1 Department of Internal Medicine, University of Helsinki, Finland.
2 Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland.
Eur J Prev Cardiol. 2019 Jan;26(2):199-207. doi: 10.1177/2047487318804618. Epub 2018 Oct 24.
The Duke treadmill score, a widely used treadmill testing tool, is a weighted index combining exercise time or capacity, maximum ST-segment deviation and exercise-induced angina. No previous studies have investigated whether the Duke treadmill score and its individual components based on bicycle exercise testing predict cardiovascular death.
Two populations with a standard bicycle testing were used: 3936 patients referred for exercise testing (2371 men, age 56 ± 13 years) from the Finnish Cardiovascular Study (FINCAVAS) and a population-based sample of 2683 men (age 53 ± 5.1 years) from the Kuopio Ischaemic Heart Disease study (KIHD).
Cox regression was applied for risk prediction with cardiovascular mortality as the primary endpoint.
In FINCAVAS, during a median 6.3-year (interquartile range (IQR) 4.5-8.2) follow-up period, 180 patients (4.6%) experienced cardiovascular mortality. In KIHD, 562 patients (21.0%) died from cardiovascular causes during the median follow-up of 24.1 (IQR 18.0-26.2) years. The Duke treadmill score was associated with cardiovascular mortality in both populations (FINCAVAS, adjusted hazard ratio (HR) 3.15 for highest vs. lowest Duke treadmill score tertile, 95% confidence interval (CI) 1.83-5.42, P < 0.001; KIHD, adjusted HR 1.71, 95% CI 1.34-2.18, P < 0.001). However, after progressive adjustment for the Duke treadmill score components, the score was not associated with cardiovascular mortality in either study population, as exercise capacity in metabolic equivalents of task was the dominant harbinger of poor prognosis.
The Duke treadmill score is associated with cardiovascular mortality among patients who have undergone bicycle exercise testing, but metabolic equivalents of task, a component of the Duke treadmill score, proved to be a superior predictor.
杜克跑步机评分是一种广泛使用的跑步机测试工具，它是一个综合了运动时间或能力、最大 ST 段偏移和运动诱发心绞痛的加权指数。以前没有研究探讨过基于自行车运动测试的杜克跑步机评分及其各组成部分是否可以预测心血管死亡。
使用了两个进行标准自行车测试的人群：来自芬兰心血管研究（FINCAVAS）的 3936 名接受运动测试的患者（2371 名男性，年龄 56±13 岁）和来自于库奥皮奥缺血性心脏病研究（KIHD）的一个基于人群的 2683 名男性样本（年龄 53±5.1 岁）。
应用 Cox 回归进行风险预测，以心血管死亡率为主要终点。
在 FINCAVAS 中，中位随访 6.3 年（四分位距 4.5-8.2）期间，180 例患者（4.6%）发生心血管死亡。在 KIHD 中，在中位随访 24.1（四分位距 18.0-26.2）年期间，562 例患者（21.0%）死于心血管原因。在这两个群体中，杜克跑步机评分与心血管死亡率相关（FINCAVAS，最高与最低杜克跑步机评分三分位组相比，调整后的危险比（HR）为 3.15，95%置信区间（CI）为 1.83-5.42，P<0.001；KIHD，调整后的 HR 为 1.71，95%CI 为 1.34-2.18，P<0.001）。然而，在对杜克跑步机评分的各组成部分进行逐步调整后，在这两个研究人群中，评分与心血管死亡率均无关联，因为运动能力的代谢当量是预后不良的主要预示因素。
在接受过自行车运动测试的患者中，杜克跑步机评分与心血管死亡率相关，但杜克跑步机评分的组成部分之一，即代谢当量，证明是更好的预测因素。
