Clinical role of the Duke Activity Status Index in the selection of the optimal type of stress myocardial perfusion imaging study in patients with known or suspected ischemic heart disease

Phillips, Lawrence M.; Wang, Jing Wa; Pfeffer, Brad; Gianos, Eugenia; Fisher, Daniel; Shaw, Leslee J.; Mieres, Jennifer H.

doi:10.1007/s12350-011-9456-y

Cited by 27 publications

(24 citation statements)

References 14 publications

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“…However, it is not always usable either due to patient physical condition or when it may expose a given patient to higher-than-normal risk. Questionnaires are an inexpensive, simple and safe tool to assess the functional or clinical status 1,2 that might be used before the exercise test to determine a patient's ability to perform appropriate effort 3 . …”

Section: Introductionmentioning

confidence: 99%

Duke Activity Status Index for Cardiovascular Diseases: Validation of the Portuguese Translation

Coutinho-Myrrha¹,

Dias²,

Fernandes³

et al. 2014

Arquivos Brasileiros De Cardiologia

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BackgroundThe Duke Activity Status Index (DASI) assesses the functional capacity of patients with cardiovascular disease (CVD), but there is no Portuguese version validated for CVD. ObjectivesTo translate and adapt cross-culturally the DASI for the Portuguese-Brazil language, and to verify its psychometric properties in the assessment of functional capacity of patients with CVD. MethodsThe DASI was translated into Portuguese, then checked by back-translation into English and evaluated by an expert committee. The pre-test version was first evaluated in 30 subjects. The psychometric properties and correlation with exercise testing was performed in a second group of 67 subjects. An exploratory factor analyses was performed in all 97 subjects to verify the construct validity of the DASI. ResultsThe intraclass correlation coefficient for test-retest reliability was 0.87 and for the inter-rater reliability was 0.84. Cronbach's α for internal consistency was 0.93. The concurrent validity was verified by significant positive correlations of DASI scores with the VO2max (r = 0.51, p < 0.001). The factor analysis yielded two factors, which explained 54% of the total variance, with factor 1 accounting for 40% of the variance. Application of the DASI required between one and three and a half minutes per patient. ConclusionsThe Brazilian version of the DASI appears to be a valid, reliable, fast and easy to administer tool to assess functional capacity among patients with CVD.

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Section: Introductionmentioning

confidence: 99%

Duke Activity Status Index for Cardiovascular Diseases: Validation of the Portuguese Translation

Coutinho-Myrrha¹,

Dias²,

Fernandes³

et al. 2014

Arquivos Brasileiros De Cardiologia

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“…The Duke Activity Status Index (DASI) is a simple self-administered 12-item questionnaire that predicts METs likely to be achieved on exercise treadmill testing. 11 Being able to predict beforehand which patients are most likely to achieve high workloads would reduce the number of radioisotope doses prepared for provisional imaging. The ''What Is the Optimal Method for Ischemia Evaluation in Women?''…”

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confidence: 99%

Provisional use of myocardial perfusion imaging in patients undergoing exercise stress testing: A worthy concept fraught with challenges

Bateman

2013

Journal of Nuclear Cardiology

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See related article, pp. 739-747It has been recognized for many years that patients who achieve a high workload on exercise stress testing have an excellent prognosis, particularly in the absence of ischemic ST segment depression. [1][2][3][4] Outpatients with a low-risk Duke Treadmill Score (based on exercise duration, magnitude of ST deflection and an angina index) had an observed annual mortality rate of only 0.25%. 5 Exercise capacity has been shown to be a better predictor of all-cause mortality than maximum exercise heart rate.1 Myers et al 1 reported that patients achieving a workload of C10 metabolic equivalents (METs), even in the presence of cardiovascular disease, had a relatively low risk of death during follow-up. For every 1-MET increment in peak treadmill workload, there was an associated 12% improvement in survival. These investigators found that, in both healthy subjects and those with cardiovascular disease, the peak exercise capacity was a stronger predictor of an increased risk of death than clinical variables or coronary artery disease (CAD) risk factors such as hypertension, smoking, and diabetes. It had greater prognostic value than peak exercise heart rate, ST depression, or exercise-induced arrhythmias. Morise et al 6 found a 14% reduction in cardiac events among subjects \65 years of age, and an 18% reduction among subjects C65 years of age for each 1-MET increase in workload. After adjustment for age, the peak METs achieved was the strongest predictor of subsequent mortality. In another study, among patients with a positive exercise ECG, who achieved C10 METs, 93% had a negative exercise echocardiogram and less than 1% mortality after 7.2 years of follow-up. 7More recently, Bourque et al 8 from the University of Virginia reported that in more than 470 consecutive patients referred for exercise SPECT myocardial perfusion imaging (MPI), who achieved C85% of maximum predicted heart rate (MPHR) and C10 METs, the prevalence of significant ischemia defined as comprising 10% or more of the left ventricle (LV), was only 0.4%. In fact, no patient who achieved C10 METs without ischemic ST depression had significant ischemia on MPI. The prevalence of 5-9% LV ischemia in such patients was also very low at 0.7%. This population had an intermediate-to-high pretest likelihood of CAD, with 20% having known CAD and 70% with chest pain as the indication for testing. Ischemia involving C10% of the LV was also low (2.4%) in the 82 patients who achieved C10 METs, but \85% of MPHR. Bourque et al 9 then published the subsequent cardiac mortality and nonfatal cardiac event rates in this patient cohort achieving C10 METs. They reported a remarkably low annual cardiac mortality of 0.1% and a combined annual cardiac death or nonfatal myocardial infarction rate of 0.4%. None of the event patients had either [5% or [10% LV ischemia, and none was in the subsets which achieved \85% of MPHR or who had ST depression. Therefore, even if perfusion imaging was performed, it would not have identified the patients who subs...

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“…In addition, the Duke Activity Status Index (DASI) is a 12-item questionnaire that utilizes self-reported physical work capacity to estimate peak metabolic equivalents (METs) and has been shown to be a valid measurement of functional capacity. 13 While we did not incorporate either method into our protocol, future studies may consider integrating this questionnaire in effort to determine which patients are likely to fail to reach the THR with exercise alone; such methodology could facilitate the selection of those patients who may benefit from a combined exercise plus regadenoson protocol.…”

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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Clinical role of the Duke Activity Status Index in the selection of the optimal type of stress myocardial perfusion imaging study in patients with known or suspected ischemic heart disease

Cited by 27 publications

References 14 publications

Duke Activity Status Index for Cardiovascular Diseases: Validation of the Portuguese Translation

Duke Activity Status Index for Cardiovascular Diseases: Validation of the Portuguese Translation

Provisional use of myocardial perfusion imaging in patients undergoing exercise stress testing: A worthy concept fraught with challenges

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

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