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A high exercise workload of ≥ 10 METS predicts a low risk of significant ischemia and cardiac events in older adults

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Patients who achieve ≥ 10 METS during exercise SPECT myocardial perfusion imaging (MPI) have very low rates of significant ischemia and major adverse cardiac events (MACE). It is unknown how many older adults can achieve ≥ 10 METS, and if low risk extends to this subgroup.

Methods and results

We examined the workload achieved, prevalence and predictors of ischemia, and MACE (cardiac death, non-fatal MI, late revascularization) in a cohort of 382 patients ≥ 65 years of age who underwent exercise 99mTc SPECT MPI. The cohort was 64.4% male and 36.9% had known coronary artery disease (CAD). All achieved ≥ 85% of maximum age-predicted heart rate. A workload of ≥ 10 METS was achieved in 25.4%; 50.3% attained 7-9 METS, and 24.4% reached < 7 METS. There was a stepwise decrease in prevalence of any ischemia and significant ischemia (≥ 10% of the left ventricle (LV)) as workload increased (P = 0.037). Patients achieving ≥ 10 METS had a 3.1% prevalence of ≥ 10% LV ischemia (1.2% in those without ST depression). Cardiac death and MACE rates in the ≥ 10 METS subgroup were 0.6%/year and 2.6%/year over a median 7.0 years of follow-up.

Conclusions

A substantial proportion of older adults who undergo exercise SPECT MPI can achieve ≥ 10 METS. This subgroup has low rates of significant LV ischemia and MACE. The favorable diagnostic and prognostic implications of achieving a high workload in an older adult population suggest it is feasible, with certain exceptions, to include this subgroup in workload-based strategies of provisional imaging.

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Abbreviations

CAD:

Coronary artery disease

CV:

Cardiovascular

ECG:

Electrocardiography

LV:

Left ventricular

MAPHR:

Maximum age-predicted heart rate

METS:

Metabolic equivalents

MI:

Myocardial infarction

MPI:

Myocardial perfusion imaging

SPECT:

Single photon-emission computed tomography

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Disclosure

Dr. Jamieson Bourque has received research grant support from Astellas Pharma US Inc. Drs. Smith, Myc, Watson, and Beller have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Cardiovascular Division, Department of Internal Medicine, Cardiovascular Imaging Center, University of Virginia Health System, Box 800662, 1215 Lee Street, Charlottesville, VA, 22908, USA

    LaVone Smith MD, Lukasz Myc MD, Denny Watson PhD, George A. Beller MD & Jamieson M. Bourque MD, MHS

  2. Department of Radiology, University of Virginia Health System, Charlottesville, VA, USA

    Denny Watson PhD & Jamieson M. Bourque MD, MHS

Authors
  1. LaVone Smith MD
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  2. Lukasz Myc MD
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  3. Denny Watson PhD
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  4. George A. Beller MD
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  5. Jamieson M. Bourque MD, MHS
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Corresponding author

Correspondence to Jamieson M. Bourque MD, MHS.

Additional information

The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.

An audio interview was held July 23, 2018 between Associate Editor, Fadi G. Hage, and Jamieson Bourque, co-author of this article. An audio file of the interview is available as an .mp3 download at the article webpage on SpringerLink.com, and can be found by searching for the article title or DOI.

Funding

NIH K-Award 5K23HL119620-02.

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Smith, L., Myc, L., Watson, D. et al. A high exercise workload of ≥ 10 METS predicts a low risk of significant ischemia and cardiac events in older adults. J. Nucl. Cardiol. 27, 1486–1496 (2020). https://doi.org/10.1007/s12350-018-1376-7

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  • DOI: https://doi.org/10.1007/s12350-018-1376-7

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