Validity of Exercise ECG
In their review article, the authors have presented the often underestimated importance especially of bicycle and treadmill ergometry beyond the exercise electrocardiogram (ECG) (1). A mention of the limited sensitivity of exercise ECG in diagnosing coronary heart disease would still have been desirable, because the pretest probability is low in athletes and most sports medical patients.
An important target criterion in exercise testing in sports medicine is the physical performance, measured as maximal oxygen intake (VO2max), for example. In order to ensure the most accurate possible assessment, it is necessary to consider different criteria for volitional exhaustion such as maximal heart rate, maximal lactate concentration or maximal respiratory quotient. It is not clear why the authors included VO2max as a criterion for exhaustion, in addition to the criteria mentioned above (1). A low VO2max does not necessarily mean a low degree of exhaustion, but usually inadequate physical performance. When an exercise test is not exhaustive, the highest oxygen intake during exercise is known as VO2peak.
The authors assessed training recommendations on the basis of lactate thresholds as rather negative (1). This sounds apodictic especially since they cite mainly their own publications. In order to do justice to this complex problem, an adequate discussion of the international literature is required (2).
The authors make a daring statement by saying that blood pressure values of up to 300 mm Hg can be regarded as normal at very high intensities (1). Highly trained endurance athletes with high cardiac output can reach systolic blood pressure values during maximal exercise tests that clearly exceed the upper limit of 210 mm Hg (3) named in the ESC (European Society of Cardiology) guidelines (4). In any case, however, if extreme values near 300 mm Hg are reached, further diagnostic evaluation should be performed. Whether high blood pressure values in athletes are of prognostic relevance is something that cannot currently be evaluated.
Prof. em. Dr. med. Wilfried Kindermann
Institut für Sport- und Präventivmedizin
Universität des Saarlandes
|1.||Löllgen H, Leyk D: Exercise testing in sports medicine. Dtsch Arztebl Int 2018; 115: 409–16 VOLLTEXT|
|2.||Faude O, Kindermann W, Meyer T: Lactate threshold concepts: how valid are they? Sports Med 2009; 39: 469–90 CrossRef MEDLINE|
|3.||Mancia G, Fagard R, Narkiewicz K, et al.: 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34: 2159–219 CrossRef MEDLINE|
|4.||Caselli S, Vaquer Segui A, Quattrini F, et al.: Upper normal values of blood pressure response to exercise in olympic athletes. Am Heart J 2016; 177: 120–8 CrossRef MEDLINE|