Characteristics and outcomes of patients who achieve high workload (≥10 metabolic equivalents) during treadmill exercise echocardiography.

OBJECTIVE: To determine the frequency and prognostic significance of abnormal exercise echocardiographic results for patients achieving a workload of 10 or more metabolic equivalents during treadmill exercise echocardiography. PATIENTS AND METHODS: Patients who underwent treadmill exercise echocardiography from November 1, 2003, through December 31, 2008, and exercised for 9 or more minutes using the Bruce protocol (N=7236) were included. Clinical and exercise echocardiographic characteristics and outcomes were evaluated. Variables associated with abnormal exercise echocardiographic results and mortality were identified. RESULTS: Exercise echocardiographic results were positive for ischemia in 862 patients (12%). Extensive ischemia developed in 265 patients (4%). For patients with normal exercise echocardiographic results, all-cause and cardiovascular mortality rates were 0.30% and 0.05% per person-year of follow-up, respectively. For patients who had extensive ischemia, all-cause and cardiovascular mortality rates were 0.84% and 0.25% per person-year of follow-up, respectively. Patients at highest risk were those who had extensive and severe regional wall motion abnormalities at rest (n=58), and their all-cause and cardiovascular mortality rates were 2.65% and 0.76% per person-year of follow-up. Exercise echocardiographic variables did not identify sizable patient subgroups at risk for death and did not provide incremental prognostic information (C statistic was 0.74 compared with 0.73 for the clinical plus exercise electrocardiography model). CONCLUSION: Patients achieving a workload of 10 or more metabolic equivalents during treadmill exercise testing do not often have extensive ischemic abnormalities on exercise echocardiography. Although exercise echocardiographic results provide some prognostic information, it is not of incremental value for these patients, whose short-term and medium-term prognosis is excellent.

AN INVERSE ASSOCIATION BETWEEN PREDICTED 50%VO₂MAX PER BODY WEIGHT AND CORONARY RISK FACTORS / 体力科学

The aim of this study is to elucidate the relationship between the predicted 50%VO₂max/wt (ml/kg/min) and coronary risk factors (CRFs).Seven hundred eighty six men (37.3 +/- 13.5 years old) and 1,268 women (41.5 +/- 13.6 years old) were studied. The predicted 50%VO₂max/wt was calculated by utilizing data from the continuous incremental exercise test with a stationary bicycle ergometer and the age-predicted heart rate at 50%VO₂max (=138-age/2). As CRFs, percent body fat, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, high density lipoprotein cholesterol, fasting blood sugar and HbA1c were measured.The age-adjusted odds ratio of having abnormal values in CRFs across quartiles of the predicted 50%VO₂max/wt (highest to lowest) were 1.00 (reference), 1.39, 2.64, and 6.78 in men, and 1.00, 1.73, 2.33 and 3.44 in women (for trend, <i>p</i><0.001), respectively.This study indicated that the lower 50%VO₂max/wt resulted in the higher odds ratio of having abnormal values in CRFs among Japanese. It was also confirmed that the sub-maximal aerobic capacity was associated with CRFs.

COMPARISON OF HEART RATE AT DOUBLE PRODUCT BREAK POINT TO AGE-PREDICTED HEART RATE AT 50%VO₂max / 体力科学

In this study, we examined a reliability of age-predicted heart rate (HR) for the 50%VO₂max which is widely used during a training program for health promotion as compared to HR at the double product break point (DPBP). Two hundred fifty six non-hypertensive subjects (NHT), and 49 hypertensive ones under medication (HT) were studied. HT subjects were divided into two subgroups based on antihypertensive medications, ones with HR non-suppression agents (HT+HRNS) and the other with HR suppression agents (HT+HRS). DPBP was measured with the use of an incremental exercise test, and HR at DPBP (HR@DPBP) was determined. Age-predicted HR for the 50%VO₂max intensity of exercise was calculated with the following formula; HR=138–age/2. Measurable rate of DPBP and HR@DPBP in NHT, HT+HRNS and HT+HRS were 93.8% and 120±14bpm, 92.7% and 104±12bpm, 78.5% and 94±16bpm, respectively. There were significant differences in HR@DPBP and age-predicted HR in NHT and HT+HRS (<i>p</i><0.01 in both groups). But %ΔHR ((age-predicted HR–HR@DPBP)/HR@DPBP x 100) within -10%∼+10% in NHT, HT+HRNS and HT+HRS were 68%, 58% and 14%, respectively. This might be due to HR at rest with sitting position that was significantly correlated to %ΔHR in all groups (r=-0.604, <i>p</i><0.001 in NHT, r=-0.689, <i>p</i><0.001 in HT+HRNS and r=-0.761, <i>p</i><0.05 in HT+HRS, respectively). And the range of HR at rest with sitting position corresponding to -10%∼+10% of %ΔHR were 70∼95bpm in NHT, 71∼93bpm in HT+HRNS and 83∼102bpm in HT+HRS. In addition, this study indicated that DPBP could be measured even under antihypertensive medication that might affect DPBP measurement.In conclusion, we demonstrated that HR at DPBP and age-predicted HR were similar among 58-68% of NHT and HT+HRNS. And the range of HR at rest with sitting position to ensure reliability of age-predicted HR was elucidated.