The value of treadmill exercise test parameters together in patients with known or suspected peripheral arterial...

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.

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).

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).

Exercise tests give multiple parameters, which together provide important prognostic information on long-term outcome in both patients with normal resting ABI and PAD.