Related Experiment Video
Updated: Oct 31, 2025
Cardiac Stress Test Induced by Dobutamine and Monitored by Cardiac Catheterization in Mice
Published on: February 10, 2013
Changing Drivers of Mortality Among Patients Referred for Cardiac Stress Testing
Alan Rozanski1,2, Heidi Gransar2, Sean W Hayes2
1Division of Cardiology and Department of Medicine, Mount Sinai Morningside Hospital, Mount Sinai Heart, and the Icahn School of Medicine at Mount Sinai, New York, NY.
Insights
Coronary artery disease risk factors are shifting, with declining typical angina but increasing diabetes and obesity. This change, alongside increased pharmacological stress testing, has not altered overall mortality rates in patients undergoing cardiac stress tests.
Area of Science:
- Cardiology
- Public Health
- Medical Diagnostics
Background:
- Coronary artery disease (CAD) risk factor profiles and clinical outcomes evolve over time.
- Understanding these temporal shifts is crucial for effective patient management and public health strategies.
- Radionuclide stress testing provides valuable data on cardiac health trends.
Purpose of the Study:
- To analyze changes in CAD risk factors, clinical presentation, and mortality rates over 22 years.
- To investigate temporal trends in patients undergoing radionuclide stress testing.
- To correlate shifts in risk factors with mortality outcomes.
Main Methods:
- Retrospective analysis of 39,750 diagnostic patients and 10,982 known CAD patients.
- Patients underwent radionuclide stress testing between 1991 and 2012, with at least 5 years of follow-up.
- Assessment of temporal changes in typical angina, myocardial ischemia, diabetes, obesity, hypertension, and pharmacological stress testing use.
Main Results:
- A significant decrease in typical angina and myocardial ischemia was observed.
- Prevalence of diabetes, obesity, and hypertension progressively increased.
- Use of pharmacological stress testing rose substantially, while mortality rates remained stable.
- Adjusted annualized mortality ranged from 1.57% to 1.76% for diagnostic patients and 2.46% to 2.75% for known CAD patients.
Conclusions:
- The primary drivers of mortality in patients undergoing cardiac stress tests are shifting.
- Declining factors like typical angina and ischemia are being replaced by increasing factors such as diabetes and exercise intolerance.
- These evolving risk profiles necessitate updated clinical approaches and preventative measures.
Objective:
To identify temporal shifts in coronary artery disease (CAD) risk factor profiles, clinical parameters, and corresponding mortality rates among patients referred for radionuclide stress testing over 22 years.
Patients And Methods:
We assessed 39,750 patients with suspected CAD ("diagnostic" patients) and 10,982 patients with known CAD who underwent radionuclide stress testing between January 2, 1991, and December 31, 2012, and were followed up for at least 5 years (median, 12.7 years).
Results:
Among both diagnostic patients and those with known CAD, there was a marked temporal decline in typical angina and myocardial ischemia. However, several risk factors for disease progressively increased, including diabetes, obesity, and hypertension. In addition, the need to perform pharmacological testing in lieu of exercise increased markedly between the first and fourth epochs among both diagnostic patients (from 26.5% [1634 of 6176] to 53.0% [5781 of 10,908]; P<.001) and patients with known CAD (from 31.1% [999 of 3213] to 75.5% [1405 of 1860]; P<.001). The net effect of these competing positive and negative risk factor trends was no change in the adjusted annualized rate of mortality over the temporal span in our study, ranging from 1.57% per year in 1991-1995 to 1.76% per year in 2006-2012 among diagnostic patients and from 2.46% per year to 2.75% per year during the same intervals among patients with known CAD.
Conclusion:
Our findings suggest a marked contemporary shift in the drivers of all-cause mortality among patients undergoing cardiac stress tests away from such factors as typical angina and inducible myocardial ischemia, which are declining in prevalence, and toward such factors as diabetes and an inability to perform exercise, which are increasing in prevalence.
More Related Videos
08:35Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
Related Concept Videos
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:28Imaging Studies for Cardiovascular System V: CT
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...