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Doppler echographic criteria were developed to define the anaerobic threshold and to detect lower extremity ischemia. Multi-stage treadmill test provided the criteria involving impairments in the time course of recovery of continuous diastolic blood flow in the lower extremity arteries. The criteria allow the anaerobic threshold to be defined in the range of low and high exercises and the severity of ischemia of the saved and amputated limb to be assessed in arterial occlusions. The diagnostic sensitivity of the criteria is 82-87%, its specificity and predictive value are 95-100%.

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The authors studied the possibility of evaluating peripheral arterial insufficiency according to the values of oxygen transport (consumption and oxygen debt) in the multistep treadmill test. Sixty patients with angiographically recognized affection of the vessels and 38 healthy individuals (controls) were examined. Both values were found to reflect the severity of arterial insufficiency of the lower limbs. The oxygen debt value was most informative in its evaluation. The degree of arterial insufficiency may be evaluated according to the level of the load in the treadmill test at the moment of inadequate oxygen debt occurrence.

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The study was undertaken to examine whether the linear arterial blood velocity in the lower extremities is related to impaired cardiac pump function and anaerobic threshold. A stepwise treadmill test was performed in 40 healthy individuals and 39 patients with cardiac malformations. The changes in maximal diastolic blood velocity and resistive index which had been determined by Doppler echoflowmetry after each step of the treadmill test were compared with those in the oxygen restoration coefficient, ventilation equivalent by oxygen and carbon dioxide levels in the expired air. It was found that the blood velocity in the lower extremities may be used as noninvasive criteria for impaired cardiac pump function and anaerobic threshold.

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The treadmill test was conducted, according to an elaborated program for evaluating insufficient pumping function of the left/right heart and the threshold of +lactic acidosis decompensation, in 53 patients before and in 86 patients after radical correction of Fallot's tetralogy. Insufficiency of left-heart pumping functions occurred after the operation significantly less frequently in patients with a monocuspic graft (14 +/- 7%; M +/- m) and more frequently in suture plastics (54 +/- 14%). A similar tendency was also authentic for right-ventricular ejection and decompensation of acidosis load. It was proved that patients with a monocusp are distinguished by higher and most stable results for a period of 5 years after the correction. Lower results were characteristic of transannular plastics and of patients who were operated on through a longitudinal approach; the lowest results occurred in suture plastics through a transverse approach. It was found that ++re-shunting of the ventricular septal defect levels the results of the various types of correction of the anomaly. It is shown that the criteria of insufficiency of the heart pumping function may be used in the diagnosis of latent stenoses and regurgitations of the infundibulum of the heart and the pulmonary artery whose functional significance is revealed only during a load.

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A multi-stage treadmill test was performed in 80 patients with mitral valvular disease and 24 healthy subjects. In organic involvement of the tricuspid valve, there was a decrease in oxygen uptake increase to 0.36 metabolic units at Stage 3 of the proposed treadmill test protocol versus 1.02 units (p less than 0.05) in patients without this valve disease or healthy individuals. The sensitivity and specificity of the oxygen uptake stabilization as a diagnostic sign accounted for 75% and 91%, respectively. The stabilization was demonstrated to reflect pulmonary effective oxygenized blood flow derangement. It is concluded that the load leading to oxygen uptake stabilization quantitatively shows the severity of hemodynamic tricuspid valve dysfunctions.

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The treadmill test was conducted in 328 patients who underwent prosthetics of the aortic or mitral valve for rheumatic heart disease. The object of the test was evaluation of the heart pumping function according to the dynamics of the oxygen debt, pulmonary hypertension according to the pseudoanaerobic threshold, and decompensation of metabolic acidosis according to the appearance of the hypocapnic reaction. The findings were compared with the results of preoperative examination. The results of the preoperative treadmill test were found to be in accord with the probability of a positive effect of prosthetics. Depending on an increase of the critical loads level this probability rose from 2 to 87% in mitral and from 25 to 100% in aortic prosthetics. It is shown that development of lactoacidosis decompensation in addition to the heart pumping function defect significantly aggravates the late-term results of the operation.

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The incidence of angina pectoris was investigated and the treadmill test was carried out to assess the presence of myocardial ischemia and heart pump function in 238 patients suffering from mitral and aortal heart disease. Comparison with the coronarography readings has demonstrated that the diagnostic value of the painful syndrome in the health status and anamnesis does not exceed 24%. The appearance of an angina pectoris attack in combination with ischemic alterations on the ECG raised the diagnostic value up to 50%. The authors have distinguished a symptom-complex including the development of angina pectoris, appearance of the ischemic signs on the ECG with the integrity of heart pump function, increasing the diagnostic value of the test up to 83-100%. The integrity or insufficiency of heart pump function were shown to allow differentiation between atherosclerotic and relative coronary insufficiency. The conclusion is drawn about the necessity of carrying out the treadmill test according to the program in patients suffering from heart disease with suspected coronary insufficiency.

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In 198 cardiosurgical patients the treadmill test was performed with the noninvasive evaluation of the pump function of the heart and anaerobic threshold. The results were compared with echocardiographic sizes of the left atrium (LA), systolic and diastolic sizes of the left ventricle (CLV and DLV). It was shown that in patients with mitral stenosis the pump function of the heart reliably corresponded to the size of the LA, in mitral regurgitation--O of the DLV, in aortal defects--that of the CLV and DLV. After isolated prosthezing of the heart valves the correlation found was not retained. It was proved that the maximum consumption of O2 did not reliably correlate with LA, CLV and DLV.

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Treadmill and isometric tests were carried out in 108 patients with coronary heart disease confirmed at coronary arteriography versus 51 healthy subjects. Among myocardial ischemia criteria depressed S-T segment came out as most reliable (probability of valid diagnosis greater than 90%), less significant was wave T inversion, wider wave R amplitude, painful syndrome (probability 70%). The rise and depression of oblique upward segment S-T, abnormal T amplitude proved inferior to the above signs (probability less than 50%). To achieve valid diagnosis of coronary heart disease and to assess its severity, exercise tests should produce reliable criteria of myocardial ischemia.

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A treadmill test involving a noninvasive evaluation of cardiac pump function and the anaerobic threshold (AT) was performed to examine 110 patients with cardiac malformations, 31 with atherosclerotic lesions in arteries of the lower limbs, and 49 normal subjects. The results were compared with those of direct measurement of blood lactate concentrations. Simultaneously, changes in transcutaneous O2 tension (TcpO2) were recorded in the recovery periods after each exercise stage, recovery of continuous blood flow (td). TcpO2 and td were indicated to reflect AT resulted just from decompensation of cardiac pump function in patients with impaired central hemodynamics. It was ascertained that TcpO2 and td might be objective measures for severity of central or peripheral hemodynamic abnormalities and reflected the levels of AT at systemic, organic, and microcirculatory levels.

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A multistage treadmill test was conducted according to a developed program of noninvasive appraisal of heart pumping function in 128 patients with rheumatic mitral or aortic valvular diseases before and in 95 patients 1-3 yours after prosthesis of the heart valves. It is proved that functional classifications employing maximum load indices reflect central hemodynamics less adequately than does noninvasive appraisal of the heart pumping function, particularly before operation in seriously ill patients. It is shown that on the basis of classifications according to the O2-debt dynamics, in distinction from maximum O2 consumption, the course of the immediate postoperative period and the late-term results of the operation can be predicted and the initial signs of the dysfunctions of the heart valve prosthesis revealed.

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A noninvasive criterion of occlusions of the lower limb arteries was elaborated from the results of transcutaneous measurement of oxygen tension (TmO2) during treading on a treadmill. The authors examined 44 patients with angiographically diagnosed affection of the vessels and 35 patients of the control group. Fall of TmO2 during a load by 20 mm Hg of relative rest was found to be a reliable criterion of occlusion marked by high sensitivity, specificity, and prognostic value.

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A method of diagnostics and assessment of the severity of arterial insufficiency of lower extremities was developed on the basis of multistep treadmill-test and measuring time of reestablishment of continuous bloodflow in the popliteal artery by the method of ultrasonic doppler flowmetry. An examination of 40 patients with angiographically detected alterations of the vessels and 18 healthy persons was performed. It was found that the diagnostic and assessment criterion of arterial insufficiency in treadmill-test with high parameters of sensitivity and specificity is longer duration of the period of reestablishment of continuous bloodflow over 180 sec. The arterial insufficiency severity is estimated by the value of exercise by the moment of the appearance of the criterion.

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The many-stage treadmill test was carried out according to a worked-out program in 41 patients before and in 55 patients after radical correction of Fallot's tetrad (40 healthy individuals were the controls). The pump function of the heart (oxygen debt dynamics), the anaerobic threshold (complex of gas analytical indices), and the efficacy of blood flow in lesser circulation (O2 consumption plateau) were appraised. The results proved to be best according to all criteria in patients with trans-annuloplasty of the conus arteriosus and pulmonary trunk with the use of a monocusp graft, and poorest in patients who were operated on through a transverse approach. This regularity was also encountered in 31 patients who were studied in follow-up periods of 3 years after the operation.

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A multistage treadmill test was conducted by the authors' program in 75 patients with mitral and aortic valvular disease and in 25 healthy individuals with noninvasive evaluation of the anaerobic threshold (AT) and the pumping function of the heart according to the dynamics of the oxygen debt. During the treadmill test in patients with pulmonary hypertension and arterio-capillary type of stasis in pulmonary circulation the AT occurred before the pumping function of the heart became decompensated. The diagnostic sensitivity of the AT outstripping appearance to marked types of pulmonary circulation stasis was 48% and to pulmonary hypertension - 80%. It was found that the AT occurring in the treadmill test before disorders of heart pumping function is an unfavourable prognostic criterion for late-term (8-12 months) results of isolated mitral valve prosthetics.

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Long-term examination findings in 78 patients after radical correction of Fallot's tetralogy and preoperative assessment of the circulatory status in 68 patients using treadmill test are analysed. The quantitative estimates of circulatory defects at different levels at later postoperative terms (from 6 months to 6 years) depended on the type of plastic surgery of the outflow part of the right ventricle and pulmonary trunk: suture plasty, right ventricular outflow plasty with a xeno-pericardial flap, and transannular plasty with the use of a mono-septal xeno-pericardial graft. Preoperatively, 59.0 per cent patients were attributed to functional class IV and 41.0 per cent patients to class III. After the radical tetralogy correction, most patients (55.0 per cent) were related to the functional class I. The advantages of using mono-septal xeno-pericardial grafts for plastic surgery of the right ventricular outflow and pulmonary trunk are demonstrated.

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Estimations of minute circulation volume (MCV) and the recovery coefficient (RC) as a parameter of oxygen debt were compared during the treadmill test in 83 cardiologic patients and 32 normal subjects in order to assess their pumping activity. At every stage of exercise, MCV was calculated on the basis of oxygen uptake, using Hossak's formula. MCV values were similar in the patients and normal subjects at similar stages of the treadmill test, and in patients belonging to different severity classes. RC variation was, on the contrary, different and depended on the magnitude of hemodynamic disorders: as pumping insufficiency developed, there was an abrupt drop in RC. A method is proposed for the quantitative assessment of pumping functional reserve on the basis of the ratio of oxygen uptake (at the stage where RC change occurred) to the maximum achievable by a normal subject of the same age, sex and body weight.

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