Harb Serge C, Cremer Paul C, Wu Yuping, Xu Bo, Cho Leslie, Menon Venu, Jaber Wael A
Heart and Vascular Institute, Cleveland Clinic, USA.
Eur J Prev Cardiol. 2021 Oct 13;28(12):1295-1302. doi: 10.1177/2047487319826400. Epub 2019 Feb 13.
We sought to estimate patients' age based on their stress testing exercise performance (A-BEST), and evaluate whether A-BEST would be a better predictor of mortality when compared to chronological age.
We included 126,356 consecutive patients referred for exercise (electrocardiography, echocardiography or myocardial perfusion imaging) stress testing at our institution from January 1st, 1991 to February 27th, 2015. Estimated age was computed based on exercise capacity (number of peak estimated metabolic equivalents of task), chronotropic reserve index and heart rate recovery, taking into account patient's gender and medications that affect heart rate. Uni and multivariable Cox models were used to determine the association of A-BEST with mortality. Improvement in predicting mortality using A-BEST compared to chronological age was evaluated with the use of net reclassification improvement and C statistic.
Mean age was 53.5 ± 12.6 years and 59% were men. At follow-up (mean duration was 8.7 years), 9929 (8%) died. After adjustment for clinical comorbidities, higher metabolic equivalents of task (adjusted hazard ratio (HR) for mortality 0.71, 95% confidence interval (CI) 0.70-0.72, P < 0.001) and higher chronotropic reserve index (adjusted HR for mortality 0.97, 95% CI 0.96-0.99, P = 0.0135) were associated with improved survival, whereas abnormal heart rate recovery (adjusted HR for mortality 1.53, 95% CI 1.46-1.61, P < 0.001) and higher A-BEST (adjusted HR for mortality 1.05, 95% CI 1.04-1.05, P < 0.001) were associated with higher mortality. When comparing prediction models using A-BEST versus chronological age, a significant increase in the area under the curve was demonstrated if A-BEST was used (0.82 vs. 0.79, P < 0.001). The overall net reclassification improvement was 0.30 (P < 0.001).
Estimated age based on exercise stress testing performance is a better predictor of mortality when compared to chronological age.
我们试图根据患者的运动应激试验表现（A-BEST）来估算其年龄，并评估与实际年龄相比，A-BEST是否能更好地预测死亡率。
我们纳入了1991年1月1日至2015年2月27日期间在我院连续接受运动（心电图、超声心动图或心肌灌注成像）应激试验的126356例患者。根据运动能力（峰值估计代谢当量任务数）、变时性储备指数和心率恢复情况，并考虑患者的性别和影响心率的药物来计算估计年龄。使用单变量和多变量Cox模型来确定A-BEST与死亡率之间的关联。通过净重新分类改善和C统计量评估使用A-BEST与实际年龄相比在预测死亡率方面的改善情况。
平均年龄为53.5±12.6岁，男性占59%。在随访（平均持续时间为8.7年）期间，9929例（8%）患者死亡。在调整临床合并症后，较高的代谢当量任务数（死亡率调整后风险比（HR）为0.71，95%置信区间（CI）为0.70-0.72，P<0.001）和较高的变时性储备指数（死亡率调整后HR为0.97，95%CI为0.96-0.99，P=0.0135）与生存率提高相关，而异常的心率恢复（死亡率调整后HR为1.53，95%CI为1.46-1.61，P<0.001）和较高的A-BEST（死亡率调整后HR为1.05，95%CI为1.04-1.05，P<0.001）与较高的死亡率相关。当比较使用A-BEST与实际年龄的预测模型时，如果使用A-BEST，曲线下面积有显著增加（0.82对0.79，P<0.001）。总体净重新分类改善为0.30（P<0.001）。
与实际年龄相比，基于运动应激试验表现估算的年龄是更好的死亡率预测指标。
