Exercise Testing in Nonatherosclerotic Heart Disease

Abstract

Exercise testing first appeared in the medical literature in1938.1Since then, exercise testing has achieved anestablished place in the armamentarium of tests available tothe physician for evaluating patients with known or suspectedcardiac disease. In clinical practice, the application of exer-cise testing is often combined with cardiac imaging. This isreflected in recently available appropriate use criteria formyocardial perfusion imaging and stress echocardiography.2,3However, exercise testing as a standalone test without imag-ing still has value in properly selected patients. The latestiteration of guidelines from the American College of Cardi-ology/American Heart Association (ACC/AHA) concerningexercise testing is dominated by diagnostic or prognosticassessments of atherosclerotic coronary artery disease appli-cations.4Less prominent are those applications that pertain tohypertrophic cardiomyopathy (HCM), valvular heart disease,and arrhythmias including pacemakers, all of which are thesubject of this review.