TY - JOUR
T1 - Added value of exercise test findings beyond traditional risk factors for cardiovascular risk stratification
AU - Bonikowske, Amanda R.
AU - Lopez-Jimenez, Francisco
AU - Barillas-Lara, Maria Irene
AU - Barout, Ahmad
AU - Fortin-Gamero, Sonia
AU - Sydo, Nora
AU - Allison, Thomas G.
N1 - Publisher Copyright:
© 2019
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Background: Functional aerobic capacity (FAC) determined by treadmill exercise testing (TMET) is associated with cardiovascular (CV) disease mortality independent of traditional CV risk factors and is a potentially underutilized tool. The purpose of this study was to determine added prognostic value of reduced FAC and other exercise test abnormalities beyond CV risk factors for predicting total and CV mortality. Methods: The TMET database was queried for Minnesota patients (≥30 years) without baseline CV disease from September 21, 1993, through December 20, 2010. Risk factors and exercise abnormalities including low FAC (<80% predicted), abnormal heart rate recovery (<13 bpm), and abnormal electrocardiogram (ST depression ≥1 mm regardless of baseline) were extracted. Mortality data were obtained through February 2016. Patients were divided into 9 groups by abnormality number (0, 1, or ≥2) and risk factors (0, 1, or ≥2). Cox regression was used to determine mortality risk according to exercise abnormalities/CV risk factors, adjusted for age and sex. Results: 19,551 patients met inclusion criteria; 1271 (6.5%) died over 12.4 ± 5.0 years' follow-up (405 [32%] CV deaths). Exercise abnormalities significantly modified risk for every number of CV risk factors. Hazard ratios (95% CI) for total mortality (0 vs ≥2 abnormalities) were 2.4 (1.9–2.9; P <.001) for 0 CV risk factors; 2.7 (2.2–3.3; P <.001), 1 risk factor; and 6.1 (4.8–7.7; P <.001), ≥2 risk factors. Similar results were noted for CV disease mortality. Conclusions: Exercise test abnormalities strongly predict mortality beyond traditional CV risk factors. Our results indicate that TMET should be considered for CV risk assessment.
AB - Background: Functional aerobic capacity (FAC) determined by treadmill exercise testing (TMET) is associated with cardiovascular (CV) disease mortality independent of traditional CV risk factors and is a potentially underutilized tool. The purpose of this study was to determine added prognostic value of reduced FAC and other exercise test abnormalities beyond CV risk factors for predicting total and CV mortality. Methods: The TMET database was queried for Minnesota patients (≥30 years) without baseline CV disease from September 21, 1993, through December 20, 2010. Risk factors and exercise abnormalities including low FAC (<80% predicted), abnormal heart rate recovery (<13 bpm), and abnormal electrocardiogram (ST depression ≥1 mm regardless of baseline) were extracted. Mortality data were obtained through February 2016. Patients were divided into 9 groups by abnormality number (0, 1, or ≥2) and risk factors (0, 1, or ≥2). Cox regression was used to determine mortality risk according to exercise abnormalities/CV risk factors, adjusted for age and sex. Results: 19,551 patients met inclusion criteria; 1271 (6.5%) died over 12.4 ± 5.0 years' follow-up (405 [32%] CV deaths). Exercise abnormalities significantly modified risk for every number of CV risk factors. Hazard ratios (95% CI) for total mortality (0 vs ≥2 abnormalities) were 2.4 (1.9–2.9; P <.001) for 0 CV risk factors; 2.7 (2.2–3.3; P <.001), 1 risk factor; and 6.1 (4.8–7.7; P <.001), ≥2 risk factors. Similar results were noted for CV disease mortality. Conclusions: Exercise test abnormalities strongly predict mortality beyond traditional CV risk factors. Our results indicate that TMET should be considered for CV risk assessment.
KW - Abnormal exercise electrocardiogram
KW - Abnormal heart rate recovery
KW - Cardiorespiratory fitness
KW - Cardiovascular risk factors
KW - Functional aerobic capacity
KW - Treadmill exercise testing
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U2 - 10.1016/j.ijcard.2019.04.030
DO - 10.1016/j.ijcard.2019.04.030
M3 - Article
C2 - 31027984
AN - SCOPUS:85064632419
SN - 0167-5273
VL - 292
SP - 212
EP - 217
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -