical disease and smoking, TG, LDL, CHOL, HDL, FBS, SBP, and DBP were listed in the checklist and were evaluated later. The SPSS software was used to analyze data statistically using t-test, Mann-Whitney, and Chi-Square tests. P>0.05 was considered significant.   Mean Heart Rate Recovery, in the first mean, was 16.35 ± 10.56 in the study group and was 25.9 ± 13 in the control group (P=0.001). The mean heart rate during rest in the study group was 84.39 ± 13.5 and in the control group was 81.44 ± 14.27 beat/min (P=0.110). The mean Heart Rate Reserve in the study group was 48.43 ± 18.87 and in the control group was 57.8 ± 24.17 (P=0.001). Negative Chronotropic Incompetence was seen in 10 patients and 19 healthy individuals (P=0.048).   According to our results and previous studies, heart rate recovery in diabetic patients is significantly less than in healthy individuals. The risk of cardiovascular disease in these patients is higher versus healthy individuals, and according to this fact, they need periodic visits.

Volleyball requires high anaerobic and aerobic capacity, so to evaluate this important issue, there are various tests such as Bruce maximal test. There is no standard field test to measure cardiovascular function for women volleyball according to exercise mode.

This study aimed to design and validation of functional cardiorespiratory exercise field tests in women volleyball players.

In a diagnostic value study, 64 competitive female volleyball players with three years of playing experience (Age: 27 ± 6) were voluntarily selected from Tehran’s first division league. To evaluate VO2max, the Bruce test and the newly designed test, which was fully explained in the methodology section, were used. Data were analyzed using the ROC curve test.

The results showed that the area under the curve exceeded 0.71%, and the sensitivity and specificity values were 70.8% and 75%, respectively. The PPV obtained in this study was 89.5, and also the NPV values were 46.2, indicating relatively good reliability for screening.

The present study shows that the newly designed test for women volleyball players, which uses a special exercise mode in modeled volleyball, has relatively good reliability. This test may be used as an efficient and inexpensive field test to measure the VO2max in women volleyball players.

Torsade de pointes (TdP) is an infrequent, yet fatal ventricular arrhythmia as it may degenerate into sudden cardiac death. Given its lethality, it is important to understand its triggering factors and management. We report a rare case of TdP during an exercise stress test. A 64-year-old woman with controlled hypertension underwent an exercise stress test due to her atypical chest pain. She had no family history of sudden cardiac death. A baseline electrocardiogram showed an insignificant prolongation in her corrected QT (QTc) value (479 ms). During the second stage, she developed a transient TdP and was managed in the intensive care unit. A further examination showed moderate hypokalemia, and coronary angiography showed 90% to 95% stenosis in her right coronary artery. A follow-up exercise stress test after electrolyte replacement therapy and coronary revascularization showed a negative ischemic response without arrhythmia. TdP in this patient might have been related to 3 conditions: ischemic burden, hypokalemia, and exercise. Further examinations are needed to inform further management and preventive measures. (Iranian Heart Journal 2021; 22(4): 140-144)

The acute occlusion of a coronary artery without the evidence of myocardial infarction might immediately affect both the diagnosis and treatment of coronary artery disease. We present the case with a sudden occlusion of the left main coronary artery without typical chest pain following an exercise tolerance test and rapid spontaneous reperfusion of the left main coronary artery.

To evaluate asymptomatic cardiac disease in patients with ocular pseudoexfoliation.Patients and

Forty-two patients with ocular pseudoexfoliation (with or without glaucoma) and 40 patients without pseudoexfoliation, who had no positive signs or symptoms of cardiac diseases, were enrolled in this study. For each participant a standard treadmill exercise test, as a noninvasive and reliable method for detecting ischemic heart disease, was performed under supervision of a cardiologist. The prevalence of ischemic heart disease was compared in the case and control groups.

The mean age of participants was 68.38 ± 8.10 years in the case and 62.45 ± 8.40 years in the control group. There was no statistically significant difference between the two groups in terms of diabetes mellitus, hyperlipidemia, smoking, and family history of ischemic heart disease. Twenty patients (47.6 %) with pseudoexfoliation and 9 participants (22.5 %) without pseudoexfoliation had hypertension (P = 0.02). There were 10 (23.8 %) positive exercise tests in the pseudoexfoliation group and 8 (20 %) positive exercise tests in participants without pseudoexfoliation (P = 0.78).

Based on our findings ocular pseudoexfoliation was not associated with increased risk of asymptomatic ischemic heart disease as evaluated by a treadmill exercise test. Keywords: Pseudoexfoliation syndrome; Exercise test; Myocardial ischemia; Iran.

Considering the increased expenditure in public health sector, especially the increased cost in hospitals and clinics, there is an urgent need to control these costs mainly by ensuring adherence to clinical guidelines for diagnostic procedures. In this study we aim to investigate the adherence of heart clinics to guideline for exercise tolerance test.

This cross-sectional study was performed on 308 patients who were referred for ECG exercise test in 3 clinics located in the city of Shiraz, Iran in 2018. Demographic and clinical data were recorded and the indications of exercise test for each patient was reviewed according to the ACC/AHA guideline for exercise tolerance test.

Exercise tests were found to be inappropriately done in 121 (39.3%) participants. Among the patients for whom the test was done without indication 79 (65.3%) were women and the gender difference was statistically significant (P < 0.01); women were 18.5% more likely to undergo exercise test without indication. There was more inappropriate tests among nonanginal pain subsets comparing to other presenting symptoms (P < 0.001). Age, coronary risk factors, reason for performing exercise tests and private health system were not predictors of inappropriate use (P > 0.05).

This study confirms that more than one third of exercise tests done in the participants are inappropriate. Wide availability of exercise test makes it vulnerable to overuse and additional unnecessary cost to health care systems.

Pedometer feedback home-based cardiac rehabilitation (PFHCR) programs have been effective in augmenting exercise tolerance. Our aim was to investigate the effects of PFHCR on cardiovascular functional capacity in patients with myocardial infarction (MI).

Forty MI patients were divided into two intervention and two control groups (n=10)in a randomized controlled trial. The intervention group received a PFHCR program including routine medications along with continuous exercise program, whereas the control group received traditional care without PFHCR. Baseline evaluations and cardiovascular stresses were controlled during the 8-week follow-up rehabilitation program in all patients. Data analysis was conducted using one-way ANOVA and paired sample student’s t-test (P ≤ 0.05).

At baseline, no significant differences were observed between the groups. After eight weeks of PFHCR, the intervention groups had significantly higher metabolic equivalent(P = 0.001), VO2max (P = 0.001), total exercise times (P = 0.001), and total distance traveled(P = 0.003) when compared with the control groups. However, no significant intra-group or inter-group differences in variables were observed between the men and women.

Our results showed that PFHCR exhibited significant optimal effects on the cardiovascular functional capacity in MI patients.

Hypertension is nowadays increasingly observed among the workforce population. There are many risk factors for hypertension. This study was conducted to survey hypertension and its associated risk factors among male workers of the industrial sector in Shiraz city. 500 male workers employed in Shiraz city industries participated voluntarily (age range of 20 to 59 years). A questionnaire and direct measurements were used to collect required data. The questionnaire consisted of two parts including a) demographic and occupational and b) anthropometric (height, weight, BMI, WHtR) and physiological (blood pressure and VO2-max) characteristics of the subjects. Mean (standard deviation) of systolic and diastolic Blood Pressure (BP), and Mean Arterial Pressure (MAP) in workers were 128.37±14.78, 83.13±13.10, and 98.21±13.36 mmHg, respectively. The results showed that systolic and diastolic BP, and MAP significantly were related to BMI, shift work, and smoking. Also, statistical analysis revealed that mean values of VO2-max between workers with normal and high blood pressure are significantly different. The results of this study demonstrated that domestic and occupational life style and cardio-respiratory fitness are the risk factors for hypertension in the studied workers.

There exist gaps in the implementation of guideline-recommended treatments and interventions to manage syncope. The present study aimed to investigate the adherence to the current guideline for the diagnosis and management of syncope patients referred to a tertiary center. A cross-sectional study was carried out with the study group consisting of 324 consecutive patients, who were diagnosed with unexplained syncope with one or more attacks and were referred for head-up tilt table test (HUTT) between September 2009 and September 2011 to Tehran Heart Center. All the patients underwent a thorough evaluation, including a careful medical history and physical examination as well as a thorough history of all procedures performed before referral. The data collected was compared between patients with positive and negative HUTT results and also based on the referring physician, in order to assess the deviation from syncope guideline in their management. We compared the selected groups using a chi-square test for categorical variables and student t-test or analysis of variance (ANOVA) for continuous variables where appropriate. A total of 324 patients with a Mean (SD) age of 41.04 (17.74) years were enrolled in the study (158 patients, i.e. 48.8%, were male). HUTT was positive in 181 (55.8%) patients. Brain computed tomography scan and coronary angiography were performed more in the initial assessment of the patients with a negative HUTT compared with patients with negative HUTT (P=0.001 and P=0.01, respectively). Significantly higher rates of brain MRI (P=0.01), brain imaging (P=0.03), and electroencephalography (P=0.002) were observed among the neurologists' referrals while echocardiography (P<0.001), exercise tolerance test (P=0.001), electrocardiogram Holter monitoring (P<0.001), and coronary angiography (P=0.02) were significantly more performed in patients referred by a cardiologist. We observed a noticeable deviation from the current guideline for the management of syncope although the patients underwent expensive tests with little benefit.

Age-related obesity, besides genetics, depends on diet and exercise. There are various strategies for the time duration of exercise. Nevertheless, there continues to be little knowledge about its diverse models for women in middle-age. This study investigated the impacts of interval training on the loss of weight and coronary risk panel and compared its effectiveness with continuous training effectiveness. This research was a simplified randomized trial. Participants (n = 86) were selected among sedentary overweight or obese women aged 45 - 65 years who had attended (during the three months before the study) weight-loss consulting programs. Of all 86 participants, 74 completed the study. They were randomly divided into 2 groups: A group with continuous training and a group with interval training. The weight assessment parameters, including change of weight, body composition, and blood sample tests, were carried out before and after the 12-week intervention. In comparison with baseline data, all parameters changed significantly in both groups. The study groups showed a similar weight loss pattern after the intervention. The same changes were noticed in the body mass index (BMI), total cholesterol (TC), and low-density lipoprotein (LDL) cholesterol levels in post-test groups (P > 0.05). Elevation in high-density lipoprotein (HDL) cholesterol levels differed significantly in post-test groups (P < 0.05). The decrease in the ratio of TC to HDL-C was more in interval exercise than in continuous training. Both exercise time models could improve significantly the weight loss parameters but it seems that the interval-training pattern provides more health along with weight loss. This may be clinically useful and provide a physical activity guideline for body weight loss in middle-aged women.