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Arch Cardiovasc Dis. 2018 Aug 6. pii: S1875-2136(18)30103-7. doi: 10.1016/j.acvd.2018.05.005. [Epub ahead of print]

French Society of Cardiology guidelines on exercise tests (part 1): Methods and interpretation.

Author information

1
Cardiac Rehabilitation Department, Turin Clinic, 75008 Paris, France.
2
Cardiac Rehabilitation Department, Loire-Vendée-Océan Hospital, boulevard des Régents, BP2, 44270 Machecoul, France. Electronic address: pavy.bruno@wanadoo.fr.
3
Paediatric and Congenital Cardiology Department, M3C Regional Competences Centre, University Hospital, 54511 Vandoeuvre-les-Nancy, France; EA 3450, Development, Adaptation and Disadvantage, Faculty of Medicine, University of Lorraine, 54600 Villers-lès-Nancy, France.
4
Platform for Clinical Research Assistance, University Hospital, 54511 Vandoeuvre-les-Nancy, France; EA 4360 APEMAC, Faculty of Medicine, University of Lorraine, 54600 Villers-lès-Nancy, France.
5
Cardiac Rehabilitation Department, Bligny Medical Centre, 91640 Briis-sous-Forges, France.
6
Cardiac Rehabilitation Department, Bordeaux University Hospital, 33604 Pessac, France.
7
Cardiac Rehabilitation Department, Corentin-Celton Hospital, 92130 Issy-Les-Moulineaux, France.
8
Cardiac Rehabilitation Department, Les Rosiers Clinic, 21000 Dijon, France.
9
Paediatric and Congenital Cardiology Department, M3C Regional Reference Centre, University Hospital, 34295 Montpellier, France; Physiology and Experimental Biology of Heart and Muscles Laboratory, PHYMEDEXP, UMR CNRS 9214-Inserm U1046, University of Montpellier, 34295 Montpellier, France.
10
Cardiology Functional Evaluation Department, University Hospital Laennec, 44800 Nantes, France.
11
Cardiology Department, Hospital Lariboisière, 75010 Paris, France.
12
Department of Sport Medicine, Pontchaillou Hospital, Inserm 1099, University of Rennes 1, 35043 Rennes, France.

Abstract

The exercise test is still a key examination in cardiology, used for the diagnosis of myocardial ischemia, as well as for the clinical evaluation of other heart diseases. The cardiopulmonary exercise test can further define functional capacity and prognosis for any given cardiac pathology. These new guidelines focus on methods, interpretation and indications for an exercise test or cardiopulmonary exercise test, as summarized below. The safety rules associated with the exercise test must be strictly observed. Interpretation of exercise tests and cardiopulmonary exercise tests must be multivariable. Functional capacity is a strong predictor of all-cause mortality and cardiovascular events. Chest pain, ST-segment changes and an abnormal ST/heart rate index constitute the first findings in favor of myocardial ischemia, mostly related to significant coronary artery disease. Chronotropic incompetence, abnormal heart rate recovery, QRS changes (such as enlargement or axial deviations) and the use of scores (based on the presence of various risk factors) must also be considered in exercise test interpretation for a coronary artery disease diagnosis. Arrhythmias or conduction disorders arising during the exercise test must be considered in the assessment of prognosis, in addition to a decrease or low increase in blood pressure during the exercise phase. When performing a cardiopulmonary exercise test, peak oxygen uptake and the volume of expired gas/carbon dioxide output slope are the two main variables used to evaluate prognosis.

KEYWORDS:

Cardiopulmonary exercise test; Exercise test; French guidelines; Interpretation; Interprétation; Recommandations françaises; Safety; Sécurité; Test cardiopulmonaire; Épreuve d’effort

PMID:
30093254
DOI:
10.1016/j.acvd.2018.05.005

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