Risk of mortality increases with increasing number of abnormal non-ST parameters recorded during exercise testing.
BACKGROUND
Abnormal non-ST segment treadmill parameters are associated with an increased mortality risk. Such measures include fitness, resting heart rate (HR), chronotropic incompetence, and HR recovery. However, whether there is an additive association among these parameters and the risk of mortality is unknown.


METHODS
Prospective observational registry study.


METHODS
We assessed the risk of cardiovascular and all-cause mortality in 25 642 individuals as an additive function of the number of these parameters. Abnormal responses were defined as follows: abnormal resting HR as a HR>or=80 bpm, abnormal fitness as an adjusted fitness level in the lowest 20%, chronotropic incompetence as an inability to achieve at least 80% of the predicted HR reserve, and abnormal HR recovery as an HR decline less than 12 bpm 1 min after exercise.


RESULTS
During 7.2 years of follow-up, 392 participants died, with 94 from cardiovascular causes. Each parameter was significantly associated with all-cause and cardiovascular mortality (P<0.01) after adjustment for cardiovascular risk factors. There was a significant trend between both all-cause or cardiovascular mortality and the number of abnormal parameters (P<0.05).


CONCLUSIONS
There is a continuum of risk as the number of abnormal parameters increases, suggesting that it may be important to determine their presence and number during exercise testing.
Ho
John S
JS
Cooper Clinic, 12200 Preston Road, Dallas, TX 75230, USA. jsho@cooper-clinic.com
Fitzgerald
Shannon J
SJ
Barlow
Carolyn E
CE
Cannaday
John J
JJ
Kohl
Harold W
HW
Haskell
William L
WL
Cooper
Kenneth H
KH
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D002423:Cause of Death; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020127:Recovery of Function; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D013997:Time Factors