Added value of exercise test findings beyond traditional risk factors for cardiovascular risk stratification

Amanda R. Bonikowske, Francisco Lopez-Jimenez, Maria Irene Barillas-Lara, Ahmad Barout, Sonia Fortin-Gamero, Nora Sydo, Thomas G. Allison

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalInternational Journal of Cardiology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Exercise Test
Exercise
Mortality
Cardiovascular Abnormalities
Cardiovascular Diseases
Electrocardiography
Heart Rate
Databases

Keywords

  • Abnormal exercise electrocardiogram
  • Abnormal heart rate recovery
  • Cardiorespiratory fitness
  • Cardiovascular risk factors
  • Functional aerobic capacity
  • Treadmill exercise testing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Added value of exercise test findings beyond traditional risk factors for cardiovascular risk stratification. / Bonikowske, Amanda R.; Lopez-Jimenez, Francisco; Barillas-Lara, Maria Irene; Barout, Ahmad; Fortin-Gamero, Sonia; Sydo, Nora; Allison, Thomas G.

In: International Journal of Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

Bonikowske, Amanda R. ; Lopez-Jimenez, Francisco ; Barillas-Lara, Maria Irene ; Barout, Ahmad ; Fortin-Gamero, Sonia ; Sydo, Nora ; Allison, Thomas G. / Added value of exercise test findings beyond traditional risk factors for cardiovascular risk stratification. In: International Journal of Cardiology. 2019.
@article{e96aa6ecca5340b48c2b31e0147a7193,
title = "Added value of exercise test findings beyond traditional risk factors for cardiovascular risk stratification",
abstract = "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.",
keywords = "Abnormal exercise electrocardiogram, Abnormal heart rate recovery, Cardiorespiratory fitness, Cardiovascular risk factors, Functional aerobic capacity, Treadmill exercise testing",
author = "Bonikowske, {Amanda R.} and Francisco Lopez-Jimenez and Barillas-Lara, {Maria Irene} and Ahmad Barout and Sonia Fortin-Gamero and Nora Sydo and Allison, {Thomas G.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.ijcard.2019.04.030",
language = "English (US)",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

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.

PY - 2019/1/1

Y1 - 2019/1/1

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

UR - http://www.scopus.com/inward/record.url?scp=85064632419&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064632419&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2019.04.030

DO - 10.1016/j.ijcard.2019.04.030

M3 - Article

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -