Prognostic Value of Treadmill Stress Echocardiography at Extremes of Exercise Performance: Submaximal <85% Maximum Predicted Heart Rate versus High Exercise Capacity ≥10 Metabolic Equivalents

2013 ◽  
Vol 31 (3) ◽  
pp. 340-346 ◽  
Author(s):  
Siu-Sun Yao ◽  
Vikram Agarwal ◽  
Farooq A. Chaudhry
Keyword(s):  
Heart Rate ◽  
Exercise Capacity ◽  
Exercise Performance ◽  
Prognostic Value ◽  
Stress Echocardiography ◽  
Metabolic Equivalents ◽  
Rate Versus ◽  
Treadmill Stress

P1511Promising prognostic value of negative stress echocardiography in patients with incomplete revascularization after successful primary PCI

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Boskovic ◽  
F Markovic ◽  
M T Petrovic ◽  
V Giga ◽  
I Jovanovic ◽  
...  
Keyword(s):  
Heart Rate ◽  
Adverse Events ◽  
Prognostic Value ◽  
Stress Echocardiography ◽  
Heart Rate Recovery ◽  
Target Heart Rate ◽  
Metabolic Equivalents ◽  
Increased Risk ◽  
Incomplete Revascularization

Abstract Background The specific role of non-invasive functional testing in a risk stratification of patients with incomplete revascularization after primary percutaneous coronary intervention (pPCI) still needs to be evaluated. The aim of our study was to assess negative prognostic value of stress echocardiography (SECHO) after successful pPCI and incomplete revascularization of non-culprit lesions. Methods Our study consisted of 202 patients (mean age 59±10 years, male 142) successfully treated with pPCI, who performed SECHO according to Bruce protocol in order to assess residual ischemia in coronary artery with non-culprit lesion. Duke treadmill score, functional capacity (Metabolic Equivalents - METs), achieved target heart rate (THR), heart rate recovery (HRR), wall motion score index (WMSI) and ejection fraction were interrogated in all patients. Slow HRR was defined as ≤18 beats/min. Median follow-up of the patients was 70 months (IQR 55–83 months) for the occurrence of cardiovascular death and non-fatal myocardial infarction. We also assessed the independent predictors for the occurrence of the adverse events. Results Out of 202 patients, 42 (20.8%) had positive SECHO test, 4 patients (1.98%) had died due to non-cardiac causes and 7 patients (3.5%) were lost to follow-up. From the remaining 149 patients with negative SECHO, 13 (8.7%) had an adverse event (7 cardiovascular deaths and 6 non-fatal MI). Negative predictive value of SECHO test was 91.3%. Univariate predictors of adverse events were slow HRR (HR 4.343 [95% CI 1.473–14.011], p=0.008), and not achieved THR (HR 0.322 [95% CI 0.105–0.985], p=0.047). By multivariate analysis, only slow HRR remained independent predictor of adverse events (HR 3.324 [95% CI 1.013–10.906], p=0.048). Conclusion SECHO test has excellent negative prognostic value in patients with incomplete revascularization of non-culprit lesions after successful pPCI. Still, particular care should be taken to the patients with slow HRR and negative SECHO due to increased risk for the occurrence of adverse events. Acknowledgement/Funding Ministry of Education and Science of the Republic of Serbia (Grant No III41022)

scholarly journals Sex-related differences in exercise performance and outcome of patients with hypertrophic cardiomyopathy

2019 ◽  
Vol 27 (17) ◽  
pp. 1821-1831 ◽  
Author(s):  
Luca Ghiselli ◽  
Alberto Marchi ◽  
Carlo Fumagalli ◽  
Niccolò Maurizi ◽  
Andrea Oddo ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Exercise Capacity ◽  
Exercise Performance ◽  
Cardiac Death ◽  
Predictive Accuracy ◽  
Multivariable Analysis ◽  
Peak Exercise ◽  
Exercise Echocardiography ◽  
Metabolic Equivalents ◽  
Age Related

Aims Exercise performance is known to predict outcome in hypertrophic cardiomyopathy (HCM), but whether sex-related differences exist is unresolved. We explored whether functional impairment, assessed by exercise echocardiography, has comparable predictive accuracy in females and males with HCM. Methods We retrospectively evaluated 292 HCM patients (46 ± 16 years, 72% males), consecutively referred for exercise echocardiography; 242 were followed for 5.9 ± 4.2 years. Results Peak exercise capacity was 6.5 ± 1.6 metabolic equivalents (METs). Sixty patients (21%) showed impaired exercise capacity (≤5 METs). Exercise performance was reduced in females, compared with males (5.6 ± 1.6 vs 6.9 ± 1.5 METs, p < 0.001; peak METs ≤ 5 in 40% vs 13%, p < 0.001), largely driven by a worse performance in women >50 years of age. At multivariable analysis, female sex was independently associated with impaired exercise capacity (odds ratio: 4.67; 95% confidence interval (CI): 1.83–11.90; p = 0.001). During follow-up, 24 patients (10%) met the primary endpoint (a combination of cardiac death, heart failure requiring hospitalization, sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator discharge, resuscitated sudden cardiac death and cardioembolic stroke). Event-free survival was reduced in females ( p = 0.035 vs males). Peak METs were inversely related to outcome in males (hazard ratio (HR) per unit increase: 0.57; 95% CI: 0.39–0.84; p = 0.004) but not in females (HR: 1.22; 95% CI: 0.66–2.24; p = 0.53). Conclusions Female patients with HCM showed significant age-related impairment in functional capacity compared with males, particularly evident in post-menopausal age groups. While women were at greater risk of HCM-related complications and death, impaired exercise capacity predicted adverse outcome only in men. These findings suggest the need for sex-specific management strategies in HCM.

Abstract P363: Incremental Prognostic Value of Exercise Capacity in Patients With Advanced Renal Insufficiency

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Mohammad Zaidan ◽  
Mohammad Alqarqaz ◽  
Tanmay Swadia ◽  
Waqas Qureshi ◽  
David Lanfear ◽  
...  
Keyword(s):  
Renal Insufficiency ◽  
Exercise Capacity ◽  
Prognostic Value ◽  
Prognostic Information ◽  
Chi Square ◽  
Metabolic Equivalents ◽  
The Social ◽  
Social Security Death Index ◽  
Incremental Prognostic Value

Background: Exercise capacity has been shown to predict outcomes in the general population. However, patients with advanced renal failure have been typically excluded from these studies. The aim of this analysis is to evaluate the incremental prognostic value of exercise capacity in patients with Stage III and IV renal insufficiency. Methods: We included 3733 consecutive patients with glomerular filtration rate<60 ml/min who underwent exercise testing between 1991 and 2008. Baseline characteristics and exercise data were collected prospectively at the time of testing including Metabolic Equivalents (METS). The primary endpoint is all cause mortality confirmed by the social security death index. Results: A total of 946, 2026 and 761 patients achieved >10, 4-10 and <4 METS respectively. Patients with poor exercise capacity (< 4 METS) were older, more often females (54% vs. 49%), less often whites (66% vs. 77%) with higher prevalence of hypertension (90% vs. 78%) and prior coronary disease (37% vs. 17%). After a median follow-up duration of 6.4 years (range 1-15 years), 1032 patients (28%) died. Using multivariable Cox hazard regression, exercise capacity added incremental prognostic value over clinical variables and renal function (Increase in global Chi square from 778 to 921, p<0.0001, METS achieved HR per 1 METS 0.83, 95% CI 0.81-0.85, p<0.0001). Conclusions: In this large cohort of advanced renal insufficiency patients, decreased exercise capacity adds incremental prognostic information and is independently associated with decreased survival over long follow-up duration.

Gender differences in exercise stress testing protocol selection, exercise capacity, and prognostic value of METs

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Harb ◽  
T.W Wang ◽  
Y.W Wu ◽  
M.V Menon ◽  
L.C Cho ◽  
...  
Keyword(s):  
Gender Differences ◽  
Exercise Capacity ◽  
Prognostic Value ◽  
Stress Testing ◽  
Exercise Stress ◽  
Exercise Stress Testing ◽  
Metabolic Equivalents ◽  
Testing Protocols ◽  
Gender Specific

Abstract Background Exercise capacity, as measured by metabolic equivalents of task [METs], varies with gender and is an independent predictor of mortality. We sought to investigate gender differences in the protocol selected, the estimated exercise capacity, and the prognostic value of METs. Purpose Investigate the gender differences in the protocol chosen (adjusting for age and comorbidities), the METs achieved (also adjusting for the protocol selected), and the predictive value of exercise capacity adjusted to METs achieved. Methods In a 25-year stress testing registry spanning from 1991 to 2015, we identified 120,705 patients who underwent exercise stress testing. Protocols were split into Bruce vs. non-Bruce. METs were estimated based on established gender-specific formulas (the St James Take Heart Project formula for women, and the Veterans Affairs cohort formula for men).The primary outcome was all-cause mortality. Results The mean age was 53.3±12.5 years, and 59% were male. Table 1 presents the baseline characteristics and exercise parameters. A total of 8426 death occurred over 8.7 years of mean follow-up duration. Females were more commonly referred for non-Bruce protocols [adjusted OR 2.6; 95% CI (2.5–2.7)] even after adjusting for age and comorbidities. Within the same protocol chosen, females achieved lower estimated METs [Beta −1.4; 95% CI (−1.43 to −1.37)]. Exercise capacity was inversely related to mortality in both genders and across protocols (figure 1), however, after adjusting for age, comorbidities, protocol chosen, and the number of METs achieved, the HR for death was significantly lower for women [adjusted HR=0.44; 95% CI (0.41–0.46)]. Conclusion After adjusting for age and comorbidities, women tend to be more commonly referred for non-Bruce protocols, achieve less estimated METs (after adjusting for the protocol chosen), and have half the mortality for the same METs achieved. Death vs. Exercise capacity by gender Funding Acknowledgement Type of funding source: None

scholarly journals Additive prognostic value of coronary flow and heart rate reserve during vasodilator stress echocardiography in hypertrophic cardiomyopathy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Tesic ◽  
A Nemes ◽  
Q Ciampi ◽  
F Rigo ◽  
L Cortigiani ◽  
...  
Keyword(s):  
Heart Rate ◽  
Hypertrophic Cardiomyopathy ◽  
Coronary Flow ◽  
Prognostic Value ◽  
Stress Echocardiography ◽  
Vasodilator Stress ◽  
Heart Rate Reserve ◽  
Survival Curves ◽  
Kaplan Meier

Abstract Background Coronary flow velocity reserve (CFVR) and heart rate reserve (HRR) during vasodilator stress echocardiography (SE) assess coronary microvascular function and cardiac sympathetic reserve respectively. Both CFVR and HRR can be impaired in hypertrophic cardiomyopathy (HCM). Objectives To evaluate the prognostic value of CFVR and HRR during vasodilator SE in HCM. Methods We enrolled 244 HCM patients (age=51±15 years, 116 men) studied with vasodilator SE from 1999 to 2019 in 5 certified centers. Stress modality was either adenosine (Ado, 0.14 mg/kg/min in 2', n=171) or dipyridamole (Dip, 0.84 mg/kg in 6', n=73). Left ventricular outflow tract obstruction was present at rest in 80 patients (33%). We assessed CFVR in left anterior descending coronary artery (by TTE in 225, and TEE in 19 patients) and HRR (peak/rest heart rate). Abnormal values of HRR were based on receiver operating characteristics for Ado and Dip separately calculated. All patients completed the follow-up. Results CFVR was 2.17±0.46 for Dip and 2.13±0.43 for Ado (p=ns); HRR was 1.36±0.19 for Dip and 1.10±0.16 for Ado (p&lt;0.001). An abnormal CFVR (&lt;2.0 for both Ado and Dip) was present in 28 patients for Dip and 73 for Ado (38% vs 43%, p=ns). An abnormal HRR (≤1.34 for Dip and ≤1.03 for Ado) was present in 39 patients for Dip and in 70 patients for Ado (53% vs 41%, p=ns). During a median follow-up of 67 months (interquartile range: 29–103 months), 97 spontaneous events occurred in 71 patients: 29 all-cause deaths, 32 new hospital admission for acute heart failure, 3 sustained ventricular tachycardias, 32 atrial fibrillations and 1 heart transplantation. Event rate was 2.5%/year in patients with normal CFVR and HRR, 4.7%/year in patients with only one abnormal criterion and 10.9%/year in patients with abnormal responses of both criteria (see figure). At multivariate analysis, abnormality of both CFVR and HRR (Hazard ratio 4.033, 95% CI 1.863–8.729, p&lt;0.001) was independent predictor of events. Conclusions A reduced CFVR and blunted HRR during vasodilator SE identify distinct phenotypes and show independent value in predicting outcome in HCM patients. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Kaplan-Meier spontaneous event-free survival curves based on HRR and CFVR. Kaplan-Meier survival curves (considering spontaneous events) in patients stratified with the abnormal HRR and/or CFVR. Number of patients at risk per year is shown.

Abstract MP78: Effect of Beta-Blocker Therapy, Maximal Heart Rate and Exercise Capacity During Stress Testing on Long-Term Survival

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Rupert K Hung ◽  
Mouaz Al-Mallah ◽  
Seamus P Whelton ◽  
Roger S Blumenthal ◽  
Clinton A Brawner ◽  
...  
Keyword(s):  
Heart Rate ◽  
Exercise Capacity ◽  
Beta Blocker ◽  
Prognostic Value ◽  
Stress Testing ◽  
Maximal Heart Rate ◽  
Blocker Therapy ◽  
Beta Blocker Therapy ◽  
Long Term Mortality

Background: Whether beta-blocker therapy (BBT) attenuates the prognostic value of percentage-predicted maximal heart rate (ppMHR) achieved during stress testing remains unclear. The combined effect of ppMHR and exercise capacity on long-term mortality is unknown. Methods: We analyzed 67,772 adults (54 ± 13 years old, 54% men (36,639 of 67,772), 29% black (19,834 of 67,772)) from The FIT Project, a retrospective cohort study of patients who underwent physician-referred exercise stress testing at a single healthcare system between 1991 and 2009. Patients were categorized by baseline use of BBT. Maximal age-predicted heart rate was defined as 220-age. We derived adjusted mortality rates over the range of ppMHR using margins of response logistic regression models. Our primary model included adjustment for demographic data, resting blood pressures, medical history, pertinent medications, and indication for stress testing. Our secondary model included further adjustment for exercise capacity. Results: There were 10,594 deaths over 11 ± 5 years of follow-up. Patients on BBT tended to have more comorbidities and other medication use (P<.001). After accounting for differences between BBT groups, BBT was associated with an 8% lower ppMHR (83% in BBT vs. 91% in no BBT) in both men and women. ppMHR was inversely associated with all-cause mortality in both analyses performed (P≤.001), though the association was significantly attenuated by BBT (P=.03) [Panel A]. Exercise capacity further attenuated the prognostic value of ppMHR in all patients, particularly in those on BBT, and reduced the difference in risk between those on BBT and not on BBT (P=.08) [Panel B]. Conclusion: BBT attenuated the association between ppMHR achieved during stress testing and long-term mortality. Exercise capacity further attenuated the prognostic significance of ppMHR, particularly in patients on BBT.

scholarly journals Sildenafil enhances central hemodynamic responses to exercise, but not V̇o2peak, in people with diabetes mellitus

2019 ◽  
Vol 127 (1) ◽  
pp. 1-10
Author(s):  
Timothy J. Roberts ◽  
Andrew T. Burns ◽  
Richard J. MacIsaac ◽  
Andrew I. MacIsaac ◽  
David L. Prior ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Rate ◽  
Cardiac Output ◽  
Pulmonary Vascular Resistance ◽  
Exercise Capacity ◽  
Vascular Resistance ◽  
Exercise Performance ◽  
Exercise Echocardiography ◽  
Cardiopulmonary Exercise ◽  
Central Hemodynamic

Exercise capacity is frequently reduced in people with diabetes mellitus (DM), and the contribution of pulmonary microvascular dysfunction remains undefined. We hypothesized that pulmonary microvascular disease, measured by a novel exercise echocardiography technique termed pulmonary transit of agitated contrast (PTAC), would be greater in subjects with DM and that the use of pulmonary vasodilator agent sildenafil would improve exercise performance by reducing right ventricular afterload. Forty subjects with DM and 20 matched controls performed cardiopulmonary exercise testing and semisupine exercise echocardiography 1 h after placebo or sildenafil ingestion in a double-blind randomized crossover design. The primary efficacy end point was exercise capacity (V̇o2peak) while secondary measures included pulmonary vascular resistance, cardiac output, and change in PTAC. DM subjects were aged 44 ± 13 yr, 73% male, with 16 ± 10 yr DM history. Sildenafil caused marginal improvements in echocardiographic measures of biventricular systolic function in DM subjects. Exercise-induced increases in pulmonary artery systolic pressure and pulmonary vascular resistance were attenuated with sildenafil, while heart rate (+2.4 ±1.2 beats/min, P = 0.04) and cardiac output (+322 ± 21 ml, P = 0.03) improved. However, the degree of PTAC did not change ( P = 0.93) and V̇o2peak did not increase following sildenafil as compared with placebo (V̇o2peak: 31.8 ± 9.7 vs. 32.1 ± 9.5 ml·min−1·kg−1, P = 0.42). We conclude that sildenafil administration causes modest acute improvements in central hemodynamics but does not improve exercise capacity. This may be due to the mismatch in action of sildenafil on the pulmonary arteries rather than the distal pulmonary microvasculature and potential adverse effects on peripheral oxygen extraction. NEW & NOTEWORTHY This is one of the largest and most comprehensive studies of cardiopulmonary exercise performance in people with diabetes mellitus and to our knowledge the first to assess the effect of sildenafil using detailed echocardiographic measures during incremental exercise. Sildenafil attenuated the rise in pulmonary vascular resistance while augmenting cardiac output and intriguingly heart rate, without conferring any improvement in exercise capacity. The enhanced central hemodynamic indexes may have been offset by reduced peripheral O2 extraction.

Sign in / Sign up

Export Citation Format

Share Document