Abstract 16414: Prognostic Value of Exercise Tolerance and Exercise-Associated Diastolic Dysfunction in Elderly Patients Referred for Exercise Stress Echocardiography
Joseph Elias, Swiri Konje, Alba Munoz, Ga Hee Kim, Kruti Gandhi, Errol C Moras, Christopher Perez Lizardo, Arpanjeet Kaur, Alaa Omar, Edgar Argulian- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Aim: We studied the prognostic value of exercise tolerance, measured in metabolic equivalents of tasks (METs), and exercise-associated diastolic dysfunction (Ex-DD) in elderly patients referred for exercise stress echocardiography (ExE).
Methods: Retrospectively, 583 patients (70±6 years, 57% women, EF: 61±5%) who underwent ExE using the Bruce protocol and were ≥60 years of age were included and followed for death or cardiac hospitalization. Ex-DD was defined as the presence of abnormal resting tissue Doppler mitral annular velocity (e') and post-exercise E/e' ratio.
Results: During a median follow-up period of 3.7 years, 13 patients died, 70 were hospitalized, and 77 had combined outcome. 151 (26%) patients had Ex-DD and had more combined outcome compared to no Ex-DD (29 [19%] vs. 48 [11%], p=0.01). The average workload during ExE was 8.3±2.8 METs. Receiver operating characteristic curve identified that METs <8.5 best predicts the combined outcome. As such, patients were classified into 260 with METs ≥ 8.5 and 323 with METs < 8.5. Patients with METs < 8.5 were older, had worse risk profiles, poorer resting and post-exercise diastolic variables, more Ex-DD (32% vs. 19%, p<0.001), and more outcomes (55 [17%] vs. 22 [9%], p=0.002) compared to METs ≥ 8.5. Both Ex-DD (HR: 1.9, 95% CI: 1.2-2.9) and METs < 8.5 (HR: 1.9, 95% CI: 1.1-3.1) independently predicted the combined outcome. The presence of both METs < 8.5 and Ex-DD conferred the highest risk (HR: 2.9, 95% CI: 1.5-5.6) and remained significant after adjustment and propensity score matching, while the presence of either alone carried an intermediate risk (HR: 1.9, 95% CI: 1.1-3.5), which became non-significant after adjustment and matching.
Conclusions: poor exercise capacity is associated with an adverse prognosis, irrespective of resting or Ex-DD. METs < 8.5 had particularly poor prognosis when combined with Ex-DD, while either alone did not predict outcomes.