TY - JOUR
T1 - Prognostic value of exercise tolerance and exercise-induced diastolic dysfunction in elderly patients referred for exercise stress echocardiography
AU - Matthews, Christopher N.
AU - Omar, Alaa Mabrouk Salem
AU - Khan, Mohammad I.
AU - Marinelli, Joseph D.
AU - Elias, Joseph
AU - Konje, Swiri
AU - Munoz, Alba
AU - Kim, Ga Hee
AU - Moras, Errol
AU - Gandhi, Kruti
AU - Lizardo, Christopher Perez
AU - Kaur, Arpanjeet
AU - Argulian, Edgar
N1 - Publisher Copyright:
© 2024 Elsevier B.V.
PY - 2025/1/15
Y1 - 2025/1/15
N2 - Background: We studied the prognostic value of exercise tolerance and exercise-associated diastolic dysfunction (Ex-DD) in elderly patients referred for exercise stress echocardiography (ExE). Methods: A total of 674 patients ≥60 years who underwent ExE using the Bruce protocol between January 2017 and December 2020 were included in this study. The prognostic factors examined were exercise tolerance, quantified in metabolic equivalents of tasks (METs), and Ex-DD. Patients were followed for a composite endpoint of all-cause death and cardiovascular hospitalization. Results: 122 (18 %) patients had Ex-DD and had a higher incidence of the combined outcome (23 [19 %] vs. 47 [9 %], p = 0.001) compared to patients without Ex-DD. Patients were classified into the following groups: group A (no Ex-DD and METs≥8.5), group B (either Ex-DD or METs<8.5), and group C (both Ex-DD and METs<8.5). Group B did not show higher mortality (HR: 1.6, p = 0.475) or cardiovascular hospitalization (HR: 1.8, p = 0.08) compared to group A, but showed an increased risk for the combined outcome (HR: 1.9, p = 0.038). Group C was associated with higher mortality (HR: 4.8, p = 0.032), cardiovascular hospitalization (HR: 3.9, p < 0.001), and the combined outcome (HR: 4.0, p < 0.001) compared to group A. Conclusions: Decreased exercise capacity and Ex-DD were associated with poor outcomes, especially when both findings were present.
AB - Background: We studied the prognostic value of exercise tolerance and exercise-associated diastolic dysfunction (Ex-DD) in elderly patients referred for exercise stress echocardiography (ExE). Methods: A total of 674 patients ≥60 years who underwent ExE using the Bruce protocol between January 2017 and December 2020 were included in this study. The prognostic factors examined were exercise tolerance, quantified in metabolic equivalents of tasks (METs), and Ex-DD. Patients were followed for a composite endpoint of all-cause death and cardiovascular hospitalization. Results: 122 (18 %) patients had Ex-DD and had a higher incidence of the combined outcome (23 [19 %] vs. 47 [9 %], p = 0.001) compared to patients without Ex-DD. Patients were classified into the following groups: group A (no Ex-DD and METs≥8.5), group B (either Ex-DD or METs<8.5), and group C (both Ex-DD and METs<8.5). Group B did not show higher mortality (HR: 1.6, p = 0.475) or cardiovascular hospitalization (HR: 1.8, p = 0.08) compared to group A, but showed an increased risk for the combined outcome (HR: 1.9, p = 0.038). Group C was associated with higher mortality (HR: 4.8, p = 0.032), cardiovascular hospitalization (HR: 3.9, p < 0.001), and the combined outcome (HR: 4.0, p < 0.001) compared to group A. Conclusions: Decreased exercise capacity and Ex-DD were associated with poor outcomes, especially when both findings were present.
KW - Exercise diastolic dysfunction
KW - Exercise stress echocardiography
KW - Exercise tolerance
KW - Metabolic equivalent of tasks
UR - http://www.scopus.com/inward/record.url?scp=85207300173&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2024.132668
DO - 10.1016/j.ijcard.2024.132668
M3 - Article
C2 - 39442760
AN - SCOPUS:85207300173
SN - 0167-5273
VL - 419
JO - International Journal of Cardiology
JF - International Journal of Cardiology
M1 - 132668
ER -