Abstract 11613: Hemodynamics in the Exercise Stress Test: Evaluating the Prevalence and Impact of an Abnormal Hemodynamic Response to Exercise in a Modern Population
Steven C Scherping, Syed C Ahmad, Stephanie Katz, Nisha Hosadurg, James McParland, Katirina Guinto, Jamieson M Bourque- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Background: Adverse hemodynamic responses on exercise stress testing have prognostic impact, but the cumulative effect of multiple abnormalities is not known. These markers include chronotropic incompetence, reduced metabolic equivalents achieved, abnormal hemodynamic gain index, impaired heart rate recovery, and abnormal blood pressure response.
Research Questions: In a contemporary population undergoing exercise stress testing, what is the cumulative prevalence and prognostic impact of the number of abnormal stress hemodynamic markers (asHD)?
Aims: We measured the prevalence of increasing values of asHD and the associated burden of all-cause mortality and non-fatal myocardial infarction (death/NFMI).
Methods: We performed a retrospective, single-center analysis of patients referred for exercise stress myocardial perfusion imaging from 2015-2017. Multivariable Cox proportional hazards modeling was used to explore the relationship between cumulative burden of asHD markers and death/NFMI.
Data: The study population included 1,595 patients (mean age 62.1, 36.9% female) with mean follow-up 4.8 years stratified by number of asHD markers (0, 1, 2, or 3+). 60.2% of patients tested had at least one asHD marker. The cumulative burden was 1 asHD in 32%, 2 asHD in 19%, and 3+ asHD in 9.3%. Patients with any asHD were at greater risk for death/NFMI compared to patients with 0 asHD (HR 1.98 [95% CI, 1.39 - 2.83], p<0.001) with a stepwise increase in risk seen with a greater burden of asHD (compared to 0 asHD): 1 asHD: HR 1.70 [95% CI,1.14 - 2.52], p=0.009; 2 asHD: HR 2.02 [95% CI, 1.32-3.10], p=0.001; and 3+ asHD: HR 2.88 [95% CI 1.82-4.56], p<0.001.
Conclusion: Contemporary patients referred to exercise stress testing have a substantial burden of abnormal hemodynamic markers. There is an increasing risk of death/NFMI with a greater number of abnormal markers. This data may illuminate cause of symptoms and inform prognosis, supporting the value of functional testing in this group.