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The accuracy of noninvasive stress myocardial imaging for detecting coronary artery disease in clinical practice.

https://arctichealth.org/en/permalink/ahliterature143550
Source
Hosp Pract (1995). 2010 Apr;38(2):14-8
Publication Type
Article
Date
Apr-2010
Author
Leonard Schwartz
Christopher B Overgaard
Author Affiliation
Toronto General Hospital, Toronto, ON, Canada. Dr.Leonard.Schwartz@uhn.on.ca
Source
Hosp Pract (1995). 2010 Apr;38(2):14-8
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Chi-Square Distribution
Coronary Angiography - standards
Coronary Artery Disease - diagnosis - epidemiology
Echocardiography - standards
Exercise Test - standards
False Positive Reactions
Female
Humans
Male
Mass Screening - methods - standards
Middle Aged
Ontario - epidemiology
Patient Selection
Predictive value of tests
Prevalence
Sensitivity and specificity
Sex Distribution
Tomography, Emission-Computed, Single-Photon - standards
Abstract
There is a wide variation in reported accuracy ofnoninvasive stress myocardial imaging as a screening tool for coronary artery disease (CAD). This study was undertaken to determine its current accuracy in a wide spectrum of patients with chest pain syndromes using invasive coronary angiography as the gold standard.
The patient population consisted of consecutive patients undergoing coronary angiography in whom noninvasive stress imaging, either nuclear or echocardiographic, was performed within 6 months prior to the angiogram. The specificity, sensitivity, positive and negative predictive values, and diagnostic accuracy for detecting > or =1 lesions with > or =50% diameter coronary stenosis were determined for each modality.
Of the 227 eligible patients, 141 were men and 86 were women; 70% had significant CAD. The diagnostic accuracy overall was 71% and was no different for nuclear or echocardiographic testing. The positive predictive value (86% vs. 52%; P = 0.002) and diagnostic accuracy (83% vs. 51%; P = 0.002) were better in men than in women.
In this study, noninvasive stress imaging lacked the accuracy of a good screening test for significant CAD. This finding was particularly true for women, for whom it was not much better than a coin toss.
PubMed ID
20469609 View in PubMed
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Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation.

https://arctichealth.org/en/permalink/ahliterature119409
Source
Eur J Prev Cardiol. 2013 Jun;20(3):442-67
Publication Type
Article
Date
Jun-2013
Author
Alessandro Mezzani
Larry F Hamm
Andrew M Jones
Patrick E McBride
Trine Moholdt
James A Stone
Axel Urhausen
Mark A Williams
Author Affiliation
Salvatore Maugeri Foundation IRCCS, Scientific Institute of Veruno, Exercise Pathophysiology Laboratory, Cardiac Rehabilitation Division, Italy. alessandro.mezzani@fsm.it
Source
Eur J Prev Cardiol. 2013 Jun;20(3):442-67
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Canada
Europe
Exercise Test - standards
Exercise Therapy - standards
Exercise Tolerance
Heart Diseases - diagnosis - physiopathology - rehabilitation
Humans
Predictive value of tests
Recovery of Function
Societies, Medical - standards
Time Factors
Treatment Outcome
United States
Abstract
Aerobic exercise intensity prescription is a key issue in cardiac rehabilitation, being directly linked to both the amount of improvement in exercise capacity and the risk of adverse events during exercise. This joint position statement aims to provide professionals with up-to-date information regarding the identification of different exercise intensity domains, the methods of direct and indirect determination of exercise intensity for both continuous and interval aerobic training, the effects of the use of different exercise protocols on exercise intensity prescription and the indications for recommended exercise training prescription in specific cardiac patients' groups. The importance of functional evaluation through exercise testing prior to starting an aerobic training program is strongly emphasized, and ramp incremental cardiopulmonary exercise test, when available, is proposed as the gold standard for a physiologically comprehensive exercise intensity assessment and prescription. This may allow a shift from a 'range-based' to a 'threshold-based' aerobic exercise intensity prescription, which, combined with thorough clinical evaluation and exercise-related risk assessment, could maximize the benefits obtainable by the use of aerobic exercise training in cardiac rehabilitation.
PubMed ID
23104970 View in PubMed
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Clinical experience of a new reference material for exercise capacity in exercise stress testing in Sweden.

https://arctichealth.org/en/permalink/ahliterature295512
Source
Clin Physiol Funct Imaging. 2018 Jul; 38(4):699-702
Publication Type
Comparative Study
Journal Article
Multicenter Study
Date
Jul-2018
Author
Thomas Lindow
Henrik Mosén
Henrik Engblom
Author Affiliation
Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden.
Source
Clin Physiol Funct Imaging. 2018 Jul; 38(4):699-702
Date
Jul-2018
Language
English
Publication Type
Comparative Study
Journal Article
Multicenter Study
Keywords
Adult
Aged
Aged, 80 and over
Bicycling - standards
Cardiovascular Diseases - diagnosis - physiopathology
Exercise Test - standards
Exercise Tolerance
Female
Humans
Male
Middle Aged
Myocardial Perfusion Imaging
Predictive value of tests
Reference Values
Reproducibility of Results
Retrospective Studies
Sweden
Abstract
In 2014, the Swedish Association of Clinical Physiology recommended the use of a new reference material for exercise capacity in bicycle exercise stress testing, 'the Kalmar material'. Compared to the formerly used reference material, 'the Kristianstad material', an increase in the amount of patients being classified as having decreased exercise capacity was expected, but the extent of this in clinical practice is not known.
Results of exercise capacity from 1449 bicycle exercise tests, in patients aged =20 years (656 women, 793 men) performed at two departments of Clinical Physiology before and after change of reference materials, were collected. Maximal workload was related to the predicted values of both reference materials. If made, recommendations for supplemental nuclear myocardial perfusion imaging study by the attending physician were noted.
Using the new reference material, 31% of all patients were classified as having a decreased exercise capacity, compared to 17% using the formerly used reference material. The difference between the two reference materials was largest in the older age groups. In one of the departments, an increase in recommendations of supplemental myocardial perfusion studies was seen after introduction of the new reference material, whereas the opposite was seen at the other department.
A large amount of patients are being classified as having decreased exercise capacity and very few as having good exercise capacity using the new reference material for exercise capacity.
PubMed ID
28940689 View in PubMed
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Commonly used reference values underestimate oxygen uptake in healthy, 50-year-old Swedish women.

https://arctichealth.org/en/permalink/ahliterature294246
Source
Clin Physiol Funct Imaging. 2018 Jan; 38(1):25-33
Publication Type
Comparative Study
Journal Article
Date
Jan-2018
Author
M Genberg
B Andrén
L Lind
H Hedenström
A Malinovschi
Author Affiliation
Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.
Source
Clin Physiol Funct Imaging. 2018 Jan; 38(1):25-33
Date
Jan-2018
Language
English
Publication Type
Comparative Study
Journal Article
Keywords
Age Factors
Cardiorespiratory fitness
Exercise Test - standards
Female
Forced expiratory volume
Humans
Lung - physiology
Male
Middle Aged
Models, Biological
Muscle Contraction
Muscle, Skeletal - metabolism
Oxygen consumption
Predictive value of tests
Prospective Studies
Reference Values
Reproducibility of Results
Respiration
Sex Factors
Spirometry
Sweden
Vital Capacity
Abstract
Cardiopulmonary exercise testing (CPET) is the gold standard among clinical exercise tests. It combines a conventional stress test with measurement of oxygen uptake (VO2 ) and CO2 production. No validated Swedish reference values exist, and reference values in women are generally understudied. Moreover, the importance of achieved respiratory exchange ratio (RER) and the significance of breathing reserve (BR) at peak exercise in healthy individuals are poorly understood. We compared VO2 at maximal load (peakVO2 ) and anaerobic threshold (VO2@AT ) in healthy Swedish individuals with commonly used reference values, taking gender into account. Further, we analysed maximal workload and peakVO2 with regard to peak RER and BR. In all, 181 healthy, 50-year-old individuals (91 women) performed CPET. PeakVO2 was best predicted using Jones et al. (100·5%), while SHIP reference values underestimated peakVO2 most: 112·5%. Furthermore, underestimation of peakVO2 in women was found for all studied reference values (P 1·1 (2 328·7 versus 2 176·7 ml min-1 , P = 0·11). Lower BR (=30%) related to significantly higher peakVO2 (P 1·1 in healthy individuals was found. A lowered BR is probably a normal response to higher workloads in healthy individuals.
Notes
ErratumIn: Clin Physiol Funct Imaging. 2018 May;38(3):524 PMID 29656605
PubMed ID
27312352 View in PubMed
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Feasibility of a 2-km walking test for fitness assessment in a population study.

https://arctichealth.org/en/permalink/ahliterature223722
Source
Scand J Soc Med. 1992 Jun;20(2):119-26
Publication Type
Article
Date
Jun-1992
Author
R M Laukkanen
P. Oja
K H Ojala
M E Pasanen
I M Vuori
Author Affiliation
President Urho Kaleva Kekkonen Institute for Health Promotion Research, Kaupinpuistonkatu, Tampere.
Source
Scand J Soc Med. 1992 Jun;20(2):119-26
Date
Jun-1992
Language
English
Publication Type
Article
Keywords
Adult
Aged
Body mass index
Exercise Test - standards
Feasibility Studies
Female
Finland
Heart rate
Humans
Male
Mass Screening - standards
Middle Aged
Oxygen consumption
Physical Fitness
Time Factors
Walking
Abstract
A simple 2-km Walking Test has been developed for determining the cardiorespiratory fitness of healthy adults. In the present study the following aspects of the feasibility of this test for population assessment were investigated: participation willingness, the percentage of test qualified subjects, the percentage of acceptable test performances and the resources needed for field test administration. A representative sample was drawn from the 27 to 65-year-old population in a rural municipality in northeastern Finland. Subjects were recruited on the basis of the results of health questionnaires and interviews. One fourth of the volunteers were excluded from the test because of health problems. The 2-km walking tests were administered outdoors in the municipality center. More than 50% of the subjects successfully completed two consecutive walking tests. This study indicated that the 2-km Walking Test is a feasible alternative as a measure of cardiovascular fitness for large population groups and could potentially be used in exercise related health promotion programmes.
PubMed ID
1496331 View in PubMed
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In search of childhood asthma: questionnaire, tests of bronchial hyperresponsiveness, and clinical evaluation.

https://arctichealth.org/en/permalink/ahliterature15412
Source
Thorax. 2002 Feb;57(2):120-6
Publication Type
Article
Date
Feb-2002
Author
S T Remes
J. Pekkanen
K. Remes
R O Salonen
M. Korppi
Author Affiliation
Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland. Sami.Remes@kuh.fi
Source
Thorax. 2002 Feb;57(2):120-6
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Asthma - diagnosis
Bronchial Hyperreactivity - diagnosis
Bronchial Provocation Tests - standards
Bronchoconstrictor Agents - diagnostic use
Child
Diagnosis, Differential
Exercise Test - standards
Humans
Methacholine Chloride - diagnostic use
Questionnaires
Research Support, Non-U.S. Gov't
Sensitivity and specificity
Spirometry - standards
Abstract
BACKGROUND: The definition or diagnosis of asthma is a challenge for both clinicians and epidemiologists. Symptom history is usually supplemented with tests of bronchial hyperresponsiveness (BHR) in spite of their uncertainty in improving diagnostic accuracy. METHODS: To assess the interrelationship between respiratory symptoms, BHR, and clinical diagnosis of asthma, the respiratory symptoms of 1633 schoolchildren were screened using a questionnaire (response rate 81.2%) and a clinical study was conducted in a subsample of 247 children. Data from a free running test and a methacholine inhalation challenge test were available in 218 children. The diagnosis of asthma was confirmed by a paediatric allergist. RESULTS: Despite their high specificity (>0.97), BHR tests did not significantly improve the diagnostic accuracy after the symptom history: area under the receiver operator characteristic (ROC) curve was 0.90 for a logistic regression model with four symptoms and 0.94 for the symptoms with free running test and methacholine inhalation challenge results. On the other hand, BHR tests had low sensitivity (0.35-0.47), whereas several symptoms had both high specificity (>0.97) and sensitivity (>0.7) in relation to clinical asthma, which makes them a better tool for asthma epidemiology than BHR. CONCLUSIONS: Symptom history still forms the basis for defining asthma in both clinical and epidemiological settings. BHR tests only marginally increased the diagnostic accuracy after symptom history had been taken into account. The diagnosis of childhood asthma should not therefore be overlooked in symptomatic cases with no objective evidence of BHR. Moreover, BHR should not be required for defining asthma in epidemiological studies.
PubMed ID
11828040 View in PubMed
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A new approach to the interpretation of Canadian Home Fitness Test scores.

https://arctichealth.org/en/permalink/ahliterature220484
Source
Can J Appl Physiol. 1993 Sep;18(3):304-16
Publication Type
Article
Date
Sep-1993
Author
R J Shephard
C. Bouchard
Author Affiliation
School of Physical & Health Education, University of Toronto, Ontario.
Source
Can J Appl Physiol. 1993 Sep;18(3):304-16
Date
Sep-1993
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Biomechanical Phenomena
Canada
Classification
Energy Metabolism
Exercise Test - standards
Female
Health Surveys
Heart rate
Humans
Male
Mathematics
Middle Aged
Motivation
Oxygen consumption
Physical Fitness
Pulse
Reference Values
Reproducibility of Results
Selection Bias
Sex Factors
Abstract
A modification of the Astrand (1960) nomogram procedure was applied to Canadian Home Fitness Test data obtained on 13,258 subjects, ages 15 to 69 years, during the 1981 Canada Fitness Survey. Norms were developed to allow an empirical five-level categorization of aerobic fitness, based on the attained rate of stepping and the recovery pulse count 5 to 15 s following exercise. Because of uncertainties regarding the net mechanical efficiency of stepping and the selective recruitment of fit older subjects, the apparent rate of aerobic fitness decrease with aging was no more than half of that seen in laboratory measurements, and the sex differential at any given age (about 25%) was larger than expected. The new approach thus does not claim a high level of accuracy for the predicted peak MET values. Nevertheless, it has an inherent advantage over the equation of Jetté et al. (1976) in that it takes more direct account of variations in pulse count when categorizing fitness. Moreover, there is no artificial ceiling that limits scores for very fit subjects. Tests are now needed to assess the accuracy of the proposed fitness categorizations relative to laboratory determinations of maximal oxygen intake.
Notes
Comment In: Can J Appl Physiol. 1994 Mar;19(1):103-78186761
Comment In: Can J Appl Physiol. 1994 Jun;19(2):226-348081325
PubMed ID
8031343 View in PubMed
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PAR-Q, Canadian Home Fitness Test and exercise screening alternatives.

https://arctichealth.org/en/permalink/ahliterature233392
Source
Sports Med. 1988 Mar;5(3):185-95
Publication Type
Article
Date
Mar-1988
Author
R J Shephard
Author Affiliation
School of Physical and Health Education, Faculty of Medicine, University of Toronto.
Source
Sports Med. 1988 Mar;5(3):185-95
Date
Mar-1988
Language
English
Publication Type
Article
Keywords
Canada
Exercise Test - standards
Health Status Indicators
Humans
Physical Exertion
Physical Fitness
Predictive value of tests
Questionnaires
Risk factors
Abstract
Procedures for the preliminary screening of asymptomatic adults who wish to exercise are reviewed with particular reference to experience gained through the mass use of the physical activity readiness questionnaire (PAR-Q) and the Canadian Home Fitness Test (CHFT). It is argued that both a brief submaximal exercise test and a subsequent moderate increase of habitual activity are extremely safe tactics to recommend to a symptom-free adult. There are some useful minor modifications which could be made to the PAR-Q instrument, but its sensitivity and specificity relative to such criteria as medical examination, hypertension, CHFT completion and exercise-induced ECG abnormalities compare favourably with alternative self-administered procedures. The basic difficulty of screening an asymptomatic population (highlighted by Bayes theorem) is the high percentage of false positive and false negative test results. One remedy would be to stratify the population in terms of known cardiac risk factors and to restrict detailed pre-exercise screening to the high risk segment of the population.
PubMed ID
3368685 View in PubMed
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Re: "A new approach to the interpretation of Canadian Home Fitness Test Scores" by R.J. Shephard and C. Bouchard.

https://arctichealth.org/en/permalink/ahliterature218659
Source
Can J Appl Physiol. 1994 Mar;19(1):103-7
Publication Type
Article
Date
Mar-1994

13 records – page 1 of 2.