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4-second exercise test: normative values for healthy adults aged 18 to 81 years old

Session Poster Session III - Friday 08:30 - 12:30

Speaker Claudio Gil Araujo

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2015

  • Topic : preventive cardiology
  • Sub-topic : Exercise Testing
  • Session type : Poster Session

Authors : CG Araujo (Rio de Janeiro,BR), CL Castro (Rio de Janeiro,BR), JF Franca (Rio de Janeiro,BR), PS Ramos (Juiz de Fora,BR)

CG Araujo1 , CL Castro2 , JF Franca2 , PS Ramos3 , 1Federal University of Rio de Janeiro, Heart Institute Edson Saad/CLINIMEX - Rio de Janeiro - Brazil , 2Exercise Medicine Clinic - CLINIMEX - Rio de Janeiro - Brazil , 3Faculty of Medical Sciences - SUPREMA, Therezinha de Jesus Hospital - Juiz de Fora - Brazil ,


Purpose: Physiological reflexes primarily modulated by vagus allow heart rate to decrease and to increase rapidly after a deep inspiration followed by fast limb movements. These are the physiological basis of the 4-s exercise test (4sET) that has been pharmacologically validated (Clin Autonom Res 1992) for the evaluation of vagal modulation on the cardiac chronotropism. The aim of the study was to establish reference values for the 4sET results in healthy adults.

Methods: Revising 4sET data from 1994 to 2013 and after application of rigid inclusion/exclusion criteria, we obtained a sample of 1,605 healthy adults (61% men) aged between 18 and 81 years old. In the 4sET, a cardiac vagal index (CVI) was obtained by calculating the ratio between the duration of two electrocardiogram RR-intervals: 1) after 4-s of a fast full inspiration and immediately before start to pedal the cycle and 2) at the end of 4-s of fast unloaded (no resistance added) cycling.

Results: CVI was negatively related to age (r=-.33; p<.01) and the linear regression’s intercepts and slopes were similar to men and women (p>.05) and so, the results for subjects of both genders were grouped for further analysis. Considering the heterocedasticity and the skewness of CVI distribution as related to age, it was preferable to report the reference values as percentiles to eight different age-groups (years): 18-30 (N=282), 31-40 (N=449), 41-45 (N=260), 46-50 (N=239), 51-55 (N=128), 56-60 (N=110), 61-65 (N=76) e 66+ (N=61). It was found that CVI median values progressively declined from 1.63 to 1.24.

Conclusions: Availability of CVI’s age-percentile reference values would possibly facilitate a broader clinical application of the 4sET, a simple, valid and safe tool to assess the vagal modulation of the chronotropic response.

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