title: Utility of graded exercise tolerance tests for prediction of cardiovascular mortality in old age: The Rancho Bernardo Study.
abstract: BACKGROUND
  Exercise electrocardiography in asymptomatic adults has been criticized because of relatively poor accuracy predicting future heart disease risk, but studies may have been too short. We investigated if integrated analysis of graded exercise tolerance tests (GXT) predicted long-term coronary heart disease (CHD) and all-cause mortalities among community-dwelling older adults.
  
  
  RESULTS
  From 1972 to 1974, 1789 adult residents of a predominantly Caucasian, middle- to upper-middle-class southern California community participated in a clinical evaluation that included a GXT; 52.4% (N=939) of those who had baseline GXT were followed up to 2010-up to 36years-for vital status, CHD and all-cause mortality. Multiply adjusted hazard ratios of an abnormal graded GXT were 1.65 (95% CI 0.78-3.49) and 1.56 (95% CI 1.15-2.11) for CHD and all-cause mortality, respectively. An integrated analysis hazard ratio was calculated based on the following GXT findings: significant ST change, inability to achieve target heart rate [THR], abnormal heart rate recovery [HRR], and chronotropic incompetency [ChI]. Compared to those with 0 or 1 abnormality, participants with 2 or more positive findings had significantly higher CHD (HR 2.18) and all-cause (HR 1.92) mortalities. Participants with 3 or more positive findings showed even higher hazard ratios-CHD (HR 6.16) and all-cause (HR 2.49) mortalities. When adjusted for any of 3 Framingham risk models, the integrated electrocardiographic model correlated well with CHD and all-cause mortalities.
  
  
  CONCLUSIONS
  An integrated analysis of electrocardiographic and non-electrocardiographic measures of GXT is useful in predicting long-term CHD and all-cause mortalities in an asymptomatic middle-aged population.
authors.affiliation: Epidemiology Division, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States; Regional Medical Affairs Women's HealthCare, Bayer HealthCare Pharmaceuticals, Seoul, Republic of Korea.
authors.forename: So-Young
authors.initials: SY
authors.lastname: Shin
authors.affiliation: Cardiology Division, Internal Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea.
authors.forename: Joong-Il
authors.initials: JI
authors.lastname: Park
authors.affiliation: Epidemiology Division, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States; Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sue K
authors.initials: SK
authors.lastname: Park
authors.affiliation: Epidemiology Division, Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States. Electronic address: ebarrettconnor@ucsd.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality*; D004562:Electrocardiography / Q000401:mortality* / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000401:mortality* / Q000706:statistics & numerical data*; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011237:Predictive Value of Tests; D012307:Risk Factors
keywords: Cardiovascular disease; Chronotropic incompetency; GXT (graded exercise tolerance test); Heart rate recovery; ST segment change; Target heart rate