Diagnostic exercise testing in 104 patients over 65 years of age

Abstract

Since 1979 we have carried out symptom limited exercise stress tests for the diagnosis of chest pain in 104 patients, 61 male, 43 female, over 65 years of age; mean age 68 +/- 3 years. An upright bicycle ergometer was used for 64 tests, a treadmill for 38 tests and a supervised walk for 2 patients unable to undergo formal exercise testing. A positive result of greater than or equal to 1 mm of ST depression was recorded in 45% of patients; males 57%, females 28% (P less than 0.01). Bicycle and treadmill tests were equally likely to produce a positive result; bicycle 43%, treadmill 50% (NS). The limiting symptom was chest pain in 43%, dyspnoea in 26% and fatigue in 30% of patients. No serious arrhythmias or collapses occurred. During a mean follow up to 24 +/- 18 months 13 patients died. A positive exercise test was associated with a significantly increased risk of cardiac death; 8 of 47 patients with positive tests died compared with 1 of 57 patients with negative or equivocal tests (P less than 0.02). The remaining 4 deaths were due to malignancy. Exercise testing can thus be safely performed in elderly subjects with the expectation of a high diagnostic yield. A positive result confers a poor prognosis.

Exercise Standards for Testing and Training

“…101 Ischemic ST segment depression predicted an increased risk of cardiac death in another study of older patients with stable CAD. 102 Although not recommended for routine use in apparently healthy older adults, exercise testing has also demonstrated prognostic significance in such a population. 103 In summary, the utility and safety of exercise testing in the elderly are similar to those in younger populations.…”

Exercise Standards for Testing and Training

“…295 Ischemic ST-segment depression predicted an increased risk of cardiac death in another study of older patients with stable CAD. 296 Although not recommended for routine use in apparently healthy older adults, exercise testing has also demonstrated prognostic significance in such a population. 297 Although information about the utility of exercise testing among individuals >75 years of age is limited, available data suggest similar value to that in younger elders, a possible exception being concentration of risk by the Duke treadmill score.…”

Stress Testing in the Elderly

“…In 149 CAD patients >65 years old, the severity of ST segment depression during cycle ergometry predicted triple‐vessel disease 14 . In a similar population, Glover et al 15 demonstrated that an ischemic exercise EKG predicted cardiovascular mortality.…”