Prognostic Value of Functional Capacity in Different Exercise Protocols
Author
Harb, Serge C.Bhat, Pavan
Cremer, Paul C.
Wu, Yuping
Cremer, Laura J.
Berger, Stephanie
Cho, Leslie
Menon, Venu
Gulati, Martha
Jaber, Wael A.
Affiliation
Univ Arizona, Coll Med, Div CardiolIssue Date
2020-07
Metadata
Show full item recordPublisher
WILEYCitation
Harb, S. C., Bhat, P., Cremer, P. C., Wu, Y., Cremer, L. J., Berger, S., ... & Jaber, W. A. (2020). Prognostic Value of Functional Capacity in Different Exercise Protocols. Journal of the American Heart Association, 9(13), e015986.Rights
Copyright © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License.Collection Information
This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.Abstract
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.Note
Open access journalISSN
2047-9980PubMed ID
32578479Version
Final published versionae974a485f413a2113503eed53cd6c53
10.1161/JAHA.119.015986
Scopus Count
Collections
Except where otherwise noted, this item's license is described as Copyright © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License.
Related articles
- Associations between cardiorespiratory fitness, sex and long term mortality amongst adults undergoing exercise treadmill testing.
- Authors: Harb SC, Wang TKM, Cremer PC, Wu Y, Cho L, Menon V, Jaber WA
- Issue date: 2021 Nov 1
- Evaluation of functional capacity during exercise radionuclide angiography.
- Authors: Foster C, Pollock ML, Rod JL, Dymond DS, Wible G, Schmidt DH
- Issue date: 1983
- A nomogram to select the optimal treadmill ramp protocol in subjects with high exercise capacity: validation and comparison with the Bruce protocol.
- Authors: Maeder M, Wolber T, Atefy R, Gadza M, Ammann P, Myers J, Rickli H
- Issue date: 2006 Jan-Feb
- Association of post-diagnosis cardiorespiratory fitness with cause-specific mortality in cancer.
- Authors: Groarke JD, Payne DL, Claggett B, Mehra MR, Gong J, Caron J, Mahmood SS, Hainer J, Neilan TG, Partridge AH, Di Carli M, Jones LW, Nohria A
- Issue date: 2020 Oct 1
- Sex Differences in Cardiorespiratory Fitness and All-Cause Mortality: The Henry Ford ExercIse Testing (FIT) Project.
- Authors: Al-Mallah MH, Juraschek SP, Whelton S, Dardari ZA, Ehrman JK, Michos ED, Blumenthal RS, Nasir K, Qureshi WT, Brawner CA, Keteyian SJ, Blaha MJ
- Issue date: 2016 Jun