Prognostic value of the duke treadmill score in asymptomatic women.

The Duke Treadmill Score (DTS) has been shown to predict mortality in women who have symptomatic heart disease, but its ability to do so in asymptomatic women is unknown, as is its comparative advantage to exercise capacity. We investigated whether a decreased DTS is associated with increased mortality in a prospective cohort of 5,636 asymptomatic women. A symptom-limited exercise treadmill test using Bruce's protocol was performed at baseline. DTS was calculated using exercise time, exercise-induced angina, and ST-segment depression. Exercise capacity was measured in METs. Deaths and cause of death were identified from 1992 to 2000. After adjusting for the Framingham Risk Score, the risk of death decreased by 9% for each unit increase in DTS and by 17% for every 1-MET increase (p <0.001). Those who had a DTS <5 (moderate or high risk) had hazard ratios for death and cardiac death that were 2.2 and 2.5 times greater, respectively, than did those who had a DTS > or =5 (low risk), after adjusting for Framingham Risk Score (p <0.001). Receiver-operating characteristic curves for the DTS model and the exercise capacity model were not significantly different. In conclusion, we have demonstrated that, although the DTS is an independent predictor of mortality and cardiac mortality in asymptomatic women, it does not appear to be a better predictor than exercise capacity alone. The role of ST-segment changes and symptoms with stress testing in asymptomatic women does not provide additional prognostic information.

[1]  A. Keys,et al.  XVI. The Electrocardiogram in Prediction of Five‐Year Coronary Heart Disease Incidence Among Men Aged Forty through Fifty‐Nine , 1970, Circulation.

[2]  C. G. Blomqvist,et al.  Guidelines for exercise testing. A report of the Joint American College of Cardiology/American Heart Association Task Force on Assessment of Cardiovascular Procedures (Subcommittee on Exercise Testing). , 1986, Circulation.

[3]  D. Cox.  Regression Models and Life-Tables , 1972 .

[4]  Ronald A. Thisted,et al.  Exercise Capacity and the Risk of Death in Women: The St James Women Take Heart Project , 2003, Circulation.

[5]  F. Harrell,et al.  Use of a prognostic treadmill score in identifying diagnostic coronary disease subgroups. , 1998, Circulation.

[6]  T. W. Mattingly.  The postexercise electrocardiogram. Its value in the diagnosis and prognosis of coronary arterial disease. , 1962, The American journal of cardiology.

[7]  Daniel B. Mark,et al.  Diagnosing and managing unstable angina. Agency for Health Care Policy and Research. , 1994, Circulation.

[8]  E. Antman,et al.  ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). , 2002, Journal of the American College of Cardiology.

[9]  D. Hosmer,et al.  Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease. , 1973, American heart journal.

[10]  E. DeLong,et al.  Value of exercise treadmill testing in women. , 1998, Journal of the American College of Cardiology.

[11]  R A Bruce,et al.  Exercise testing for evaluation of ventricular function. , 1977, The New England journal of medicine.

[12]  L. T. Sheffield,et al.  Predictive value of the exercise tolerance test for mortality in North American men: the Lipid Research Clinics Mortality Follow-up Study. , 1986, Circulation.

[13]  P. Peduzzi,et al.  Veterans Administration Cooperative Study of medical versus surgical treatment for stable angina--progress report. Section 8. Prognostic value of baseline exercise tests. , 1986, Progress in cardiovascular diseases.

[14]  A. Morabito,et al.  Prognostic value of exercise EKG testing in asymptomatic normotensive subjects. A prospective matched study. , 1983, The New England journal of medicine.

[15]  V. Froelicher,et al.  Nomogram based on metabolic equivalents and age for assessing aerobic exercise capacity in men. , 1993, Journal of the American College of Cardiology.

[16]  M. Ellestad,et al.  Predictive Implications of Stress Testing: Follow‐up of 2700 Subjects After Maximum Treadmill Stress Testing , 1975, Circulation.

[17]  Scott D Flamm,et al.  Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: Consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervent , 2005, Circulation.

[18]  D. Levy,et al.  Prediction of coronary heart disease using risk factor categories. , 1998, Circulation.

[19]  F. Harrell,et al.  Factors affecting sensitivity and specificity of exercise electrocardiography. Multivariable analysis. , 1984, The American journal of medicine.

[20]  J. Doyle,et al.  The Prognosis of an Abnormal Electrocardiographic Stress Test , 1970, Circulation.

[21]  A. C. Burton,et al.  RECOMMENDATIONS for human blood pressure determinations by sphygmomanometers. , 1967, Journal of the American Medical Association.

[22]  David J. Feild.  Guidelines for exercise testing. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Cardiovascular Procedures (Subcommitte on Exercise Testing). , 1986, Journal of the American College of Cardiology.

[23]  Ancel Keys.  Coronary heart disease in seven countries. , 1971, The Medical journal of Australia.

[24]  T D Miller,et al.  Prognostic value of a treadmill exercise score in symptomatic patients with nonspecific ST-T abnormalities on resting ECG. , 1999, JAMA.

[25]  F. Harrell,et al.  Exercise treadmill score for predicting prognosis in coronary artery disease. , 1987, Annals of internal medicine.

[26]  Myrvin H. Ellestad,et al.  Stress Testing: Principles and Practice , 1975 .

[27]  J. Cutler,et al.  Prognostic value of exercise electrocardiogram in men at high risk of future coronary heart disease: Multiple Risk Factor Intervention Trial experience. , 1986, Journal of the American College of Cardiology.

[28]  R. Gillum.  New Considerations in Analyzing Stroke and Heart Disease Mortality Trends: The Year 2000 Age Standard and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision , 2002, Stroke.

[29]  T. W. Mattingly.  Its Value in the Diagnosis and Prognosis of Coronary Arterial Disease , 1962 .

[30]  F. Harrell,et al.  Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. , 1991, The New England journal of medicine.

[31]  P. Peduzzi,et al.  Veterans Administration Cooperative Study of medical versus surgical treatment for stable angina--progress report. Section 4. Long-term survival results in medically and surgically randomized patients. , 1985, Progress in cardiovascular diseases.