TY - JOUR
T1 - Cardiovascular mortality prediction in veterans with arm exercise vs pharmacologic myocardial perfusion imaging
AU - Martin, Wade H.
AU - Xian, Hong
AU - Chandiramani, Pooja
AU - Bainter, Emily
AU - Klein, Andrew J.P.
N1 - Funding Information:
Drs Martin, Xian, and Chandiramani and Ms Bainter were supported by a Merit Review research award from the Department of Veterans Affairs, Washington, DC.
Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Background No data exist comparing outcome prediction from arm exercise vs pharmacologic myocardial perfusion imaging (MPI) stress test variables in patients unable to perform treadmill exercise. Methods In this retrospective study, 2,173 consecutive lower extremity disabled veterans aged 65.4 ± 11.0 years (mean ± SD) underwent either pharmacologic MPI (1730 patients) or arm exercise stress tests (443 patients) with MPI (n = 253) or electrocardiography alone (n = 190) between 1997 and 2002. Cox multivariate regression models and reclassification analysis by integrated discrimination improvement (IDI) were used to characterize stress test and MPI predictors of cardiovascular mortality at >10-year follow-up after inclusion of significant demographic, clinical, and other variables. Results Cardiovascular death occurred in 561 pharmacologic MPI and 102 arm exercise participants. Multivariate-adjusted cardiovascular mortality was predicted by arm exercise resting metabolic equivalents (hazard ratio [HR] 0.52, 95% CI 0.39-0.69, P <.001), 1-minute heart rate recovery (HR 0.61, 95% CI 0.44-0.86, P <.001), and pharmacologic and arm exercise delta (peak-rest) heart rate (both P <.001). Only an abnormal arm exercise MPI prognosticated cardiovascular death by multivariate Cox analysis (HR 1.98, 95% CI 1.04-3.77, P <.05). Arm exercise MPI defect number, type, and size provided IDI over covariates for prediction of cardiovascular mortality (IDI = 0.074-0.097). Only pharmacologic defect size prognosticated cardiovascular mortality (IDI = 0.022). Conclusions Arm exercise capacity, heart rate recovery, and pharmacologic and arm exercise heart rate responses are robust predictors of cardiovascular mortality. Arm exercise MPI results are equivalent and possibly superior to pharmacologic MPI for cardiovascular mortality prediction in patients unable to perform treadmill exercise.
AB - Background No data exist comparing outcome prediction from arm exercise vs pharmacologic myocardial perfusion imaging (MPI) stress test variables in patients unable to perform treadmill exercise. Methods In this retrospective study, 2,173 consecutive lower extremity disabled veterans aged 65.4 ± 11.0 years (mean ± SD) underwent either pharmacologic MPI (1730 patients) or arm exercise stress tests (443 patients) with MPI (n = 253) or electrocardiography alone (n = 190) between 1997 and 2002. Cox multivariate regression models and reclassification analysis by integrated discrimination improvement (IDI) were used to characterize stress test and MPI predictors of cardiovascular mortality at >10-year follow-up after inclusion of significant demographic, clinical, and other variables. Results Cardiovascular death occurred in 561 pharmacologic MPI and 102 arm exercise participants. Multivariate-adjusted cardiovascular mortality was predicted by arm exercise resting metabolic equivalents (hazard ratio [HR] 0.52, 95% CI 0.39-0.69, P <.001), 1-minute heart rate recovery (HR 0.61, 95% CI 0.44-0.86, P <.001), and pharmacologic and arm exercise delta (peak-rest) heart rate (both P <.001). Only an abnormal arm exercise MPI prognosticated cardiovascular death by multivariate Cox analysis (HR 1.98, 95% CI 1.04-3.77, P <.05). Arm exercise MPI defect number, type, and size provided IDI over covariates for prediction of cardiovascular mortality (IDI = 0.074-0.097). Only pharmacologic defect size prognosticated cardiovascular mortality (IDI = 0.022). Conclusions Arm exercise capacity, heart rate recovery, and pharmacologic and arm exercise heart rate responses are robust predictors of cardiovascular mortality. Arm exercise MPI results are equivalent and possibly superior to pharmacologic MPI for cardiovascular mortality prediction in patients unable to perform treadmill exercise.
UR - http://www.scopus.com/inward/record.url?scp=84939574070&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2015.05.004
DO - 10.1016/j.ahj.2015.05.004
M3 - Article
C2 - 26299235
AN - SCOPUS:84939574070
SN - 0002-8703
VL - 170
SP - 362-370.e2
JO - American heart journal
JF - American heart journal
IS - 2
ER -