Prognostic Value of a Treadmill Exercise Score in Outpatients with Suspected Coronary Artery Disease

Mark, Daniel B.; Shaw, Linda K.; Harrell, Frank E.; Hlatky, Mark A.; Lee, Kerry L.; Bengtson, James R.; McCants, Charles B.; Califf, Robert M.; Pryor, David B.

doi:10.1056/nejm199109193251204

Cited by 739 publications

(399 citation statements)

References 15 publications

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“…The Duke score was calculated as previously described. 7,8 Near peak exercise, 3 to 4 mCi of 201 Tl were injected. Patients were imaged in the supine position beginning 10 minutes after exercise.…”

Section: Exercise 201 Tl Spectmentioning

confidence: 99%

“…[3][4][5] The guidelines acknowledge that the elderly and women represent special populations in whom treadmill testing may be less accurate, but there are insufficient data to recommend stress imaging over standard treadmill testing in these groups. We recently reported that the Duke treadmill score 6,7 failed to stratify elderly patients according to risk. 8 Although single-photon emission computed tomography (SPECT) generally is more accurate for prognostic purposes than standard treadmill testing, 9 -13 there are few published data on the prognostic value of exercise myocardial perfusion imaging in the elderly, especially elderly women.…”

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confidence: 99%

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Exercise Single-Photon Emission Computed Tomography Provides Effective Risk Stratification of Elderly Men and Elderly Women

Valeti¹,

Miller²,

Hodge³

et al. 2005

ACC Current Journal Review

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Background-In a recent study, we reported that the Duke treadmill score was unable to effectively stratify elderly patients according to risk. The purpose of this study was to evaluate the prognostic value of exercise single-photon emission computed tomography (SPECT) in this same population and to examine results by gender. Methods and Results-A cohort of 247 elderly (age Ն75 years) patients (108 women, 139 men, age 77Ϯ3 years) who underwent exercise thallium-201 SPECT were followed up for a median duration of 6.4 years. SPECT variables were significantly associated with cardiac death: summed stress score (SSS) 2 ϭ19.

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Section: Exercise 201 Tl Spectmentioning

confidence: 99%

mentioning

confidence: 99%

Exercise Single-Photon Emission Computed Tomography Provides Effective Risk Stratification of Elderly Men and Elderly Women

Valeti¹,

Miller²,

Hodge³

et al. 2005

ACC Current Journal Review

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“…This may seem to be a high number but in a comparable study by Mark et al [12] and in the multicentre study by Gibbons et al [8] the number of equivocals after exercise test was as high as 34Á57%. Nearly half of the patients who underwent MPS showed signs of IHD.…”

Section: Discussionmentioning

confidence: 91%

Exercise testing and myocardial perfusion scintigraphy in primary care patients with chest pain of new onset

Scheike¹,

Nilsson²,

Nylander³

2007

Scandinavian Journal of Primary Health Care

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“…Symptom perception varies with activity and can be difficult to elicit. Treadmill exercise tolerance testing (ETT) can unmask symptoms; ETT findings have geometric and functional correlates in aortic regurgitation (AR) (4) and prognostic value in coronary artery disease (5) and AR (6). ET correlates with RV ejection fraction, a prognosticator in MR (7).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Exercise Tolerance Testing in Asymptomatic Chronic Nonischemic Mitral Regurgitation

Supino

Borer

Schuleri

et al. 2007

The American Journal of Cardiology

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In many heart diseases, exercise treadmill testing(ETT) has useful functional correlates and/or prognostic value. However, its predictive value in mitral regurgitation(MR) is undefined. To determine whether ETT descriptors predict death or indications for mitral valve surgery among patients with MR, we prospectively followed, for 7±3 endpoint-free years, a cohort of 38 patients with chronic severe nonischemic MR who underwent modified Bruce ETT; all lacked surgical indications at study entry. Their baseline exercise descriptors also were compared with those from 46 patients with severe MR who, at entry, already had reached surgical indications. Endpoints during follow-up among the cohort included sudden death(n=1), heart failure symptoms(n=2), atrial fibrillation(n=4), LVEF<60%(n=2), LV systolic dimensions(IDs)≥45 mm(n=12) and LVIDs>40mm(n=11), LVEF<60%+LVIDs 45 mm(n=3), and heart failure+LVIDs 45mm +LVEF<60%(n=1). In univariate analysis, exercise duration(p=.004), chronotropic response(p=. 007), percent predicted peak heart rate(p=.01) and heart rate recovery(p<.02) predicted events; in multivariate analysis, only exercise duration was predictive(p<.02). Average annual event risk was 5-fold lower(4.62%) with exercise duration≥15 minutes vs. <15 minutes(average annual risk=23.48%, p=.004). Relative risks among patients with and without exercise-inducible ST segment depression were comparable(≤1.3 [NS]) whether defined at entry and/or during follow-up. Exercise duration, but not prevalence of exercise-inducible ST segment depression, was lower(p<. 001) among patients with surgical indications at entry vs. initially endpoint-free patients. In conclusion, among asymptomatic patients with chronic severe nonischemic MR and no objective criteria for operation, progression to surgical indications generally is rapid. However, those with excellent exercise tolerance have a relatively benign course. Exercise-inducible ST segment depression has no prognostic value in this population.We followed, for 7±3 endpoint-free years, 38 patients with chronic severe nonischemic mitral regurgitation (MR) who underwent modified Bruce exercise treadmill testing (ETT) to determine whether ETT descriptors predict death or indications for mitral valve surgery. At study entry, all lacked surgical indications. Exercise duration independently predicted subsequent events; event risks among patients with and without exercise-inducible ST segment depression were comparable. We conclude that among asymptomatic patients with chronic severe nonischemic MR Address for Correspondence: Jeffrey S. Borer, M.D., New York-Presbyterian Hospital New York Weill Cornell Center, 525 East 68 th Street, New York, N.Y. 10021, 212-746-4646=phone, 212-746-8448=fax, canadaD45@aol.com=email Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulti...

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Prognostic Value of a Treadmill Exercise Score in Outpatients with Suspected Coronary Artery Disease

Abstract: The treadmill score is a useful and valid tool that can help clinicians determine prognosis and decide whether to refer outpatients with suspected coronary disease for cardiac catheterization. In this study, it was a better predictor of outcome than the clinical assessment.

Cited by 739 publications

References 15 publications

Exercise Single-Photon Emission Computed Tomography Provides Effective Risk Stratification of Elderly Men and Elderly Women

Exercise Single-Photon Emission Computed Tomography Provides Effective Risk Stratification of Elderly Men and Elderly Women

Exercise testing and myocardial perfusion scintigraphy in primary care patients with chest pain of new onset

Prognostic Value of Exercise Tolerance Testing in Asymptomatic Chronic Nonischemic Mitral Regurgitation

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