title: The value of treadmill exercise test parameters together in patients with known or suspected peripheral arterial disease.
abstract: BACKGROUND
  Exercise test parameters (exercise ankle brachial index (ABI), walking distance and blood pressure response) separately are associated with long-term outcome in patients with known or suspected peripheral arterial disease (PAD). However, the clinical value of the combination of these parameters together is unknown.
  
  
  METHODS
  2165 patients performed a treadmill exercise test to diagnose or to evaluate their PAD. Resting ABI, exercise ABI, abnormal blood pressure response (hypotensive and hypertensive) and walking distance (impairment <150 m) were measured. The study population was divided into patients with a resting ABI ≥ 0.90 and patients with PAD (resting ABI < 0.90).
  
  
  RESULTS
  The mean follow-up period was 5 years (0.5-14 years). Long-term mortality rate and risks increases when more exercise parameters became abnormal (p-value = 0.001). Patients with a normal resting ABI but with an abnormal exercise test had a higher mortality risk--HR 1.90 (1.32-2.73)--than patients with a normal exercise test. The highest mortality risk and cardiac death was observed in PAD patients with a walking impairment together with an abnormal blood pressure response--HR 3.48 (2.22-5.46).
  
  
  CONCLUSIONS
  Exercise tests give multiple parameters, which together provide important prognostic information on long-term outcome in both patients with normal resting ABI and PAD.
authors: Department of Anaesthesiology, Erasmus MC, Rotterdam, The Netherlands.
authors: Inge I
authors: II
authors: de Liefde
authors: Hence J M
authors: HJ
authors: Verhagen
authors: Robert Jan
authors: RJ
authors: Stolker
authors: Ron T
authors: RT
authors: van Domburg
authors: Don
authors: D
authors: Poldermans
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D001794:Blood Pressure; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D016138:Walking / Q000502:physiology