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Area of Science:

  • Cardiology
  • Exercise Physiology
  • Diagnostic Testing

Background:

  • Clinical guidelines recommend tailoring exercise testing to individual patient needs, including symptom reproduction.
  • The diagnostic value of adding customized exercise protocols to standard graded exercise testing for exertional complaints remains under-investigated.

Purpose of the Study:

  • To evaluate the diagnostic yield of supplementary customized exercise testing following inconclusive graded exercise tests in patients with exertional symptoms.
  • To determine the proportion of patients who receive a clinically actionable diagnosis or symptom reproduction through additional customized testing.

Main Methods:

  • Prospective analysis of data from 1,110 patients undergoing graded exercise testing.
  • Selective application of customized exercise provocation (e.g., sprint intervals, race simulations) for 122 symptomatic patients with inconclusive initial tests.
  • Definition of 'positive' additional testing as revealing a clinically actionable diagnosis or reproducing symptoms without a clear pathology.

Main Results:

  • Of 122 patients receiving additional testing, 39% had a positive result.
  • A clinically actionable diagnosis was identified in 54% of positive additional tests (26/48 patients).
  • Symptoms were reproduced without an explanatory diagnosis in 46% of positive additional tests (22/48 patients).

Conclusions:

  • Selective, patient-centered customization of exercise testing enhances diagnostic accuracy.
  • Adding customized exercise provocation after inconclusive graded exercise tests improves the overall diagnostic yield of exercise assessment.
  • This approach is particularly relevant for patients with exertional symptoms like palpitations, lightheadedness, chest pain, dyspnea, and exertional intolerance.