Add to bookmarks
Poster

Exercise Test as a Prognostic Tool

This is an educational poster aimed at reviewing the interpretation of exercise ECG test as a prognostic tool. In order to do so, the poster goes over some factors that should be considered when evaluating the results of this test and it reviews the electrode placement of the Modified Mason-Likar Configuration. Lastly, this poster reviews the Heart Rate Recovery (HRR) and Metabolic Equivalents of Tasks (METs) graphs and give an overview of some of the more common exercise testing protocols used.

HRR (Heart Rate Recovery)

METs (Metabolic equivalents of task)

Exercise Test Responses

Exercise test interpretation 

Factors to consider

  • ST Measurements
    • ST slope/level 
    • ST/HR index 
    • ST/HR Hysteresis
  • Risk Assessment
    • HRR 
    • METs 
    • TWA 
    • Duke
    • FVEr
  • Functional measurements
    • METs 
    • HRR 
    • RPP 
    • Chronotropic responses

Exercise Testing Protocols

Bibliography

  1. Bourque, J.M., et al., Value of Exercise Stress Electrocardiography for Risk Stratication in Patients With Suspected or Known Coronary Artery Disease in the Era of Advanced Imaging Technologies. JACC. Cardiovascular imaging, 2015. 8(11): p. 1309-1321. 
  2. Borjesson, M., et al., The role of exercise testing in the interventional era: A shift of focus. Interventional Cardiology (London), 2012. 4(5): p. 577-583.
  3. Cole, C.R., et al., Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med, 1999. 341(18): p. 1351-7.
  4. Fletcher, G.F., et al., Exercise Standards for Testing and Training: A Scientific Statement From the American Heart Association. Circulation, 2013. 128(8): p. 873-934. 
  5. Kligfield, P., et al., Exercise electrocardiogram testing: beyond the ST segment. Circulation, 2006. 114(19): p. 2070-82. 
  6. Leino, J., et al., Combined assessment of heart rate recovery and T-wave alternans during routine exercise testing improves prediction of total and cardiovascular mortality: the Finnish Cardiovascular Study. Heart Rhythm, 2009. 6(12): p. 1765-71. 
  7. Nieminen, T., et al., T-wave alternans predicts mortality in a population undergoing a clinically indicated exercise test. Eur Heart J, 2007. 28(19): p. 2332-7. 
  8. Maddox, T.M., et al., The prognostic importance of abnormal heart rate recovery and chronotropic response among exercise treadmill test patients. American Heart Journal, 2008. 156(4): p. 736-44. 
  9. Peterson, P.N., et al., Association of exercise capacity on treadmill with future cardiac events in patients referred for exercise testing. ACC Cardiosource Review Journal, 2008. 17(6): p. 49-52.