Long‐term follow‐up of patients undergoing standardized bicycle exercise stress testing: new recommendations for grading of exercise capacity are clinically relevant

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

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Usefulness of Exercise Stress Testing for Prediction of Blood Pressure Trends

PEDIATRICS ◽

10.1542/peds.75.6.1071 ◽

1985 ◽

Vol 75 (6) ◽

pp. 1071-1075

Author(s):

David E. Fixler ◽

W. Pennock Laird ◽

Kent Dana

Keyword(s):

Blood Pressure ◽

Stress Testing ◽

Isometric Exercise ◽

Systolic Pressure ◽

Exercise Stress ◽

Female Adolescents ◽

Exercise Stress Testing ◽

Stress Tests ◽

Blood Pressures

The purpose of this study was to determine whether values of blood pressure during exercise help predict which adolescents are prone to maintain high blood pressure. Dynamic and isometric exercise stress tests were performed on 131 adolescents who had had systolic or diastolic pressures greater than the 95th percentile on three examinations the previous year. Follow-up blood pressures were measured 1 year after the stress testing, and outcomes were classified on the basis of the blood pressure status that year. Stepwise regression analysis was used to examine the association between earlier blood pressures and exercise pressures with outcome pressures. In both male and female adolescents, the average resting systolic pressure on the earlier survey was the best predictor of systolic pressure 2 years later. Blood pressures and heart rates during dynamic and isometric exercise did not significantly contribute to the models' prediction of future systolic or diastolic pressures. The data suggest that exercise stress testing is not a valid method for predicting youths whose blood pressures will remain elevated over the next 1 to 2 years.

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4097Validation of seven different exercise treadmill stress testing protocols in a large 25-year stress testing registry

European Heart Journal ◽

10.1093/eurheartj/ehz745.0109 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Harb ◽

V M Menon ◽

W U Wu ◽

P C Cremer ◽

L C Cho ◽

...

Keyword(s):

Exercise Capacity ◽

Stress Testing ◽

Multivariable Analysis ◽

Exercise Stress ◽

Exercise Stress Testing ◽

Metabolic Equivalents ◽

The Individual ◽

Stage Renal Disease ◽

End Stage ◽

Testing Protocols

Abstract Background While the Bruce protocol has been extensively validated, other modified exercise protocols with less workload burden are commonly used, though their prognostic value is not well established. Purpose We sought to assess whether exercise capacity (or workload achieved in metabolic equivalents of task [METs]) remains predictive of mortality across various exercise stress testing protocols. Methods In a 25-year stress testing registry spanning from 1991 to 2015, we identified 120,705 patients who underwent 7 different standardized symptom-limited exercise stress testing protocols: Bruce, Modified Bruce, Cornell 0%, Cornell 5%, Cornell 10%, Naughton, and modified Naughton. The choice of the protocol was dependent on the supervising exercise physiologist according to purpose of the test and the individual patient. The primary outcome was all-cause mortality. Results Mean age was 53.3±12.5 years and 59% were male. There were 74953 Bruce, 8368 modified Bruce, 2648 Cornell 0%, 9972 Cornell 5%, 20425 Cornell 10% 1226 Naughton, and 3113 modified Naughton individual protocols. A total of 8426 death occurred over 8.7 years of mean follow-up duration. Figure 1 shows that there was an inverse relationship between peak METs achieved and mortality across all 7 protocols. On multivariable analysis, increasing METs remained protective against death [adjusted HR of 0.46; 95% CI (0.44 - 0.48); p<0.001] even after adjusting for the protocol chosen, age, gender, hypertension, diabetes, coronary disease, end-stage renal disease, smoking, and statin use. METS vs. mortality by protocol Conclusion Across 7 different exercise protocols with various workloads, the predicted exercise capacity remained predictive of mortality irrespective of the protocol chosen, patients' demographics and comorbidities. Different testing choices likely represent different estimated functional capacity.

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Long-term follow-up after ventricular septal defect repair in children: cardiac autonomic control, cardiac function and exercise capacity

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezx438 ◽

2017 ◽

Vol 53 (5) ◽

pp. 1082-1088 ◽

Cited By ~ 3

Author(s):

Ineke Nederend ◽

Eco J C de Geus ◽

Nico A Blom ◽

Arend D J ten Harkel

Keyword(s):

Ventricular Septal Defect ◽

Cardiac Function ◽

Exercise Capacity ◽

Septal Defect ◽

Autonomic Control ◽

Cardiac Autonomic Control ◽

Long Term Follow Up ◽

Defect Repair

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Emergency department patient compliance with follow-up for outpatient exercise stress testing: a randomized controlled trial

CJEM ◽

10.1017/s1481803500015463 ◽

2007 ◽

Vol 9 (06) ◽

pp. 435-440 ◽

Cited By ~ 24

Author(s):

Doug Richards ◽

Nazanin Meshkat ◽

Jaqueline Chu ◽

Kevin Eva ◽

Andrew Worster

Keyword(s):

Chest Pain ◽

Stress Testing ◽

Stress Test ◽

Intervention Group ◽

Exercise Stress Test ◽

Low Risk ◽

Exercise Stress ◽

Exercise Stress Testing ◽

Control Group

ABSTRACTIntroduction:Numerous patients are assessed in the emergency department (ED) for chest pain suggestive of acute coronary syndrome (ACS) and subsequently discharged if found to be at low risk. Exercise stress testing is frequently advised as a follow-up investigation for low-risk patients; however, compliance with such recommendations is poorly understood. We sought to determine if compliance with follow-up for exercise stress testing is higher in patients for whom the investigation is ordered at the time of ED discharge, compared with patients who are advised to arrange testing through their family physician (FP).Methods:Low-risk chest pain patients being discharged from the ED for outpatient exercise stress test and FP follow-up were randomized into 2 groups. ED staff ordered an exercise stress test for the intervention group, and the control group was advised to contact their FP to arrange testing. The primary outcome was completion of an exercise stress test at 30 days, confirmed through both patient contact and stress test results. Patients were unaware that our primary interest was their compliance with the exercise stress testing recommendations.Results:Two-hundred and thirty-one patients were enrolled and baseline characteristics were similar between the 2 groups. Completion of an exercise stress test at 30 days occurred in 87 out of 120 (72.5%) patients in the intervention group and 60 out of 107 (56.1%) patients in the control group. The difference in compliance rates (16.4%) between the 2 groups was statistically significant (χ2= 6.69,p< 0.001) with a relative risk of 1.29 (95% confidence interval 1.18–1.40), and the results remained significant after a “worst case” sensitivity analysis involving 4 control group cases lost to follow-up. When subjects were contacted by telephone 30 days after the ED visit, 60% of those who were noncompliant patients felt they did not have a heart problem and that further testing was unnecessary.Conclusion:When ED staff order an outpatient exercise stress test following investigation for potential ACS, patients are more likely to complete the test if it is booked for them before ED discharge. After discharge, many low-risk chest pain patients feel they are not at risk and do not return to their FP for further testing in a timely manner as advised. Changing to a strategy of ED booking of exercise stress testing may help earlier identification of patients with coronary heart disease.

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Long-term prognostic value of myocardial perfusion imaging in octogenarians able to undergo treadmill exercise stress testing

Journal of Nuclear Cardiology ◽

10.1007/s12350-014-9991-4 ◽

2014 ◽

Vol 21 (6) ◽

pp. 1213-1222 ◽

Cited By ~ 9

Author(s):

Athanasios Katsikis ◽

Athanasios Theodorakos ◽

Spyridon Papaioannou ◽

Virginia Tsapaki ◽

Genovefa Kolovou ◽

...

Keyword(s):

Myocardial Perfusion Imaging ◽

Myocardial Perfusion ◽

Perfusion Imaging ◽

Prognostic Value ◽

Stress Testing ◽

Treadmill Exercise ◽

Exercise Stress ◽

Exercise Stress Testing

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Internal Thoracic Artery Side Branch Ligation for Post Coronary Surgery Ischemia

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230701500416 ◽

2007 ◽

Vol 15 (4) ◽

pp. 339-341 ◽

Cited By ~ 5

Author(s):

Kosmas Tsakiridis ◽

Dimitrios Mikroulis ◽

Vassilios Didilis ◽

Georgios Bougioukas

Keyword(s):

Stress Testing ◽

Internal Thoracic Artery ◽

Coronary Bypass ◽

Side Branch ◽

Coronary Surgery ◽

Recurrent Angina ◽

Long Term Follow Up ◽

Treadmill Stress

Two cases of internal thoracic artery side-branch ligation in patients with recurrent angina after coronary bypass are reported with long-term follow-up. Ligation was performed with clips via a left thoracotomy. Treadmill stress testing after 3 and 4 years did not provoke any myocardial ischemia. These findings suggest that an unligated side-branch can produce a steal phenomenon.

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