11. Evaluation of the Final report

The final protocol of a stress test is displayed in the list of recordings and identified as Final report. Press [Enter] or double-click to open a Final report for evaluation.

The Final report consists of 4 main parts: List, Graphs, ST Trend, ST List.

List of workload-phases

The ECG list of an ergometer/bicycle stress test contains the time, load, blood pressure (BP), heart rate (HR), revolutions per minute and ST values of the phases. In case of a treadmill stress test, the fields for load and the revolutions per minute are replaced with data relating to the speed, grade, MET values and the Double-Product or Cross-Product (Max HR X Max systolic BP).

In the last column choose the symbol or press [F5] to toggle between the STE, STM and STJ amplitudes, and press the [+] and [-] keys to toggle between the lead systems. The STE, STM and STJ values are replaced with J80/J60, J40/J30 ST J values if the program used the option for J+80(60) msec to determine the end of the ST segment ('Setup'   'ECG'   'J + 60/80'   'ON').

Select the ECG menu item to replay, measure, evaluate, compare and delete a recording in the same way as for resting ECG recording. Press [F3] to select recordings for comparison.

The evaluation of ECG intervals and segments of the stress test ECG is performed in an identical manner as the evaluation of resting ECG recordings. However, the automatic interpretation function in the stress test ECG differs in a few ways:

• the parameters of the P wave do not occur in the parameter tables
• if a lead is noisy or cannot be evaluated, the program does not calculate the median of this lead, but the other medians and their parameter tables are calculated
• the program does not propose a diagnosis, but you can ask for the reports of the evaluation

11.1 Calculation of the maximum performance

Maximal HR, predicted HR (220 minus age), maximal BP and the maximal workload achieved are displayed just below the recording list.

For a ergometer/bicycle stress test, the right hand side of the screen display shows an evaluation of exercise performance. The maximum expected performance from the patient can be calculated according to the weight and the body surface area, by the method of DuBois. The display also shows achieved performance as a percentage of maximum predicted. If the HR during the stress test has reached the limits defined for the PWC calculation (130, 150, 170 /min), the program gives the absolute and relative PWC values as well as the "normal" PWC values according to age and sex in a table.

For a treadmill stress test the program displays (to the right of the table) the calculated oxygen consumption (VO2), the Double-product (product of the maximal HR and the maximal systolic BP) and MET values.

11.2 Stress test graphs

You can view the diagrams and tables giving a comprehensive evaluation of the stress test.

Ergometer / Bicycle:

On the left hand side of the screen the first graph displays heart rate, blood pressure as a function of time, predicted HR, maximum HR and the maximum GP values, shown on the top right corner of the graph. Beneath this display, workload is displayed as a function of time.

On the right you can see the table of the PWC. The third graph displays the trend of heart rate as a function of exercise performance, with the PWC values marked.

Treadmill:

The first two diagrams correspond to those of the ergometer/bicycle. The third figure is the diagram of the calculated oxygen consumption as a function of time.

The right hand side of the screen displays the calculated oxygen consumption and the Double-product values. Beneath this, is a displays of the trend of the Double-product(/1000) as a function of oxygen consumption.

11.3 ST evaluation

The screen displays the ST diagrams of the 12 standard leads as a function of time. Press [F5] to toggle the STJ, STM and STE values. With [Up] and [Down] keys can you change the amplitude gain.

ST List:

The ST-list is a comprehensive table of heart rates and ST values of the standard 12 leads. Press F5 to toggle the STJ, STM and STE values.

The STE, STM and STJ values are replaced with J80/J60, J40/J30 STJ values if the program used the J+80(60) msec to determine the end of the ST segment. ('Setup'   'ECG'   'J + 60/80'   'ON').