title: The use of preoperative exercise testing to predict cardiac complications after arterial reconstruction.
abstract: To assess the value of exercise testing in the prediction of cardiac risk, 100 patients requiring arterial reconstructive surgery had either treadmill testing or arm ergometry before operation. Thirty-four patients then had abdominal aortic aneurysm repair, 48 had reconstructions for aortoiliac occlusive disease, and 18 had infrainguinal revascularization procedures. Cardiac complications included myocardial infarction in 10%, acute congestive failure in 5%, malignant ventricular arrhythmias in 7%, and cardiac death in 7%. Contingency table analysis showed that patients who achieved less than 85% of their predicted maximum heart rate (PMHR) during exercise testing had a complication rate of 24%, whereas patients who achieved more than 85% of PMHR had a 6% complication rate (p = 0.0396). The degree of ST segment depression during exercise testing was not a significant predictor of cardiac complications. However, patients who had a positive stress test (ST depression more than 1 mm) and achieved less than 85% of their PMHR had a complication rate of 33%, whereas patients with a positive stress test who achieved more than 85% of their PMHR had no complications (p = 0.048). Statistical analysis with a logistic regression model showed two factors to be significant. Patients who achieved a high maximum heart rate during exercise testing had a low probability of developing postoperative cardiac complications (p = 0.04), as did patients who achieved high cardiac work load maximal oxygen uptake (p = 0.03). We conclude that preoperative exercise testing is useful to predict cardiac complications after arterial reconstruction. Patients who are able to achieve more than 85% of their PMHR and a high maximal oxygen uptake represent a low-risk group.
authors.affiliation: Division of Vascular Surgery, University of Ottawa, Ontario, Canada.
authors.forename: N
authors.initials: N
authors.lastname: McPhail
authors.forename: J E
authors.initials: JE
authors.lastname: Calvin
authors.forename: A
authors.initials: A
authors.lastname: Shariatmadar
authors.forename: G G
authors.initials: GG
authors.lastname: Barber
authors.forename: T K
authors.initials: TK
authors.lastname: Scobie
mesh_terms: D001012:Aorta, Abdominal; D001014:Aortic Aneurysm / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000517:prevention & control; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D005080:Exercise Test; D006331:Heart Diseases / Q000517:prevention & control*; D006333:Heart Failure / Q000517:prevention & control; D006339:Heart Rate; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D012044:Regression Analysis; D012307:Risk Factors