Shaw Leslee J, Olson Marian B, Kip Kevin, Kelsey Sheryl F, Johnson B Delia, Mark Daniel B, Reis Steven E, Mankad Sunil, Rogers William J, Pohost Gerald M, Arant Christopher B, Wessel Timothy R, Chaitman Bernard R, Sopko George, Handberg Eileen, Pepine Carl J, Bairey Merz C Noel
Division of Cardiology, Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
J Am Coll Cardiol. 2006 Feb 7;47(3 Suppl):S36-43. doi: 10.1016/j.jacc.2005.03.080.
Our objective was to determine the prognostic value of estimated metabolic equivalents (METs) based on self-reported functional capacity by the Duke Activity Status Index (DASI) in symptomatic women.
Functional capacity is an important component affecting the predictive value of exercise testing, yet current guidelines offer limited assistance regarding identification of functional impairment and choice of pharmacologic stress testing.
A total of 914 women underwent clinically indicated coronary angiography and completed the 12-item DASI questionnaire; a subgroup of 251 women also underwent exercise testing. Cox proportional hazards modeling was used to estimate five-year death or myocardial infarction by DASI scores. In a secondary analysis, additional events included unstable angina, heart failure, or stroke at five years.
Average DASI-estimated functional capacity was 5.7 +/- 4.2 METs and, for exercising women, 6.0 +/- 2.6 METs. In the 914 women, event-free survival ranged from 83% to 95% in subgroups with < or =4.7 to >9.9 METs (p = 0.009); 67% of the events occurred in women scoring < or =4.7 METs (p = 0.003). Event rates were similar by exercise and DASI MET values. In women with DASI-estimated METs < or =4.7 (n = 75), ischemia occurred less (39% vs. 64%, p < 0.0001), and exercise testing results were more often indeterminate (<85% predicted maximum heart rate = 37% vs. 6%, p = 0.001) as compared to women achieving >4.7 METs.
Among women with suspected myocardial ischemia, functional impairment estimated by the DASI correlates with indeterminate exercise test results and is associated with an adverse prognosis. Use of the DASI before exercise testing can risk stratify symptomatic women and may improve the identification of higher-risk, functionally impaired subjects that would benefit from pharmacologic stress imaging and targeted risk management.
我们的目标是确定基于杜克活动状态指数（DASI）自我报告的功能能力所估算的代谢当量（METs）对有症状女性的预后价值。
功能能力是影响运动试验预测价值的一个重要因素，但目前的指南在功能损害的识别和药物负荷试验的选择方面提供的帮助有限。
共有914名女性接受了临床指征的冠状动脉造影并完成了12项DASI问卷；251名女性的亚组还进行了运动试验。采用Cox比例风险模型根据DASI评分估算五年死亡或心肌梗死情况。在二次分析中，额外的事件包括五年时的不稳定型心绞痛、心力衰竭或中风。
DASI估算的平均功能能力为5.7±4.2 METs，对于进行运动的女性，为6.0±2.6 METs。在914名女性中，代谢当量≤4.7至＞9.9的亚组中无事件生存率为83%至95%（p = 0.009）；67%的事件发生在代谢当量评分≤4.7的女性中（p = 0.003）。运动和DASI代谢当量值的事件发生率相似。与代谢当量＞4.7的女性相比，DASI估算代谢当量≤4.7（n = 75）的女性缺血发生率较低（39%对64%，p＜0.0001），运动试验结果更常为不确定（预测最大心率＜85% = 37%对6%，p = 0.001）。
在疑似心肌缺血的女性中，DASI估算的功能损害与不确定的运动试验结果相关，且与不良预后相关。在运动试验前使用DASI可对有症状女性进行风险分层，并可能改善对更高风险、功能受损受试者的识别，这些受试者将从药物负荷成像和靶向风险管理中获益。
