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Reduced Exercise Capacity Associated with Future Cardiac Events

Posted: Thursday, February 14, 2008

People who have trouble exercising on a treadmill are at increased risk of suffering a heart attack or other heart-related event and of dying, according to results of a study.

Dr. Pamela N. Peterson, of the University of Colorado at Denver and Health Sciences Center, and colleagues write, "Exercise capacity is one of many important prognostic factors measured during ETT (exercise treadmill testing)," "Little is known about the association between exercise capacity among patients referred for ETT and nonfatal cardiac events," they note.

The researchers assessed the prognostic value of exercise capacity for nonfatal cardiac events in 9191 patients referred for ETT and who were followed for a median of 2.7 years.

Exercise capacity was quantified as the proportion of age- and sex-predicted metabolic equivalents achieved, categorized as less than 85 per cent, 85-100 per cent, and greater than 100 per cent.

Patients with lower exercise capacity were more likely to be female and to have comorbid conditions such as diabetes and hypertension compared to those with greater exercise capacity. Those with lower exercise capacity were also more likely to have chest pain on the treadmill, abnormal heart rate recovery, and an abnormal chronotropic index during ETT.

During follow-up, there were 119 hospitalizations for myocardial infarction, 259 hospitalizations for unstable angina, 749 revascularization procedures, and 132 deaths.

Results of multivariate analysis adjusting for demographic, clinical, and treadmill variables, showed that exercise capacity less than 85 per cent predicted was associated with an increased risk of myocardial infarction (hazard ratio (HR), 2.36), unstable angina (HR, 2.39), and coronary revascularization (HR, 1.75), compared with exercise capacity greater than 100 per cent predicted.

"In fully adjusted models, exercise capacity was significantly associated with increased risk of all-cause mortality (HR, 2.90) for those who achieved less than 85 per cent compared with those who achieved greater than 100 per cent of age- and sex-predicted exercise capacity," Dr. Peterson and colleagues report.

Exercise capacity in the 85-100 per cent predicted range was also significantly associated with increased risk of all-cause mortality (HR, 1.78).

The findings have important implications, the researchers conclude, suggesting that "aggressive risk factor modification and close follow-up should be considered for patients with impaired exercise capacity."

Source: Diabetes In Control