Diagnostic Yield of Customized Exercise Provocation Following Routine Testing
Diagnostic Yield of Customized Exercise Provocation Following Routine Testing
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DOI：
10.1016/j.amjcard.2019.03.027
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发表时间：
2019-06-15
影响因子：
2.8
通讯作者：
Wasfy, Meagan M.
中科院分区：
文献类型：
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作者：
Churchill, Timothy W.;Disanto, Michael;Wasfy, Meagan M.
临床指南提倡定制运动试验，以解决患者特定的诊断目标，包括再现表现出的劳力性症状。然而，在有劳力性主诉的患者中，将定制的运动测试添加到分级运动中的诊断率尚未得到严格的检查，这是本研究的重点。使用前瞻性收集的数据，我们分析了在不确定的分级运动试验和气体交换测量后定制的额外运动激发的诊断率。如果在没有解释性诊断或病理学的情况下，发现与主诉相关的临床可操作诊断或再现症状，则将额外检测定义为“阳性”。在1,110名完成分级测试的患者中，122名（11%）有症状的患者接受了额外的定制运动测试（例如，冲刺间隔和比赛模拟）。与那些没有接受额外测试的人相比，这组人更年轻（29 [四分位数范围19至45]对46 [25至58]岁），女性比例不成比例（43%对27%）。主要症状包括心悸（46%）、头晕/晕厥（25%）、胸痛（14%）、呼吸困难（11%）和劳力不耐受（3%）。122例患者中有48例（39%）的额外检测结果为“阳性”，其中26例（54%）显示了临床上可采取行动的诊断，或48例患者中有22例（46%）在没有解释性诊断的情况下重现症状。总之，虽然临床指南建议以患者为中心定制运动试验，但这些数据首次证明，在不确定的分级运动试验后选择性添加定制运动激发可提高运动评估的诊断率。(C)2019爱思唯尔公司All rights reserved.
Clinical guidelines advocate for customization of exercise testing to address patient-specific diagnostic goals, including reproduction of presenting exertional symptoms. However, the diagnostic yield of adding customized exercise testing to graded exercise in patients presenting with exertional complaints has not been rigorously examined and is the focus of this study. Using prospectively collected data, we analyzed the diagnostic yield of customized additional exercise provocation following inconclusive graded exercise test with measurement of gas exchange. Additional testing was defined as "positive" if it revealed a clinically-actionable diagnosis related to the chief complaint or reproduced symptoms in the absence of an explanatory diagnosis or pathology. Of 1,110 patients who completed a graded test, 122 (11%) symptomatic patients underwent additional customized exercise testing (e.g., sprint intervals and race simulations). Compared with those who did not undergo additional testing, this group was younger (29 [interquartile range 19 to 45] vs 46 [25 to 58] year old) and disproportionately female (43% vs 27%). Presenting symptoms included palpitations (46%), lightheadedness/syncope (25%), chest pain (14%), dyspnea (11%), and exertional intolerance (3%). Additional testing was "positive" in 48 of 122 (39%) of patients by revealing a clinically actionable diagnosis in 26 of 48 (54%) or reproducing symptoms without an explanatory diagnosis in 22 of 48 (46%). In conclusion, while patient-centered customization of exercise testing is suggested by clinical guidelines, these data are the first to demonstrate that the selective addition of customized exercise provocation following inconclusive graded exercise testing improves the diagnostic yield of exercise assessment. (C) 2019 Elsevier Inc. All rights reserved.