TY - JOUR
T1 - Age, Hypertension, and Exercise Capacity are Independently Associated with Likelihood of Multi-Vessel Disease in Patients Referred for Treadmill Exercise Testing
T2 - The Intermediate-High-Workload Treadmill Score (IHWTS)
AU - Arciniegas Calle, Maria C.
AU - Abbasi, Muhannad Aboud
AU - Salah, Husam M.
AU - Scott, Christopher G.
AU - Garcia Bello, Laura B.
AU - Bonikowske, Amanda R.
AU - Villarraga, Hector R.
N1 - Publisher Copyright:
Copyright: © 2023 The Author(s). Published by IMR Press.
PY - 2023/4
Y1 - 2023/4
N2 - Background: To identify factors that increase the specificity of the treadmill exercise test (TMET), and develop a novel scoring system which accounts for functional capacity to aid in determining the need for further testing. Methods: We retrospectively evaluated the electronic health records of 600 patients who had positive TMET results and follow-up stress echocardiography from 1-January-2004, through 31-December-2016. Correlations between clinical and aerobic variables and multivessel disease (MVD) were determined. Duke Treadmill Score (DTS) was calculated and compared with a novel scoring system titled the Intermediate-High-Workload Treadmill Score (IHWTS) that used variables associated with MVD. Results: In total, 124 of 600 patients (21%) had coronary catheterization, and 51 of these patients (41%) had MVD. Mean (SD) DTS was -2.10 (6.3) among patients with MVD vs -0.16 (5) among patients without MVD (p = 0.06). Mean (SD) functional aerobic capacity (FAC) was 76% (20%) among patients with MVD vs 90% (21%) among patients without MVD (p < 0.001). Mean (SD) metabolic equivalent (MET) was 7 (2) among patients with MVD vs 8 (2) among patients without MVD (p = 0.002). Only 6 (12%) of patients with MVD achieved 9 MET or greater on TMET. DTS less than 4 did not distinguish between patients with and without MVD (p = 0.67). Age, hypertension and FAC were independently associated with MVD (all p < 0.05). Conclusions: Our novel scoring system IHWTS utilized age, hypertension, and FAC appeared comparable to DTS to risk-stratify patients regardless of baseline symptoms. Clinical parameters such as hypertension along with exercise functional capacity should be considered when evaluating a positive TMET result in patients that achieve an intermediate-high workload >5 Metabolic Equivalents (METs).
AB - Background: To identify factors that increase the specificity of the treadmill exercise test (TMET), and develop a novel scoring system which accounts for functional capacity to aid in determining the need for further testing. Methods: We retrospectively evaluated the electronic health records of 600 patients who had positive TMET results and follow-up stress echocardiography from 1-January-2004, through 31-December-2016. Correlations between clinical and aerobic variables and multivessel disease (MVD) were determined. Duke Treadmill Score (DTS) was calculated and compared with a novel scoring system titled the Intermediate-High-Workload Treadmill Score (IHWTS) that used variables associated with MVD. Results: In total, 124 of 600 patients (21%) had coronary catheterization, and 51 of these patients (41%) had MVD. Mean (SD) DTS was -2.10 (6.3) among patients with MVD vs -0.16 (5) among patients without MVD (p = 0.06). Mean (SD) functional aerobic capacity (FAC) was 76% (20%) among patients with MVD vs 90% (21%) among patients without MVD (p < 0.001). Mean (SD) metabolic equivalent (MET) was 7 (2) among patients with MVD vs 8 (2) among patients without MVD (p = 0.002). Only 6 (12%) of patients with MVD achieved 9 MET or greater on TMET. DTS less than 4 did not distinguish between patients with and without MVD (p = 0.67). Age, hypertension and FAC were independently associated with MVD (all p < 0.05). Conclusions: Our novel scoring system IHWTS utilized age, hypertension, and FAC appeared comparable to DTS to risk-stratify patients regardless of baseline symptoms. Clinical parameters such as hypertension along with exercise functional capacity should be considered when evaluating a positive TMET result in patients that achieve an intermediate-high workload >5 Metabolic Equivalents (METs).
KW - Intermediate-High-Workload Treadmill Score
KW - coronary artery disease
KW - exercise testing
KW - preventive medicine
UR - http://www.scopus.com/inward/record.url?scp=85156147371&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85156147371&partnerID=8YFLogxK
U2 - 10.31083/j.rcm2404108
DO - 10.31083/j.rcm2404108
M3 - Article
AN - SCOPUS:85156147371
SN - 1530-6550
VL - 24
JO - Reviews in cardiovascular medicine
JF - Reviews in cardiovascular medicine
IS - 4
M1 - 108
ER -