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How to Use Heart Rate Changes to Improve Exercise Test Results   V. Froelicher, MD Professor of Medicine Stanford University VA Palo Alto HCS
What are the Questions being asked regarding Coronary Disease and Exercise Testing   ,[object Object],[object Object],[object Object]
Why do we need more than ST depression?   ,[object Object],[object Object],[object Object]
Goal is convince you: ,[object Object],[object Object],[object Object]
 
Statistical Prediction Rules ,[object Object],[object Object]
Clinical Scores ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Making any of these Five Mistakes Evaluating Diagnostic Tests can invalidate Scores & Stats ,[object Object],[object Object],[object Object],[object Object],[object Object]
Making any of these Four Mistakes Evaluating Prognostic Tests can invalidate Scores & Stats ,[object Object],[object Object],[object Object],[object Object]
Population Selection Critical!! ,[object Object],[object Object],[object Object]
Duke Treadmill Score (uneven lines, the elderly?)
The HR Recovery Studies Hi-light problems with Prediction of Prognosis ,[object Object],[object Object],[object Object]
CABS History Abnormal resting ECG METs Delta PRP Resting ST depression  METs Abnormal  exercise ST   MI /Q waves CABS History METs Abnormal  exercise ST   MI /Q waves CABS History Delta PRP Resting ST depression  Variable 1.4 1.4 .9 1 1.5 .9 1.2 1.7 1.9 .9 1.2 1.5 1.7 1 1.7 HR  65  years years All causes ≥ 65 years  65 Cardiac years ≥ 65 Age Cause of death
The ST/HR index studies highlight the problem of limited challenge ,[object Object],[object Object]
 
Males Choose only one per group <40=low prob 40-60= intermediate probability >60=high probability Total Score: Reason for stopping =5 induced Angina Occurred =3 Exercise test Yes=5 Diabetes? Yes=5 Hypercholesterolemia? Non-cardiac pain =1 Probable/atypical =3 Definite/Typical = 5 Angina History 40 to 55 yrs = 12 >55 yrs =20 Age > 2mm =25 1-2mm =15 Exercise ST Depression 190 to 220 bpm =6 160 to 189 bpm =12 130 to 159 bpm =18 100 to 129 bpm = 24 Less than 100 bpm = 30 Maximal Heart Rate Sum Circle response Variable
Comparison of Tests
Therefore scores, ST/HR index and Heart rate recovery should be part of every standard ECG Exercise test

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How to Use Heart Rate Changes to Improve Exercise Test Results How to Use Heart Rate Changes to Improve Exercise Test Results

  • 1. How to Use Heart Rate Changes to Improve Exercise Test Results V. Froelicher, MD Professor of Medicine Stanford University VA Palo Alto HCS
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  • 11. Duke Treadmill Score (uneven lines, the elderly?)
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  • 13. CABS History Abnormal resting ECG METs Delta PRP Resting ST depression METs Abnormal exercise ST MI /Q waves CABS History METs Abnormal exercise ST MI /Q waves CABS History Delta PRP Resting ST depression Variable 1.4 1.4 .9 1 1.5 .9 1.2 1.7 1.9 .9 1.2 1.5 1.7 1 1.7 HR  65 years years All causes ≥ 65 years  65 Cardiac years ≥ 65 Age Cause of death
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  • 16. Males Choose only one per group <40=low prob 40-60= intermediate probability >60=high probability Total Score: Reason for stopping =5 induced Angina Occurred =3 Exercise test Yes=5 Diabetes? Yes=5 Hypercholesterolemia? Non-cardiac pain =1 Probable/atypical =3 Definite/Typical = 5 Angina History 40 to 55 yrs = 12 >55 yrs =20 Age > 2mm =25 1-2mm =15 Exercise ST Depression 190 to 220 bpm =6 160 to 189 bpm =12 130 to 159 bpm =18 100 to 129 bpm = 24 Less than 100 bpm = 30 Maximal Heart Rate Sum Circle response Variable
  • 18. Therefore scores, ST/HR index and Heart rate recovery should be part of every standard ECG Exercise test