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Is downstream cardiac testing required in patients with reduced functional capacity and otherwise negative exercise

Mark Whitman1,2, Surendran Sabapathy3, Carly Jenkins4

  • 1Griffith University, Gold Coast, 4215 Southport, Australia. mark.whitman@health.qld.gov.au.

Cardiology Journal
|September 21, 2018
PubMed

Insights

Maximum Rate Pressure Product (MRPP) during exercise stress testing (EST) can predict cardiovascular outcomes, even in patients with poor functional capacity. An MRPP over 25000 indicates a need for less follow-up testing and better patient prognosis.

Area of Science:

  • Cardiology
  • Exercise Physiology
  • Diagnostic Testing

Background:

  • Exercise stress testing (EST) in patients with poor functional capacity is often inconclusive.
  • This can lead to unnecessary further diagnostic testing.

Purpose of the Study:

  • To evaluate the maximum rate pressure product (MRPP) during initial EST to assess the need for follow-up testing.
  • To compare MRPP with age-predicted maximum heart rate (APMHR) for predicting cardiovascular (CV) events in patients with inconclusive EST.

Main Methods:

  • Analysis of 236 inconclusive ESTs due to poor functional capacity.
  • Receiver operating characteristic (ROC) analysis to determine a cut-off MRPP value of 25000 for CV events.
  • Categorization of patients based on MRPP > 25000 and < 25000.

Main Results:

  • Patients achieving an MRPP > 25000 had no abnormal downstream testing or CV events at 2-year follow-up, irrespective of treadmill time.
  • MRPP demonstrated superior sensitivity and specificity compared to APMHR (AUC 0.76 vs. 0.59).

Conclusions:

  • An MRPP > 25000 during EST, even with poor functional capacity, suggests no need for further downstream testing.
  • Patients achieving this MRPP threshold have significantly better CV event outcomes.
Abstract

Keywords:
double productexercise stress testingmyocardial indexmyocardial ischemiarate pressure product

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