scholarly journals Sex-related differences in exercise performance and outcome of patients with hypertrophic cardiomyopathy

2019 ◽  
Vol 27 (17) ◽  
pp. 1821-1831 ◽  
Author(s):  
Luca Ghiselli ◽  
Alberto Marchi ◽  
Carlo Fumagalli ◽  
Niccolò Maurizi ◽  
Andrea Oddo ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Exercise Capacity ◽  
Exercise Performance ◽  
Cardiac Death ◽  
Predictive Accuracy ◽  
Multivariable Analysis ◽  
Peak Exercise ◽  
Exercise Echocardiography ◽  
Metabolic Equivalents ◽  
Age Related

Aims Exercise performance is known to predict outcome in hypertrophic cardiomyopathy (HCM), but whether sex-related differences exist is unresolved. We explored whether functional impairment, assessed by exercise echocardiography, has comparable predictive accuracy in females and males with HCM. Methods We retrospectively evaluated 292 HCM patients (46 ± 16 years, 72% males), consecutively referred for exercise echocardiography; 242 were followed for 5.9 ± 4.2 years. Results Peak exercise capacity was 6.5 ± 1.6 metabolic equivalents (METs). Sixty patients (21%) showed impaired exercise capacity (≤5 METs). Exercise performance was reduced in females, compared with males (5.6 ± 1.6 vs 6.9 ± 1.5 METs, p < 0.001; peak METs ≤ 5 in 40% vs 13%, p < 0.001), largely driven by a worse performance in women >50 years of age. At multivariable analysis, female sex was independently associated with impaired exercise capacity (odds ratio: 4.67; 95% confidence interval (CI): 1.83–11.90; p = 0.001). During follow-up, 24 patients (10%) met the primary endpoint (a combination of cardiac death, heart failure requiring hospitalization, sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator discharge, resuscitated sudden cardiac death and cardioembolic stroke). Event-free survival was reduced in females ( p = 0.035 vs males). Peak METs were inversely related to outcome in males (hazard ratio (HR) per unit increase: 0.57; 95% CI: 0.39–0.84; p = 0.004) but not in females (HR: 1.22; 95% CI: 0.66–2.24; p = 0.53). Conclusions Female patients with HCM showed significant age-related impairment in functional capacity compared with males, particularly evident in post-menopausal age groups. While women were at greater risk of HCM-related complications and death, impaired exercise capacity predicted adverse outcome only in men. These findings suggest the need for sex-specific management strategies in HCM.

Exercise capacity is associated with rest and peak-exercise left ventricular global longitudinal strain in patients with hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.M Fava ◽  
A Alashi ◽  
Y Saijo ◽  
I Sande Mathias ◽  
Z Popovic ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricle ◽  
Exercise Capacity ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Myocardial Strain ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Left Ventricle Mass ◽  
Metabolic Equivalents

Abstract Background Patients with hypertrophic cardiomyopathy (HCM) frequently have reduced exercise capacity, which can be associated with subclinical cardiac dysfunction. Left ventricle global myocardial strain (LV-GLS) is a sensitive index to detect subclinical myocardial dysfunction. However, the clinical utility of LV-GLS during exercise test remains uncertain. Purpose We assessed the association of functional capacity with LV-GLS at rest and at the peak of stress in HCM patients. Methods We examined 566 asymptomatic/minimally symptomatic HCM patients (54±14 years, 57% men, body mass index 30±6 kg/m2, 84% on beta-blockers) by echo at rest and following maximal exercise. We recorded clinical, echo variables (LV ejection fraction [LVEF], LV thickness, left ventricle mass index [LVMI], left ventricle outflow tract [LVOT] gradient, LV-GLS at rest and at peak stress), and exercise variables (percent of age-gender predicted metabolic equivalents [AGP-METs]). Results Echo parameters were as follows: LVEF at rest of 62±6%, wall thickness of 16.9±0.4 mm, LVMI of 117±47 g/m2, LVOT gradient at rest of 27±33 mmHg, LV-GLS at rest of −15.9±3.6%, LV-GLS at peak of stress of −17.4±4.3%, and change in LV strain from rest to stress of −1.9±2.3%. Only 41% of patients achieved &gt;85% of AGP-METs. Logistic regression demonstrating an association between AGP-METs less than 85% and various predictors are shown in Table 1. Conclusion Impaired deformation at peak of stress assessed by LV-GLS was associated with reduced exercise capacity measured as AGP-METs less than 85%. These findings suggest that early systolic cardiac deterioration should be considered as a cause of exercise impairment in patients with HCM. Funding Acknowledgement Type of funding source: None

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

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.

Abstract 17002: Assessment of Exercise Function in Children With Hypertrophic Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Robert Przybylski ◽  
Mark E Alexander ◽  
Steven D Colan ◽  
Christa Miliaresis ◽  
Jonathan Rhodes
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Exercise Performance ◽  
Normal Values ◽  
Ventricular Outflow Tract ◽  
Cardiopulmonary Exercise Test ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Peak Vo2 ◽  
O2 Pulse ◽  
Established Population

Introduction: Hypertrophic cardiomyopathy (HCM) accounts for nearly half of pediatric cardiomyopathies. While impaired exercise function has been described in adults with HCM, little is known about exercise function in children with HCM. Hypothesis: Children with HCM have impaired exercise function. Methods: A retrospective cohort study was performed. Pts <21 years with a diagnosis of HCM with a cardiopulmonary exercise test (CPET) between November 1, 2002 and May 31, 2019 were included. Pts with syndromic HCM were excluded. CPETs with respiratory exchange ratio <1.09 were excluded. We compared indices of exercise performance to established population normal values using one-sample T-tests. In pts with multiple CPETs, we compared indices of exercise performance from the first to last CPET using paired T-tests. Results: We identified 124 pts with 240 CPETs. The average age at time of CPET was 14.8 ± 3.0 years. Average %predicted peak VO2 (78 ± 20%) was significantly less than the population average (p <0.01), though there was wide variability (range 35-152% predicted). Peak VO2 was <85% predicted in 67%, <50% predicted in 7%, and absolute peak VO2 was <25 cc/kg/min in 30% of tests. However, %predicted peak VO2 was >100% in 13% of tests. The %predicted peak O2 pulse (88 ± 21%; p <0.01; a surrogate for the forward stroke volume at peak exercise) and the %predicted peak heart rate (88.0 ± 12%; p <0.01) were significantly lower than established population normal values. In 63 pts with multiple CPETs, significant declines in %predicted peak VO2 (83 ± 20% v. 75 ± 19%; p <0.01) and O2 pulse (92 ± 22% v. 86 ± 21%; p <0.01) were observed at an average interval of 4.5 years. We found no statistically significant association between %predicted peak VO2 and interventricular septal thickness, resting left ventricular outflow tract gradient or echocardiographic indices of diastolic left ventricular function. Conclusions: Exercise function is at least moderately impaired in a substantial portion of children with HCM and this impairment tends to worsen over time. However, there is a significant subset of patient with remarkably well-preserved exercise function. Echocardiographic measurements did not correlate with exercise function in our cohort.

Abstract 1059: Left Atrial Volume and E/E′ Ratio are Most Predictive of Exercise Capacity in Hypertrophic Cardiomyopathy

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Vy-Van Le ◽  
Marco Perez ◽  
Matthew Wheeler ◽  
Ingela Schnittger ◽  
Euan Ashley
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Exercise Capacity ◽  
Functional Limitation ◽  
Left Atrial Volume ◽  
Exercise Group ◽  
Peak Exercise ◽  
Group I ◽  
Significant Difference ◽  
Doppler Indices ◽  
Pattern Group

Hypertrophic cardiomyopathy (HCM) is characterized by LVH and myocardial disarray which result in ischemia, diastolic dysfunction and arrhythmias. While many experience functional limitation, the precise mechanisms are still unknown. We aim to determine the relation between echocardiogram findings and exercise capacity. We studied 48 patients (48 ± 15 years; 15 females) referred for symptom-limited cardiopulmonary testing and stress echocardiography for clinical reasons: 23 had a proximal HCM pattern (group I), 7 had a classic reverse curvature pattern (group II), 4 had an apical pattern (group III) and 14 had a concentric pattern (group IV). At baseline, patients in group I were significantly older than in other groups (54 ± 13 (I) vs. 41 ± 12 (II), 38 ± 12(III) and 44 ± 17 years (IV); p=0.04). No other significant difference in clinical characteristics was noted between groups. The maximal septum thickness was higher in groups I and II than in III and IV (19 (16 – 23), 22 (17–33), 17, and 16 (13–18) mm, respectively; p=0.05). Groups I and II were more likely to have resting gradient of >10 mm Hg (68% and 18%, respectively vs. 14% in IV; p=0.01) and to present rest systolic anterior movement (74% and 15% vs. 11% in IV; p <0.001). A higher prevalence of abnormal transmitral inflow E to lateral E′ ratio (E/E′) was also noted in Group I (80%, p=0.05): high ratios are known to be associated with high pulmonary wedge pressure in non-HCM populations. At peak exercise, group I achieved a lower peak VO 2 (21.8 ±2.1 vs. 27.1±6.6 in II 36.6 ±5.1 in III and 29.4 ±2.7 ml/kg/min in IV; p=0.03). No significant differences in Valsalva and exercise gradients and delta rest-to-peak gradients were noted between patterns. In age-adjusted multivariate analysis, only negative correlations between E/E′ (R2=0.45; p=0.03) and indexed LA volume (R2=0.39; p=0.009) and peak VO 2 were significant. In contrast, no correlation was found between maximal exercise capacity and LV dimensions, conventional Doppler indices of diastolic function, lateral E′ or gradients. Lateral E/E′ and indexed LA volume are negatively correlated with functional capacity even after age-adjustment. Although patients with proximal HCM achieved the lowest peak VO 2 , gradient and morphology were not related to exercise capacity.

Value of a comprehensive exercise echocardiography assessment for patients with hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.C Peteiro Vazquez ◽  
J Peteiro ◽  
R Barriales-Villa ◽  
J Larranaga-Moreira ◽  
C Martinez-Veira ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Diastolic Function ◽  
Wall Thickness ◽  
Systolic Function ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Exercise Echocardiography ◽  
Metabolic Equivalents ◽  
Lv Systolic Function ◽  
Systolic And Diastolic Function

Abstract Background Exercise echocardiography (ExE) may assess left ventricular (LV) systolic and diastolic function, LV outflow tract (LVOT) obstruction and mitral regurgitation (MR). We aimed to assess the feasibility and prognostic value of the assessment of all these issues during exercise in patients with hypertrophic cardiomyopathy (HCM). Methods LV systolic and diastolic function, LVOT gradients, and MR were evaluated during ExE in 285 patients with HCM (age 60±14 years, 168 men) and preserved LVEF (≥50%). Recordings were obtained at rest and peak exercise for regional/global LV systolic function and at rest and within 1.5 min after exercise for the rest of assessments: LVOT gradients, MR and ratio of early LV inflow velocity to early tissue Doppler septal annulus velocity (E/e'). Results Feasibility was 100%, 97%, 98% and 98% for LV systolic function, E/e', LVOT gradients, and MR assessments at exercise, respectively. Thirty-seven patients (13%) had LVOT obstruction at rest, and 76 (27%) developed exercise-induced LVOT obstruction. Mean resting LVEF was 63±3%. New wall motion abnormalities (WMAs) were detected in 38 patients (13%). E/e'&gt;15 was observed in 108 patients at rest (38%) and in 119 at exercise (42%). Corresponding figures for significant MR (moderate or severe) were 20 (7%) and 17 (6%). During follow-up of 3.9±2.5 years, 21 patients had a hard event (cardiac death or transplantation, appropriate discharge of a defibrillator, stroke, myocardial infarction, hospitalization for heart failure), 33 a combined event (hard plus new atrial fibrillation or syncope), and 53 a combined event plus any interventionism. After adjustment, LV wall thickness, resting LVEF, maximal workload in Metabolic Equivalents (METs), and E/e' post-exercise resulted independent predictors of hard events (HR=1.45, 95% CI: 1.21–1.74, p&lt;0.001; HR=0.80, CI: 0.71–0.89, p&lt;0.001; HR=0.73, 95% CI: 0.62–0.86, p&lt;0.001; HR=1.08, 95% CI: 1.02–1.14, p&lt;0.009, respectively). Independent predictors of combined events included also LV wall thickness, resting LVEF, and METs, along with therapy with beta-blockers at the time of ExE (HR=1.29, 95% CI: 1.12–1.50, p=0.001; HR=0.89, CI: 0.81–0.97, p=0.012; HR=0.83, 95% CI: 0.74–0.93, p=0.001; HR=2.51, 95% CI: 1.20–5.25, p=0.015), whereas the model for combined events+any interventionism consisted of beta-blockers, LV wall thickness, LA dimension, METs and new WMAs. (HR=2.15, 95% CI: 1.20–3.86, p=0.01; HR=1.17, 95% CI: 1.03–1.32, p=0.02; HR=1.07, CI: 1.02–1.11, p=0.005; HR=0.90, 95% CI: 0.82–0.98, p=0.01; HR=2.33, 95% CI: 1.17–4.63, p=0.016) Conclusions A comprehensive assessment during ExE is feasible for patients with HCM and provides significant incremental prognostic information Funding Acknowledgement Type of funding source: None

scholarly journals Exercise Ventricular Rates, Cardiopulmonary Exercise Performance, and Mortality in Patients With Heart Failure With Atrial Fibrillation

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
Mohamed B. Elshazly ◽  
Bruce L. Wilkoff ◽  
Khaldoun Tarakji ◽  
Yuping Wu ◽  
Eoin Donnellan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Exercise Capacity ◽  
Exercise Performance ◽  
Stress Testing ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Peak Exercise ◽  
All Cause Mortality

Background: In heart failure (HF) with sinus rhythm, resting and exercise heart rates correlate with exercise capacity and mortality. However, in HF with atrial fibrillation (AF), this correlation is unknown. Our aim is to investigate the association of resting and exercise ventricular rates (VRs) with exercise capacity and mortality in HF with AF. Methods: We identified 903 patients with HF and AF referred for cardiopulmonary stress testing. AF was defined as history of AF and AF during cardiopulmonary stress testing. We constructed multivariable models to evaluate the association of resting VR, peak exercise VR, VR reserve (peak VR−resting VR), and chronotropic index with (1) peak oxygen consumption (PVO 2 ) ≤18 mL/kg per minute, (2) continuous PVO 2 , and (3) 10-year all-cause mortality. Results: Median (25th–75th percentile) age was 60 (52–67) years, left ventricular ejection fraction was 25 (15–50)%, and 76.1% were males. Patients with lower (quartile 1) compared with higher (quartile 4) peak VR, VR reserve, and chronotropic index were more likely to have PVO 2 ≤18 mL/kg per min (adjusted odds ratio [95% CI]: 14.92 [8.07–27.58], 24.60 [12.36–48.98], and 22.31 [11.24–44.27], respectively), and higher all-cause mortality (adjusted hazard ratio [95% CI]: 2.56 [1.62–4.04], 2.29 [1.47–3.59], and 2.30 [1.51–3.49], respectively). For every 10 beats per minute increase in VR reserve, PVO 2 increased by 1.05 mL/kg per minute (B-coefficient [95% CI]: 1.05 [0.94–1.15]) and mortality decreased by 12% (adjusted hazard ratio [95% CI]: 0.88 [0.83–0.94]). Resting VR was associated with PVO 2 (B-coefficient [95% CI]: −0.46 [−0.70 to −0.23]) but not mortality (adjusted hazard ratio [95% CI]: 0.97 [0.88–1.06]). Conclusions: In patients with HF and AF, higher resting VR and lower peak exercise VR, VR reserve, and chronotropic index were all associated with worse peak exercise capacity, but only lower exercise VR parameters were associated with higher mortality. Dedicated studies are needed to gauge whether modulating exercise VR enhances exercise performance and outcomes.

Abstract 10947: Longer and Faster Non-sustained Ventricular Tachycardia in Hypertrophic Cardiomyopathy Patients Predicts for Implantable Cardioverter Defibrillator Shocks and Sudden Cardiac Death

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Weijia Wang ◽  
Zhesi Lian ◽  
Ethan Rowin ◽  
Martin Maron ◽  
Mark Link
Keyword(s):  
Ventricular Tachycardia ◽  
Hypertrophic Cardiomyopathy ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Death ◽  
Medical Center ◽  
Multivariable Analysis ◽  
Sustained Ventricular Tachycardia ◽  
Cardioverter Defibrillator

Introduction: Non-sustained ventricular tachycardia (NSVT) may be underestimated in patients with hypertrophic cardiomyopathy (HCM). Its impact on the risk of sudden cardiac death (SCD) in HCM is controversial. There is no distinction made in the guidelines as to the length or rate of NSVT as a risk marker for SCD. Hypothesis: NSVT may be nearly universal in HCM patients with high risk of SCD and not found because of the limited time frame of monitoring. NSVT may be associated with appropriate Implantable Cardioverter Defibrillator (ICD) shocks and SCD. Methods: A retrospective study of 181 HCM patients who had an ICD and were followed for at least 6 months from 2000 to 2013 at Tufts Medical Center was performed. The pre-operative evaluations as well as routine ICD follow up notes were reviewed. Results: ICD was implanted in 175 (96.7%) patients as primary prevention and in 6 (3.3%) patients as secondary prevention for SCD. Ninety six (53.0%) patients total had NSVT, including 48 (26.5%) before and 77 (42.5%) after ICD implantation. The agreement for detecting NSVT between Holter monitoring and ICD interrogation was poor (Kappa=0.18, p=0.054). Eighteen (18.75%) patients with NSVT and 6 (7.06%) patients without NSVT had appropriate ICD shocks or SCD (Figure 1). In multivariable analysis, NSVT was independently associated with appropriate ICD shocks and SCD (OR 3.69, 95%CI: 1.31 - 10.43) and remained significant in the 175 patients who had ICD implanted as primary prevention (OR 3.86, 95%CI: 1.13 - 13.18). More rapid NSVT (Cl < 310ms) predicted appropriate ICD shocks and SCD (OR 7.7, 95%CI: 1.6, 36.8), and longer NSVT (> 18beats) also predicted appropriate ICD shocks and SCD (OR=23.7, 95%CI: 2.7, 204.9). Conclusion: The agreement for detecting NSVT between Holter and ICD interrogation is poor. NSVT is significantly associated with appropriate ICD shocks and SCD. Faster and longer NSVT are even more predictive. Extending rhythm monitor time merits consideration in HCM patients.

Invited Review: Dynamic exercise performance in Masters athletes: insight into the effects of primary human aging on physiological functional capacity

2003 ◽  
Vol 95 (5) ◽  
pp. 2152-2162 ◽  
Author(s):  
Hirofumi Tanaka ◽  
Douglas R. Seals
Keyword(s):  
Aerobic Exercise ◽  
Functional Capacity ◽  
Exercise Performance ◽  
Swimming Performance ◽  
Physiological Mechanism ◽  
Peak Exercise ◽  
Human Aging ◽  
Age Related ◽  
Masters Athletes ◽  
Exercise Status

Physiological functional capacity (PFC) is defined here as the ability to perform the physical tasks of daily life and the ease with which these tasks can be performed. For the past decade, we have sought to determine the effect of primary (healthy) adult human aging on PFC and the potential modulatory influences of gender and habitual aerobic exercise status on this process by studying young adult and Masters athletes. An initial approach to determining the effects of aging on PFC involved investigating changes in peak exercise performance with age in highly trained and competitive athletes. PFC, as assessed by running and swimming performance, decreased only modestly until age 60-70 yr but declined exponentially thereafter. A progressive reduction in maximal O2 consumption (V̇o2 max) appears to be the primary physiological mechanism associated with declines in endurance running performance with advancing age, along with a reduction in the exercise velocity at lactate threshold. Because V̇o2 max is important in mediating age-related reductions in exercise performance and PFC, we then investigated the modulatory influence of habitual aerobic exercise status on the rate of decline in V̇o2 max with age. Surprisingly, as a group, endurance-trained adults appear to undergo greater absolute rates of decline in V̇o2 max with advancing age compared with healthy sedentary adults. This appears to be mediated by a baseline effect (higher V̇o2 max as young adults) and/or a marked age-related decline in exercise training volume and intensity (stimulus) in endurance-trained adults. Thus the ability to maintain habitual physical activity levels with advancing age appears to be a critical determinant of changes in PFC in part via modulation of maximal aerobic capacity.

scholarly journals 1676 Prediction of different causes of mortality by exercise echocardiography in women

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J C Peteiro Vazquez ◽  
A Bouzas-Mosquera ◽  
S Pertega ◽  
C Barbeito-Caamano ◽  
F J Broullon ◽  
...  
Keyword(s):  
Exercise Testing ◽  
Functional Capacity ◽  
Clinical Characteristics ◽  
Suspected Coronary Artery Disease ◽  
Peak Exercise ◽  
Exercise Echocardiography ◽  
Metabolic Equivalents ◽  
Causes Of Mortality ◽  
Wall Motion Abnormalities ◽  
Artery Disease

Abstract Exercise echocardiography (ExE) can predict overall and cardiovascular mortality. We aimed to assess the value of ExE for the prediction of cardiovascular (CV), cancer (CA) and non-cardiovascular non-cancer (NCV-NCA) death in women. Methods Retrospective analysis of prospectively collected data on 4,714 women (age 64 ± 11 years) with a first treadmill ExE performed in our center for known/suspected coronary artery disease. Exclusion criteria were significant valve disease, cardiomyopathy, congenital heart disease, and age &lt;18 year-old. Ischemia was defined as the development of new wall motion abnormalities (WMAs) with exercise; abnormal ExE as ischemia or resting WMAs. A good functional capacity was defined as a maximal workload of 10 metabolic equivalents (METs). The end point was death (CV, CA or NCV-NCA). Results During a follow-up of 4.6± 4.7 years (interquartile range 0.04-8.0 years) there were 345 CV, 164 CA, and 203 NCV-NCA deaths. Multivariate analysis included clinical characteristics, resting echocardiography, exercise testing and peak exercise echocardiography. Different clinical characteristics predicted CV death, along with maximal achieved workload in Metabolic Equivalents (METs: Hazard Ratio [HR] = 0.92, 95% Confidence Interval [CI] = 0.88-0.96, p &lt; 0.001) and ExE variables. CA death was independently predicted by age and achieved METs (HR = 0.93, 95% CI =0.87-0.99, p &lt; 0.02). Similarly NCV-NCA death was predicted by clinical characteristics (age, diabetes mellitus, diuretics, nitrites) and also by achieved METs (HR = 0.83, 95% CI= 0.78-0.88, p &lt; 0.001). Nor ischemia nor abnormal ExE increased the risk for CA or NCV-NCA death. Annualized CV deaths were almost quadruple in women with bad functional capacity as compared to those with good functional capacity (2.2% vs. 0.6%, p &lt; 0.001). The same occurred for NCV-NCA death (1.4% vs. 0.3%, p &lt; 0.001), whereas CA deaths were double in patients with bad functional capacity (0.9% vs. 0.4%, p &lt; 0.001). In conclusion, an ExE study can predict not only CV death, but death due to CA or to NCV-NCA. Fit women based on the achievement of 10 METs during exercise testing, have less chance of death from any cause.

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