Elsevier

Progress in Cardiovascular Diseases

Volume 77, March–April 2023, Pages 95-106
Progress in Cardiovascular Diseases

Assessment of lifestyle-related risk factors enhances the effectiveness of cardiac stress testing

https://doi.org/10.1016/j.pcad.2023.03.004Get rights and content
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Abstract

Cardiac stress tests have been widely utilized since the 1960s for the diagnostic and prognostic assessment of patients with suspected coronary artery disease (CAD). Clinical risk is primarily based on assessing the presence and magnitude of inducible myocardial ischemia. However, the primary factors driving mortality risk have changed over recent decades. Factors such as typical angina and inducible ischemia have decreased, whereas the percentage of patients with diabetes, obesity and hypertension have increased. There has also been a marked temporal increase in the percentage of patients who require pharmacologic testing due to inability to perform treadmill exercise at the time of cardiac stress testing and this need has emerged as the most potent predictor of mortality risk in contemporary stress test populations. However, the long-term clinical risk posed by the inability to perform exercise and concomitant CAD risk factors are rarely reflected in the assessment of patients' prognostic risk in cardiac stress test reports. In this review, we suggest that the clinical utility of present-day cardiac stress testing can be improved by developing a more comprehensive assessment that integrates and reports all factors which modulate patients' long-term clinical risk following stress and testing. This should include assessment of patients' CAD risk factors, physical activity habits and mobility risks, and identification of the reasons why patients could not exercise at the time of cardiac stress testing. In addition, the assessment of four core non-aerobic functional parameters should be considered among patients who cannot exercise: assessment of gait speed, handgrip strength, lower extremity strength, and standing balance.

Abbreviations

ACSM
American College of Sports Medicine
AHA
American Heart Association
CAC
coronary artery calcium
CAD
coronary artery disease
ECG
electrocardiography
HF
heart failure
MPI
myocardial perfusion imaging
PA
physical activity
SPECT
single photon emission computed tomography

Keywords

Stress testing
Lifestyle
Risk factors
Cardiovascular disease

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