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Interpretation of immediate exercise treadmill test: Interreader reliability between cardiologist and noncardiologist in a chest pain evaluation unit

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ANNALS OF EMERGENCY MEDICINE 2000年第1期36卷 10-14页

作者： Kirk, JD Turnipseed, SD Diercks, DB London, D Amsterdam, EA Univ Calif Davis Med CtrSch Med Div Emergency Med PSSB Sacramento CA 95817 USA Univ Calif Davis Sch Med Med Ctr Div Cardiovasc Med Sacramento CA 95817 USA Univ Calif Davis Sch Med Med Ctr Dept Internal Med Sacramento CA 95817 USA

Study objective: To determine whether attending physicians in a chest pain evaluation unit (CPEU) can perform and interpret exercise testing with the same accuracy as cardiologists. Methods: Between January 1996 and November 1998, immediate exercise tests were performed and interpreted by internists with additional training in exercise testing who serve as attending physicians in a CPEU at a large university medical center. For quality assurance, all tests were overread by a cardiologist. Test results were compared for each reader, and ail tests with discrepant readings were reinterpreted by an independent cardiologist who was blinded to the previous results. Patients' clinical course was monitored for at least 30 days after exercise testing. Results: The study group consisted of 645 patients (347 men, 298 women). Discrepant interpretations were found in 11 (1.7%) patients. The agreement was 98.4% (kappa value 0.9618). The majority of discrepancies were insignificant and were based on subtle differences in the definition of a nondiagnostic test or the degree of ST-segment shift. Of the 11 discordant readings, the blinded cardiologist concurred with 5 (45%) of the CPEU interpretations and 4 (36%) of the cardiologist interpretations. in 2 cases, there was disagreement by all 3 interpreters. There was no cardiac morbidity or mortality of any patient with a discrepant reading. Conclusion: Our results suggest that noncardiologists serving as attending physicians in a CPEU can accurately interpret exercise tests and overreading by cardiologists far quality assurance is unnecessary.

关键词：心脏病学胸痛/病因学冠心病/诊断心电描记术/统计学和数值数据运动试验/统计学和数值数据医务人员医院观察者偏差病人医疗小组/统计学和数值数据质量保证卫生保健危险因素成年人女(雌)性人类男(雄)性中年人

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Test-retest reproducibility of the exercise treadmill examination in lumbar spinal stenosis

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MAYO CLINIC PROCEEDINGS 2000年第10期75卷 1002-1007页

作者： Deen, HG Zimmerman, RS Lyons, MK McPhee, MC Verheijde, JL Lemens, SM Mayo Clin Dept Neurol Surg Jacksonville FL 32224 USA Mayo Clin Dept Phys Med & Rehabil Jacksonville FL 32224 USA

Objective: To provide further validation of the treadmill test by assessing its "test-retest" reproducibility, Patients and Methods: In this prospective study, 28 patients with severe lumbar spinal stenosis underwent exercise treadmill testing, first at a walking speed of 1.2 mph and then at the patient's preferred walking speed, All patients had a second treadmill examination or "retest," No treatment intervention was performed between the initial test and the retest. Time to first symptoms (TFS) and total ambulation time (TAT) were measured, Differences between the baseline examination and the retest examination were assessed by using the concordance correlation coefficient (CCC) as well as graphically, Results: There was good reproducibility between baseline test and retest results for all 4 end points: 1.2 mph, TFS (CCC = 0.90);1.2 mph, TAT (CCC = 0.89);preferred walking speed, TFS (CCC = 0.98);and preferred walking speed, TAT (CCC = 0.96), The median difference between trials was not significantly different from zero for any of the 4 outcomes, Conclusions: Exercise treadmill testing has good test-retest reproducibility, There was no learning phenomenon associated with the test procedure. The study further validates the clinical utility of exercise treadmill testing in patients with lumbar spinal stenosis and neurogenic claudication.

关键词：运动试验/统计学和数值数据椎板切除术学习小腿/神经支配腰椎/病理生理学腰椎/外科学疼痛/病因学感觉异常/病因学周围神经系统疾病/并发症前瞻性研究椎管狭窄/病理生理学椎管狭窄/外科学统计学非参数时间因素步行/生理学老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Evaluating the exposure and disease relationship with adjustment for different types of exposure misclassification: A regression approach

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STATISTICS IN MEDICINE 1999年第20期18卷 2795-2808页

作者： Kosinski, AS Flanders, WD Emory Univ Rollins Sch Publ Hlth Dept Biostat Atlanta GA 30322 USA Emory Univ Rollins Sch Publ Hlth Dept Epidemiol Atlanta GA 30322 USA

Misclassification of exposure can lead to biased results in the epidemiologic research. Available methods accounting for misclassification often require the use of a gold standard or assume non-differential misclassification of exposure. We present a regression approach which can detect and account for different types of misclassification when estimating the exposure and disease relationship. This approach uses two imperfect measures of a dichotomous exposure and does not require a gold standard. Standard statistical packages with a logistic regression module can be used for estimation of parameters through the EM algorithm process. Two examples are used to illustrate the methodology. Copyright (C) 1999 John Wiley & Sons, Ltd.

关键词：算法血管成形术气囊冠状动脉/统计学和数值数据冠状动脉分流术/统计学和数值数据冠心病/治疗运动试验/统计学和数值数据似然函数随机对照试验(主题) 回归分析体层摄影术发射型计算机单光子/统计学和数值数据女(雌)性人类男(雄)性

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Independent and incremental value of coronary artery calcium for predicting the extent of angiographic coronary artery disease - Comparison with cardiac risk factors and radionuclide perfusion imaging

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第3期34卷 777-786页

作者： Schmermund, A Denktas, AE Rumberger, JA Christian, TF Sheedy, PF Bailey, KR Schwartz, RS Mayo Clin & Mayo Fdn Div Cardiovasc Dis & Internal Med Rochester MN 55905 USA Mayo Clin & Mayo Fdn Biostat Sect Rochester MN 55905 USA Univ Texas Sch Med Dept Internal Med Div Cardiol Houston TX USA

OBJECTIVES The study was done to test the ability to predict the extent of angiographically determined coronary artery disease (CAD) by quantification of coronary calcium using electron-beam computed tomography (EBCT) and to compare it with more conventional parameters for delineating the angiographic extent of CAD, that is, cardiovascular risk factors and radionuclide single-photon emission computed tomography (SPECT). BACKGROUND The angiographic extent of CAD is a powerful predictor of subsequent events. Use of EBCT may be able to define it by virtue of its ability to determine plaque burden. METHODS We examined 308 patients presenting with suspected but not previously known CAD who underwent selective coronary angiography. As measures of the angiographic extent of CAD, coronary artery greater even 20 (CAGE greater than or equal to 20) and CAGE greater than or equal to 50 scores represented the total number of coronary segments with greater than or equal to 20% or greater than or equal to 50% stenoses, respectively. The EBCT derived total calcium scores were obtained in 291 patients, risk factors as defined by the National Cholesterol Education Program in 239 patients, and SPECT scans in 136 patients. RESULTS Using multiple linear regression analysis, total calcium scores were better independent predictors of both CAGE greater than or equal to 20 and CAGE greater than or equal to 50 scores than either a SPECT-derived radionuclide perfusion score or the risk factors age, male gender and ratio of total/high density lipoprotein (HDL) cholesterol. The association between EBCT and angiographic scores remained highly significant after excluding the influence of all interrelated risk factors and SPECT variables (r = 0.65;p < 0.001 for CAGE greater than or equal to 20 scores, r = 0.50;p < 0.001 for CAGE greater than or equal to 50 scores). CONCLUSIONS Coronary calcium predicts the angiographic extent of CAD in symptomatic patients and provides independent and incremental

关键词：钙质沉着症/诊断显像冠状血管造影术/方法冠状血管造影术/统计学和数值数据冠心病/诊断显像冠状血管/诊断显像运动试验/方法运动试验/统计学和数值数据线性模型预后放射性药物危险因素 99m锝甲氧基异丁基异腈铊放射性同位素体层摄影术发射型计算机单光子/方法体层摄影术发射型计算机单光子/统计学和数值数据体层摄影术 X线计算机/方法体层摄影术 X线计算机/统计学和数值数据老年人女(雌)性人类男(雄)性中年人

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Intravenous prostaglandin E₁ reduces soluble vascular cell adhesion molecule-1 in peripheral arterial obstructive disease

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AMERICAN HEART JOURNAL 2001年第4期142卷 733-739页

作者： Gianetti, J De Caterina, M de Cristofaro, T Ungaro, B Biol, D Del Guercio, R De Caterina, R CNR Inst Clin Physiol Lab Thrombosis & Vasc Res I-56100 Pisa Italy Univ G dAnnunzio Dept Cardiol Chieti Italy Univ Naples 2 Dept Internal Med Naples Italy Univ Naples Federico II Dept Biochem Naples Italy Univ Naples Federico II Dept Med Biotechnol Naples Italy

Objectives Elevated levels of soluble (s) vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1, pointing to activation of cells involved in vascular inflammation, have been previously reported in peripheral arterial obstructive disease (PAOD). We tested the hypothesis that intravenous prostaglandin E-1 (PGE(1)) treatment, which produces clinical benefits in this condition, might decrease such levels. Methods Ten subjects (age range 58 +/- 10 years, 6 male, 4 female) with characterized Fontaine stage IIa to IV PAOD (ankle/arm pressure index <0.96) were entered into a treatment protocol with twice daily intravenous infusions of PGE(1) (alprostadil) at 120 mug per day, repeated for 10 consecutive days. Preinfusion and postinfusion plasma samples were stored for blind enzyme immunoassays of soluble adhesion molecules and the fibrinolytic marker tissue plasminogen activator, type-1 plasminogen-activator inhibitor, and D-dimer. Results Estimates of severity of pain at rest, consumption of analgesics, magnitude of trophic lesions, remission to lower Fontaine stages, and favorable changes in the venoarteriolar reflex documented significant beneficial effects of the treatment. Significant (P < .01) pretreatment and posttreatment reductions of in all soluble markers explored were found. Particularly, sVCAM-1 exhibited a significant decrease after each infusion, which was sustained at the last day of treatment (from 854 +/- 214 ng/mL to 775 +/- 215 ng/mL across the first infusion, from 773 +/- 146 ng/mL to 680 +/- 110 ng/mL across the last infusion). Conclusion Thus a global decrease of vascular cell activation appears to occur as a result of PGE, administration and may contribute to the observed clinical benefits in PAOD.

关键词：前列地尔/投药和剂量前列地尔/药理学前列地尔/治疗应用动脉闭塞性疾病/血液动脉闭塞性疾病/诊断动脉闭塞性疾病/药物疗法运动试验/统计学和数值数据纤维蛋白溶解/药物作用输注静脉内胞间黏附分子1/血液胞间黏附分子1/药物作用疼痛测定外周血管疾病/血液外周血管疾病/诊断外周血管疾病/药物疗法治疗结果血管细胞黏附分子1/血液血管细胞黏附分子1/药物作用老年人女(雌)性人类男(雄)性中年人

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ST-segment deviation during 24-hour ambulatory electrocardiographic monitoring and exercise stress test in healthy male subjects 51 to 75 years of age: The Copenhagen City Heart Study

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AMERICAN HEART JOURNAL 1999年第6期137卷 1070-1074页

作者： Vaage-Nilsen, M Rasmussen, V Sorum, C Jensen, G Univ Copenhagen Rigshosp Copenhagen City Heart Study DK-1168 Copenhagen Denmark Hvidovre Univ Hosp Dept Cardiol Copenhagen Denmark

Background Although ST-segment deviation has been evaluated and used during many years both on continuous electrocardiographic Holter monitoring and during exercise stress testing, considerable controversy still remains concerning the prevalence and diagnostic significance of fortuitously discovered ST-segment deviation in asymptomatic healthy persons. Methods and Results The occurrence of ST-segment deviation was studied in a population of 63 clinically healthy male subjects 51 to 75 years of age, with the use of 24-hour Hotter monitoring and exercise stress testing. The subjects were recruited from the Copenhagen City Heart Study and were without cardiovascular risk factors, chronic diseases, or medication and without cardiovascular events during 5 to 12 years before and 3 to 5 years after admission. The specificity, that is, the probability of displaying a negative test result in healthy subjects without disease, was 1.0 when using as criterion for significant ST-segment deviation a horizontal or descending ST-segment depression of >0.20 mV or ST-segment elevation greater than or equal to 0.15 mV during Holier monitoring, and acceptable, for example, 0.95, when using as criterion a horizontal or descending ST-segment depression of greater than or equal to 0.15 mV during Hotter monitoring or at the exercise test, respectively. Furthermore, the specificity was 0.95 when a horizontal or downsloping ST-segment depression of 0.1 mV was displayed in both the Holter and exercise electrocardiographic recording system. Conclusions Thus in asymptomatic persons, the usual criterion for significant ST-segment depression of 0.1 mV can be applied when occurring in both electrocardiographic recording systems. However, if one test alone is used, the criterion of significant ST-segment depression should be 0.15 mV. Absence of ST-segment deviation during Holter monitoring and exercise stress testing, indicated with a specificity of 1.0 or 0.95 according to choice of criterion, imp

关键词：运动试验/仪器和设备运动试验/方法运动试验/统计学和数值数据随访研究病人遴选前瞻性研究质量控制参考值可重复性结果敏感性与特异性统计学非参数市区人口/统计学和数值数据人类男(雄)性中年人

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Athen氏分数在运动负荷试验中的应用

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甘肃医药 1993年第2期12卷 73-74页

作者：宁金民兰州市第一医院

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PERCEPTUAL AND MOTOR SKILLS 1999年第1期88卷 304-316页

作者： Chung, PK Yuen, CK Hong Kong Sports Dev Board Sports Inst Elite Training Grp Shatin Peoples R China

To examine the criterion-related validity of traditional, modified, and YMCA sit-and-reach tests and the relationships of these with abdominal muscular strength and endurance measured by the sit-up tear, 52 university men of mean age 20.7 yr. were administered two trials of six measurements in counterbalanced order, including traditional, modified, and YMCA sit-and-reach tests, passive straight-leg raise, low-back flexibility evaluation, and 1-min. sit-up test. Pearson product-moment correlations were significant (p<.05) for traditional and modified sit-anti-reach tests with hamstrings' flexibility (rs=.71 and .77, respectively), Also, the YMCA sit-and-reach test was significantly associated with hamstrings' flexibility (r=.64) and low-back flexibility (r=. 47). Stepwise multiple regression indicated hamstrings' flexibility was the only significant predictor of traditional and modified sit-and-reach rests, explaining the variances of 59.1% and 19.8%, respectively. However, both hamstring and low-back flexibility were significant predictors fur the YMCA sit-and-reach test, which in total accounted for 52.2% of explained variance. Traditional and modified sit-and-reach tests are valid in assessing hamstrings' flexibility only, whereas the YMCA sit-and-reach test is valid for measuring both the hamstring and low-back flexibility.

关键词：腹肌/生理学生物力学运动试验/统计学和数值数据用力/生理学香港肌收缩/生理学身体耐力/生理学身体素质/生理学性别因素学生/统计学和数值数据大学青少年成年人人类男(雄)性

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Performance stability in simultaneous tasks of pedalling and reaction time

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PERCEPTUAL AND MOTOR SKILLS 1999年第3期88卷 1193-1199页

作者： Arcelin, R Brisswalter, J Univ Poitiers LAPMH Dept Appl Physiol & Hlth Factors F-86034 Poitiers France

The purpose of the study was to examine the within-subject variability in heart rate, pedal rate, choice reaction time, and error rate during simultaneous tasks of cycling and reaction time. Students in physical education classes exercised a 10-min. submaximal cycloergometer test at a relative power output corresponding to 60% of their own maximal aerobic power, in a replication procedure. Concomitantly, the subjects performed a 2-choice reaction time task from Min. 3 of the exercise bout. No significant differences (p>.05) were found between the individual means in the tests for the diverse parameters. The total intraindividual variability averaged 1.3% for heart rate, 2.2% for pedal rate, and 13.3% for choice reaction rime. Because wide within-subject. variability was observed (from 7.7 to 16.7%), the reliability of choice reaction rime was low. These data suggest that it is necessary to quantify more accurately the intraindividual differences of reaction time measures for the interpretation of exercise-changes in cognitive functioning.

关键词：选择行为/生理学认知/生理学能量代谢运动(Exercise)/生理学运动试验/统计学和数值数据心率/生理学反应时间/生理学可重复性结果作业完成和分析成年人女(雌)性人类男(雄)性

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Influence of music on Wingate Anaerobic Test performance

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PERCEPTUAL AND MOTOR SKILLS 1999年第1期88卷 292-296页

作者： Pujol, TJ Langenfeld, ME SE Missouri State Univ Dept Hlth & Leisure Cape Girardeau MO 63701 USA

While several studies have investigated the effects of music on cardiovascular endurance performance and perceived exertion during exercise of moderate intensity, few studies have investigated such effects on supramaximal exercise bouts. The purpose of the present study was to assess whether music affects performance on the Wingate Anaerobic Test. Each of the 12 men and 3 women were required to report to the laboratory on two occasions, once for tests in rile music condition and once fur tests in the nonmusic condition. Conditions were randomly ordered. All music selections were set at the saale tempo. On each test day subjects performed a series of three Wingate Anaerobic Tests with 30-sec. rests in between. On Test 3 subjects were asked to continue pedaling until fatigued. Mean Power Output, Maximum Pos er Output, Minimum Power Output, and Fatigue index were compared between conditions for each test using a repeated-measures analysis of variance. Time to fatigue on Trial 3 compared by analysis of variance gave no significant differences between conditions fur any measures.

关键词：声刺激厌氧生活/生理学方差分析运动试验/统计学和数值数据用力/生理学音乐身体耐力/生理学成年人女(雌)性人类男(雄)性

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