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85% of maximal age-predicted heart rate is not a valid endpoint for exercise treadmill testing.
MedLine Citation:
PMID:  21922347     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Exercise testing should be symptom-limited. Nevertheless, 40% of clinical laboratories applying for ICANL accreditation use 85% of maximal age-predicted heart rate (MPHR) as the primary exercise endpoint. We hypothesized that this approach importantly may underestimate exercise capacity and inducible ischemia. METHODS: Two patient cohorts were studied. 1. A prospective registry of patients referred for exercise testing. 2. A retrospective cohort of patients with positive exercise ECG. RESULTS: Of 306 registry patients, 211 (69%) continued exercising after reaching 85% MPHR to maximal HR of 101% ± 7% of MPHR. Forty-two patients (14%) stopped <1 minute after achieving 85% MPHR; 53 (17%) did not achieve 85% MPHR. More women (75%) than men (64%) achieved >85% MPHR (P = .02). Of 300 patients with positive ECG, 232 patients (77%) exercised to >85% MPHR. At 85% MPHR 144 patients (62%) had positive ECG (1.2 ± .7 mm ST depression) compared to 232 patients (100%) at peak exercise (2.3 ± .9 mm ST depression, P < .001). Mean workload at 85% MPHR was 7.3 ± 2.4 METs compared to 10.6 ± 2.8 METs at peak exercise (P < .001). CONCLUSION: Achievement of 85% MPHR is not a valid diagnostic or functional exercise endpoint because it significantly underestimates exercise capacity and inducible ischemia.
Authors:
Mohit Jain; Chileshe Nkonde; Ben A Lin; Alerice Walker; Frans J Th Wackers
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-16
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  -     ISSN:  1532-6551     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
The Section of Cardiovascular Medicine, Department of Internal Medicine and the Cardiovascular Nuclear Imaging and Stress Laboratories, Yale University School of Medicine, 333 Cedar Street Fitkin-3, New Haven, CT, 06510, USA.
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