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Optimizing the Exercise Test for Pharmacological Studies in Patients with Angina Pectoris

  • Chapter
Drug Evaluation in Angina Pectoris

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 158))

Abstract

On the basis of the multitude of studies performed over the last 20 years, many recommendations could be made concerning optimizing the yield and reliability of information from the exercise test for patients with angina. Many of these suggestions, however, have escaped application to clinical pharmaceutical trials. The strength of conclusions made in regard to drug efficacy are only as valuable as the quality of the performance of the exercise test. The following are recommendations for optimizing exercise testing when studying pharmacological therapy for patients with angina:

  1. 1.

    Only patients who exhibit a stable, reproducible chest pain response to exercise are appropriate for such studies. Several preliminary tests are required to determine the appropriateness of a given patient, and a 10% reproducibility criteria should be used.

  2. 2.

    Chest pain should be graded carefully throughout the test, and analysis points should include the onset of pain, the occurrence of moderate pain, and peak angina. The testing endpoint should reflect the intensity of pain that would cause the patient to stop normal daily activities and/or take a sublingual nitroglycerin pill.

  3. 3.

    Exercise protocols should be individualized considering the subject tested and the purpose of the test; ideally the onset of angina should occur within 3–6 minutes and peak angina should be achieved within a duration of 8–12 minutes. Increments in work should be ≤ MET.

  4. 4.

    Gas exchange techniques greatly enhance the precision and reproducibility for quantifying work. Their use in multicenter trials of drug efficacy should be strongly encouraged.

  5. 5.

    The angina response to exercise can be greatly affected by the laboratory environment and other factors, including temperature, time of day, smoking, and meals. Exercise testing should be performed in a well-ventilated room and at a temperature of 20–22°C. Serial testing should be performed at the same time of day and at least 3 hours after abstaining from food, caffeinated beverages, and smoking.

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Authors
  1. Jonathan Myers
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  2. Victor F. Froelicher
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Diego Ardissino M.D. Lionel H. Opie M.D., Ph.D. Stefano Savonitto M.D.

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Myers, J., Froelicher, V.F. (1994). Optimizing the Exercise Test for Pharmacological Studies in Patients with Angina Pectoris. In: Ardissino, D., Opie, L.H., Savonitto, S. (eds) Drug Evaluation in Angina Pectoris. Developments in Cardiovascular Medicine, vol 158. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-2628-5_4

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  • DOI: https://doi.org/10.1007/978-1-4615-2628-5_4

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