85% of maximal age-predicted heart rate is not a valid endpoint for exercise treadmill testing

Jain, Mohit; Nkonde, Chileshe; Lin, Ben A.; Walker, Alerice; Wackers, Frans J. Th.

doi:10.1007/s12350-011-9454-0

Cited by 32 publications

(19 citation statements)

References 20 publications

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“…One of these patients was on beta-blocking medication and the other showed ischaemia on MPI. Both patients achieved a high exercise workload (seven or more metabolic equivalents), which has been shown to have more value than attaining an arbitrarily chosen target heart rate [19]. PET MPI provided fewer equivocal results than SPECT, suggesting that it improves reader confidence as an important component of the report.…”

Section: Discussionmentioning

confidence: 95%

82Rb PET myocardial perfusion imaging is superior to 99mTc-labelled agent SPECT in patients with known or suspected coronary artery disease

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Fukui

et al. 2012

Eur J Nucl Med Mol Imaging

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Section: Discussionmentioning

confidence: 95%

82Rb PET myocardial perfusion imaging is superior to 99mTc-labelled agent SPECT in patients with known or suspected coronary artery disease

Flotats

Bravo

Fukui

et al. 2012

Eur J Nucl Med Mol Imaging

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“…Jain et al 10 have recently shown how terminating exercise at 85% of MPHR can significantly underestimate the amount of ischemia. However, certain conditions such as orthopedic, peripheral vascular, psychologic, or treadmill unfamiliarity can prevent achieving adequate heart rate responses despite an elevated perceived level of exertion.…”

Section: Discussionmentioning

confidence: 99%

Safety and feasibility of adjunctive regadenoson injection at peak exercise during exercise myocardial perfusion imaging: The Both Exercise and Regadenoson Stress Test (BERST) trial

Ross

Wilkins

et al. 2013

Journal of Nuclear Cardiology

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Background. The data existing in the literature regarding the safety of using regadenoson with symptom-limited exercise are limited, which motivated the authors to undertake this randomized study.Methods. We offered patients scheduled to undergo vasodilator stress nuclear myocardial perfusion imaging the opportunity to exercise instead. Patients who failed to reach target heart rate (THR) were randomized to (1) receive regadenoson at peak exercise or (2) stop exercise and receive regadenoson at rest. Patients who reached THR received a standard Tc-99m sestamibi injection with no regadenoson.Results. 200 patients were included (66% male, mean age 52.5 ± 13.6). 125 patients (62%) reached THR with exercise alone. All stress protocols were well tolerated, and there were no significant adverse events. There were no statistically significant differences in the extent of perfusion abnormalities, image quality, or rate of referral to cardiac catheterization within 60 days between the groups. In fully adjusted logistic regression models, beta-blocker use and diabetes remained significant univariate predictors of failure to reach THR (OR 0.21, 95% CI 0.1-0.5, P < .0001, OR 0.34, 95% CI 0.2-0.7, P 5 .004, respectively).Conclusions. A protocol combining regadenoson at peak exercise in patients unable to reach THR with exercise is feasible, well-tolerated, and yields comparable imaging results to a standard regadenoson injection at rest. In addition, pharmacologic stress testing may be overordered in current clinical practice, as patients referred for such testing were often able to exercise. (J Nucl

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“…A maximal symptom-limited exercise bicycle stress test with continuous 12-lead ECG and blood pressure monitoring was performed [6]. The test commenced with a workload of 25 or 50 W depending on the patient's estimated performance level; every 2 min, the load was increased by 25 W. The test was terminated at maximum exhaustion or prematurely in the case of malignant arrhythmias, severe ST-segment deviations or at a decreasing systolic blood pressure >20%.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

et al. 2015

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Objectives: In the recently updated clinical guidelines from the European Society of Cardiology on the management of stable coronary artery disease (CAD), the updated Diamond Forrester score has been included as a pretest probability (PTP) score to select patients for further diagnostic testing. We investigated the validity of the new guidelines in a population of patients with acute-onset chest pain. Methods: We examined 527 consecutive patients with either an exercise-ECG stress test or single-photon emission computed tomography, and subsequently coronary computed tomography angiography (CCTA). We compared the diagnostic accuracy of PTP and stress testing assessed by the area under the receiver operating characteristic curve (AUC) to identify significant CAD, defined as at least 1 coronary artery branch with >70% diameter stenosis identified by CCTA. Results: The diagnostic accuracy of PTP was significantly higher than the stress test (AUC 0.80 vs. 0.69; p = 0.009), but the diagnostic accuracy of the combination of PTP and a stress test did not significantly increase when compared to PTP alone (AUC 0.86 vs. 0.80; p = 0.06). Conclusions: PTP using the updated Diamond and Forrester Score is a very useful tool in risk-stratifying patients with acute-onset chest pain at a low-to-intermediate risk of having CAD. Adding a stress test to PTP does not appear to offer significant diagnostic benefit.

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85% of maximal age-predicted heart rate is not a valid endpoint for exercise treadmill testing

Abstract: Achievement of 85% MPHR is not a valid diagnostic or functional exercise endpoint because it significantly underestimates exercise capacity and inducible ischemia.

Cited by 32 publications

References 20 publications

82Rb PET myocardial perfusion imaging is superior to 99mTc-labelled agent SPECT in patients with known or suspected coronary artery disease

82Rb PET myocardial perfusion imaging is superior to 99mTc-labelled agent SPECT in patients with known or suspected coronary artery disease

Safety and feasibility of adjunctive regadenoson injection at peak exercise during exercise myocardial perfusion imaging: The Both Exercise and Regadenoson Stress Test (BERST) trial

Diagnostic Value of the Updated Diamond and Forrester Score to Predict Coronary Artery Disease in Patients with Acute-Onset Chest Pain

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