Long-term mortality with multiple treadmill exercise test abnormalities: Comparison between patients with and without cardiovascular disease

Bilal Aijaz, Luciano Babuin, Ray W. Squires, Stephen L. Kopecky, Bruce David Johnson, Randal J. Thomas, Thomas G. Allison

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Abstract

Background: Poor exercise capacity, abnormal heart rate responses, and electrocardiographic abnormalities during treadmill exercise testing independently predict mortality. The combined relationship of these 3 variables to determine the incremental increase in mortality was compared in groups with and without known cardiovascular disease (CVD). Methods: Patients referred for treadmill exercise testing during 1986 to 1991 were included. Exercise capacity <74% (of age- and gender-predicted value), heart rate reserve of <68 beat/min, and horizontal or down-sloping ST depression of ≥1 mm were considered abnormal. Cox proportional hazards regression was used to determine all-cause mortality (average follow-up of 16 years) based on the number of exercise test abnormalities (0, 1, 2, or all 3). Results: Among 10,897 patients, 20.9% (n = 2,277) had CVD. Poor exercise capacity and limited heart rate reserve were associated with increased risk of mortality (P < .0001) in both groups; however, abnormal exercise electrocardiogram was associated with an increased risk of mortality in the no-CVD group only (P < .0001). A graded increase in mortality was observed with increase in number of abnormal exercise test results in both groups. Patients without CVD having 2 or 3 abnormal exercise test results had a similar age-adjusted risk of long-term mortality as those with CVD but normal exercise test results, with a hazard ratio comparing these groups = 1.01 (95% CI 0.79-1.28). Conclusions: The combinatorial approach validates the prognostic significance of multiple exercise test variables. The presence of ≥2 exercise test abnormalities may constitute a "CVD risk equivalent" in patients without CVD.

Original languageEnglish (US)
Pages (from-to)783-789
Number of pages7
JournalAmerican Heart Journal
Volume156
Issue number4
DOIs
StatePublished - Oct 2008

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Exercise Test
Cardiovascular Diseases
Exercise
Mortality
Heart Rate
Electrocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Long-term mortality with multiple treadmill exercise test abnormalities : Comparison between patients with and without cardiovascular disease. / Aijaz, Bilal; Babuin, Luciano; Squires, Ray W.; Kopecky, Stephen L.; Johnson, Bruce David; Thomas, Randal J.; Allison, Thomas G.

In: American Heart Journal, Vol. 156, No. 4, 10.2008, p. 783-789.

Research output: Contribution to journalArticle

Aijaz, Bilal ; Babuin, Luciano ; Squires, Ray W. ; Kopecky, Stephen L. ; Johnson, Bruce David ; Thomas, Randal J. ; Allison, Thomas G. / Long-term mortality with multiple treadmill exercise test abnormalities : Comparison between patients with and without cardiovascular disease. In: American Heart Journal. 2008 ; Vol. 156, No. 4. pp. 783-789.
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N2 - Background: Poor exercise capacity, abnormal heart rate responses, and electrocardiographic abnormalities during treadmill exercise testing independently predict mortality. The combined relationship of these 3 variables to determine the incremental increase in mortality was compared in groups with and without known cardiovascular disease (CVD). Methods: Patients referred for treadmill exercise testing during 1986 to 1991 were included. Exercise capacity <74% (of age- and gender-predicted value), heart rate reserve of <68 beat/min, and horizontal or down-sloping ST depression of ≥1 mm were considered abnormal. Cox proportional hazards regression was used to determine all-cause mortality (average follow-up of 16 years) based on the number of exercise test abnormalities (0, 1, 2, or all 3). Results: Among 10,897 patients, 20.9% (n = 2,277) had CVD. Poor exercise capacity and limited heart rate reserve were associated with increased risk of mortality (P < .0001) in both groups; however, abnormal exercise electrocardiogram was associated with an increased risk of mortality in the no-CVD group only (P < .0001). A graded increase in mortality was observed with increase in number of abnormal exercise test results in both groups. Patients without CVD having 2 or 3 abnormal exercise test results had a similar age-adjusted risk of long-term mortality as those with CVD but normal exercise test results, with a hazard ratio comparing these groups = 1.01 (95% CI 0.79-1.28). Conclusions: The combinatorial approach validates the prognostic significance of multiple exercise test variables. The presence of ≥2 exercise test abnormalities may constitute a "CVD risk equivalent" in patients without CVD.

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