Prognostic Value of Functional Capacity in Different Exercise Protocols
Background Functional capacity is associated with mortality, although the prognostic value of achieved estimated metabolic equivalents (METs) across various exercise protocols is not established. We sought to determine whether achieved METs had different prognostic implications according to the prot...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.015986 |
| _version_ | 1818314912341950464 |
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| author | Serge C. Harb Pavan Bhat Paul C. Cremer Yuping Wu Laura J. Cremer Stephanie Berger Leslie Cho Venu Menon Martha Gulati Wael A. Jaber |
| author_facet | Serge C. Harb Pavan Bhat Paul C. Cremer Yuping Wu Laura J. Cremer Stephanie Berger Leslie Cho Venu Menon Martha Gulati Wael A. Jaber |
| author_sort | Serge C. Harb |
| collection | DOAJ |
| description | Background Functional capacity is associated with mortality, although the prognostic value of achieved estimated metabolic equivalents (METs) across various exercise protocols is not established. We sought to determine whether achieved METs had different prognostic implications according to the protocol employed. Methods and Results From 1991 to 2015, we identified 120 705 consecutive patients from a stress testing registry who underwent the following 7 different standardized exercise protocols: Bruce, modified Bruce, Cornell 0%, Cornell 5%, Cornell 10%, Naughton, and modified Naughton. The primary outcome was all‐cause mortality. There were 74 953 Bruce, 8368 modified Bruce, 2648 Cornell 0%, 9972 Cornell 5%, 20 425 Cornell 10%, 1226 Naughton, and 3113 modified Naughton protocols. During a mean follow‐up of 8.7 years, a total of 8426 deaths (6.9%) occurred. When compared with the Bruce protocol, after multivariable adjustment for clinical risk factors, medications, and functional capacity, test protocol was independently associated with mortality (modified Naughton [hazard ratio (HR), 2.51; 95% CI, 2.26–2.8], Naughton [HR, 1.79; 95% CI, 1.57–2.04], Cornell 0% [HR, 1.79; 95% CI, 1.59–2.01], modified Bruce [HR, 1.62; 95% CI, 1.48–1.76], Cornell 5% [HR, 1.61; 95% CI, 1.47–1.75], and Cornell 10% [HR, 1.32; 95% CI, 1.22–1.42]). Across all protocols, higher estimated METs were associated with lower mortality, although the equivalent METs achieved were associated with a worse prognosis in less‐demanding protocols. Conclusions Higher estimated METs are reliably associated with lower mortality in all exercise protocols, although the prognostic value is not transferable across different tests. Consequently, the prognostic value of METs achieved during a stress test should be considered protocol dependent. |
| first_indexed | 2024-12-13T08:57:11Z |
| format | Article |
| id | doaj.art-103294bef0fe499789db141785d561e2 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T08:57:11Z |
| publishDate | 2020-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-103294bef0fe499789db141785d561e22022-12-21T23:53:15ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-07-0191310.1161/JAHA.119.015986Prognostic Value of Functional Capacity in Different Exercise ProtocolsSerge C. Harb0Pavan Bhat1Paul C. Cremer2Yuping Wu3Laura J. Cremer4Stephanie Berger5Leslie Cho6Venu Menon7Martha Gulati8Wael A. Jaber9Heart and Vascular Institute Cleveland Clinic Cleveland OHHeart and Vascular Institute Cleveland Clinic Cleveland OHHeart and Vascular Institute Cleveland Clinic Cleveland OHDepartment of Mathematics and Statistics Cleveland State University Cleveland OHCase Western Reserve University Cleveland OHHeart and Vascular Institute Cleveland Clinic Cleveland OHHeart and Vascular Institute Cleveland Clinic Cleveland OHHeart and Vascular Institute Cleveland Clinic Cleveland OHDivision of Cardiology University of Arizona College of Medicine Phoenix AZHeart and Vascular Institute Cleveland Clinic Cleveland OHBackground Functional capacity is associated with mortality, although the prognostic value of achieved estimated metabolic equivalents (METs) across various exercise protocols is not established. We sought to determine whether achieved METs had different prognostic implications according to the protocol employed. Methods and Results From 1991 to 2015, we identified 120 705 consecutive patients from a stress testing registry who underwent the following 7 different standardized exercise protocols: Bruce, modified Bruce, Cornell 0%, Cornell 5%, Cornell 10%, Naughton, and modified Naughton. The primary outcome was all‐cause mortality. There were 74 953 Bruce, 8368 modified Bruce, 2648 Cornell 0%, 9972 Cornell 5%, 20 425 Cornell 10%, 1226 Naughton, and 3113 modified Naughton protocols. During a mean follow‐up of 8.7 years, a total of 8426 deaths (6.9%) occurred. When compared with the Bruce protocol, after multivariable adjustment for clinical risk factors, medications, and functional capacity, test protocol was independently associated with mortality (modified Naughton [hazard ratio (HR), 2.51; 95% CI, 2.26–2.8], Naughton [HR, 1.79; 95% CI, 1.57–2.04], Cornell 0% [HR, 1.79; 95% CI, 1.59–2.01], modified Bruce [HR, 1.62; 95% CI, 1.48–1.76], Cornell 5% [HR, 1.61; 95% CI, 1.47–1.75], and Cornell 10% [HR, 1.32; 95% CI, 1.22–1.42]). Across all protocols, higher estimated METs were associated with lower mortality, although the equivalent METs achieved were associated with a worse prognosis in less‐demanding protocols. Conclusions Higher estimated METs are reliably associated with lower mortality in all exercise protocols, although the prognostic value is not transferable across different tests. Consequently, the prognostic value of METs achieved during a stress test should be considered protocol dependent.https://www.ahajournals.org/doi/10.1161/JAHA.119.015986exercise stress testingmortalitystress testing protocol |
| spellingShingle | Serge C. Harb Pavan Bhat Paul C. Cremer Yuping Wu Laura J. Cremer Stephanie Berger Leslie Cho Venu Menon Martha Gulati Wael A. Jaber Prognostic Value of Functional Capacity in Different Exercise Protocols Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease exercise stress testing mortality stress testing protocol |
| title | Prognostic Value of Functional Capacity in Different Exercise Protocols |
| title_full | Prognostic Value of Functional Capacity in Different Exercise Protocols |
| title_fullStr | Prognostic Value of Functional Capacity in Different Exercise Protocols |
| title_full_unstemmed | Prognostic Value of Functional Capacity in Different Exercise Protocols |
| title_short | Prognostic Value of Functional Capacity in Different Exercise Protocols |
| title_sort | prognostic value of functional capacity in different exercise protocols |
| topic | exercise stress testing mortality stress testing protocol |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.015986 |
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