Calle Maria C Arciniegas, Abbasi Muhannad Aboud, Salah Husam M, Scott Christopher G, Bello Laura B Garcia, Bonikowske Amanda R, Villarraga Hector R
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, USA.
Rev Cardiovasc Med. 2023 Apr 17;24(4):108. doi: 10.31083/j.rcm2404108. eCollection 2023 Apr.
To identify factors that increase the specificity of the treadmill exercise test (TMET), and develop a novel scoring system which accounts for functional capacity to aid in determining the need for further testing.
We retrospectively evaluated the electronic health records of 600 patients who had positive TMET results and follow-up stress echocardiography from 1-January-2004, through 31-December-2016. Correlations between clinical and aerobic variables and multivessel disease (MVD) were determined. Duke Treadmill Score (DTS) was calculated and compared with a novel scoring system titled the Intermediate-High-Workload Treadmill Score (IHWTS) that used variables associated with MVD.
In total, 124 of 600 patients (21%) had coronary catheterization, and 51 of these patients (41%) had MVD. Mean (SD) DTS was -2.10 (6.3) among patients with MVD vs -0.16 (5) among patients without MVD ( = 0.06). Mean (SD) functional aerobic capacity (FAC) was 76% (20%) among patients with MVD vs 90% (21%) among patients without MVD ( 0.001). Mean (SD) metabolic equivalent (MET) was 7 (2) among patients with MVD vs 8 (2) among patients without MVD ( = 0.002). Only 6 (12%) of patients with MVD achieved 9 MET or greater on TMET. DTS less than 4 did not distinguish between patients with and without MVD ( = 0.67). Age, hypertension and FAC were independently associated with MVD (all 0.05).
Our novel scoring system IHWTS utilized age, hypertension, and FAC appeared comparable to DTS to risk-stratify patients regardless of baseline symptoms. Clinical parameters such as hypertension along with exercise functional capacity should be considered when evaluating a positive TMET result in patients that achieve an intermediate-high workload 5 Metabolic Equivalents (METs).
确定增加平板运动试验（TMET）特异性的因素，并开发一种新的评分系统，该系统考虑功能能力以帮助确定是否需要进一步检查。
我们回顾性评估了2004年1月1日至2016年12月31日期间600例TMET结果为阳性且接受了后续负荷超声心动图检查的患者的电子健康记录。确定了临床和有氧运动变量与多支血管疾病（MVD）之间的相关性。计算了杜克平板运动评分（DTS），并与一种名为中高负荷平板运动评分（IHWTS）的新评分系统进行比较，该系统使用了与MVD相关的变量。
600例患者中共有124例（21%）进行了冠状动脉造影，其中51例（41%）患有MVD。患有MVD的患者平均（标准差）DTS为-2.10（6.3），而无MVD的患者为-0.16（5）（P = 0.06）。患有MVD的患者平均（标准差）功能有氧能力（FAC）为76%（20%），而无MVD的患者为90%（21%）（P < 0.001）。患有MVD的患者平均（标准差）代谢当量（MET）为7（2），而无MVD的患者为8（2）（P = 0.002）。在TMET中，只有6例（12%）患有MVD的患者达到9 MET或更高。DTS小于4不能区分有无MVD的患者（P = 0.67）。年龄、高血压和FAC与MVD独立相关（均P < 0.05）。
我们的新评分系统IHWTS利用年龄、高血压和FAC，在对患者进行风险分层方面似乎与DTS相当，无论其基线症状如何。在评估达到中高负荷（≥5代谢当量[METs]）的患者TMET结果为阳性时，应考虑高血压等临床参数以及运动功能能力。
