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Herz. 1982 Feb;7(1):20-8.

[Principles of ergometry. - Part II: criteria for assessment of the exercise test. Criteria for interpretation (author's transl)].

[Article in German]


Because exercise testing is of value not only for "qualitative" but even more for "quantitative" diagnostic purposes, the exercise ECG is often of minor importance in relation to the other exercise responses. 1. Exercise capacity. Maximal aerobic power or aerobic capacity as a measure of physical and cardiovascular performance can not be calculated from measurements during submaximal exercise (with the exception of young healthy persons), but correlates well with the maximal workload attained in a (symptom-limited) maximal test when sex, age and the state of health as well as of physical training are taken into account. Therefore, exercise capacity as measured in such a test is of diagnostic and prognostic significance. 2. Heart rate. Changes in heart rate at a given submaximal workload correlate well with qualitative changes of exercise capacity in the individual. The peak heart rate that is attained in a (symptom-limited) maximal exercise test (HR max) varies greatly interindividually. It declines with age and because heart rate is one of the major determinants of myocardial oxygen uptake it is a measure of "coronary reserve" in the patient with coronary heart disease. Limits for professional activities or other physical exercise may be expressed as a certain percentage of HR max (% HR max). 3. Blood pressure. An inadequate rise of systolic blood pressure or a fall despite increasing workloads indicate inadequacy of cardiac output. In coronary heart disease, it is often a sign of acute left ventricular dysfunction due to reversible ischemia and is of therapeutic and prognostic consequence. 4. ECG. Electrocardiographic changes should always be related to other exercise responses. Sensitivity and specificity of the ST-segment changes depend on sex, age, resting ECG, type of exercise, lead system and medical treatment. In coronary heart disease, "Bayes' theorem" should be regarded. The predictive value of a test result should be calculated, based on the prevalence and the pretest likelihood of the disease. Other than ST-segment changes are or relatively minor significance or need further evaluation.

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