Arm Exercise versus Other Stress Test Modalities for Clinical Outcome Prediction

手臂锻炼与其他压力测试方式的临床结果预测

• 批准号: 8040623
• 负责人: Wade Hampton Martin
• 金额: --
• 依托单位: ST. LOUIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-10-01 至 2014-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8040623
• 关键词: Address; American; Amputation; Blood Pressure; Cardiac; Cardiac Catheterization Procedures; Cardiovascular system; Cessation of life; Characteristics; Clinical; Coronary; Data; Databases; Defect; Diagnostic; Dilatation - action; Dipyridamole; Dose; Electrocardiographic Finding; Electronics; Equipment; Exercise; Exercise stress test; Expenditure; Foot joint structure; Goals; Gold; Health; Heart Rate; Hospitalization; Hospitals; Human Resources; Image; Information Systems; Injury; Investigation; Knee; Laboratories; Leg; Lower Extremity; Measures; Medical center; Modality; Modeling; Myocardial Infarction; Myocardial perfusion; Myopathy; Nature; Outcome; Outcome Measure; Patients; Perfusion; Pharmaceutical Preparations; Physiological; Predictive Value; Probability; Publishing; Radiation; Receiver Operator Characteristics; Records; Recovery; Regression Analysis; Research; Resources; Rest; Scanning; Spinal Cord; Stress; Stress Tests; Subgroup; Symptoms; System; Test Result; Time; United States; United States Department of Veterans Affairs; Veterans; arm; arthropathies; claudication; combat; computerized; cost; demographics; disability; follow-up; hemodynamics; mortality; prognostic; response; time interval; Address; American; Amputation; Blood Pressure; Cardiac; Cardiac Catheterization Procedures; Cardiovascular system; Cessation of life; Characteristics; Clinical; Coronary; Data; Databases; Defect; Diagnostic; Dilatation - action; Dipyridamole; Dose; Electrocardiographic Finding; Electronics; Equipment; Exercise; Exercise stress test; Expenditure; Foot joint structure; Goals; Gold; Health; Heart Rate; Hospitalization; Hospitals; Human Resources; Image; Information Systems; Injury; Investigation; Knee; Laboratories; Leg; Lower Extremity; Measures; Medical center; Modality; Modeling; Myocardial Infarction; Myocardial perfusion; Myopathy; Nature; Outcome; Outcome Measure; Patients; Perfusion; Pharmaceutical Preparations; Physiological; Predictive Value; Probability; Publishing; Radiation; Receiver Operator Characteristics; Records; Recovery; Regression Analysis; Research; Resources; Rest; Scanning; Spinal Cord; Stress; Stress Tests; Subgroup; Symptoms; System; Test Result; Time; United States; United States Department of Veterans Affairs; Veterans; arm; arthropathies; claudication; combat; computerized; cost; demographics; disability; follow-up; hemodynamics; mortality; prognostic; response; time interval

DESCRIPTION (provided by applicant): Treadmill exercise capacity and hemodynamic, symptomatic, and electrocardiographic (ECG) responses to leg exercise are powerful predictors of all-cause mortality and other important measures of health outcome but none of this information is available for patients who undergo pharmacologic stress tests because of lower extremity disabilities such as amputations, knee or other arthropathies, myopathies, claudication, spinal cord, or combat injuries. The major hypothesis of this project is that composite findings of arm ergometer exercise ECG stress testing, with selective myocardial perfusion imaging (MPI) in a subset of patients such as those with highly abnormal resting ECGs or blunted hemodynamic responses, provides prognostic, clinical, and diagnostic information equivalent to non-selective pharmacologic MPI at a fraction of the cost, time expenditure, radiation exposure, and institutional equipment and personnel resource requirements in patients who cannot perform adequate lower extremity exercise. To investigate this hypothesis, we propose the following specific aims and objectives: Aim # 1 Objective # 1 is to compile data on demographics, baseline clinical characteristics, medications, stress test and MPI responses to stress, and subsequent clinical outcome in a computerized research database obtained from electronic records of approximately 5800 unique veterans who underwent 360 arm ergometer, over 2000 dipyridamole, and 3400 treadmill stress tests performed on patients at the St. Louis Veterans Administration Medical Center between 1997 and 2002. Objective # 2 is to determine by univariate and multivariate Cox regression analyses, Kaplan-Meier curves, and Wald G2 models, which exercise capacity, hemodynamic, symptomatic, ECG and MPI responses to arm ergometer, dipyridamole and treadmill stress tests independently predict survival or all-cause mortality, subsequent myocardial infarction (MI), or coronary revascularization alone and in combination, after adjustment for demographic, clinical, and medication variables, during follow-up to an endpoint of death or 12/31/2009. Objective # 3 is to compare the prognostic value of a model of independently predictive arm ergometer ECG stress test variables with dipyridamole MPI, treadmill ECG, arm ergometer and treadmill ECG plus MPI results, using receiver operator characteristic (ROC) curve analyses, for prediction of clinical outcome. Aim # 2 The goal is to develop a simple scoring system, analogous to the Duke Treadmill Score, to best prognosticate death and MI from independently predictive arm ergometer ECG stress test variables. Aim # 3 Objective # 1 is to stratify subgroups of patients in the above data base with a highly abnormal baseline ECG, blunted hemodynamic responses to stress, an abnormal stress ECG or low exercise capacity, for whom it is hypothesized that MPI information might be most beneficial for incremental prognostication of outcome. Objective # 2 is to investigate the independent incremental prognostic value of MPI in these subgroups and compare the incremental value of MPI for prediction of outcome in the various subgroups of veterans using Cox regression and G2 analyses. PUBLIC HEALTH RELEVANCE: Approximately 132,000 veterans underwent cardiac imaging stress tests in Veterans Administration (VA) hospitals in 2007 and nearly 9 million Americans a year perform such studies in the United States as a whole at a cost of more than 10 billion dollars. Because of previous combat injuries, amputations, leg or foot joint, spinal cord, circulatory and other lower extremity disabilities, 20-40% of such patients are evaluated with pharmacologic rather than leg exercise stress tests, precluding access to the powerful prognostic data available from exercise tests for prediction of survival and other health outcome measures. To address this deficiency, in the present project we propose to continue our previous published investigations of arm exercise as an alternative to pharmacologic or treadmill exercise testing in veterans with lower extremity disabilities.

描述（由申请人提供）： Treadmill exercise capacity and hemodynamic, symptomatic, and electrocardiographic (ECG) responses to leg exercise are powerful predictors of all-cause mortality and other important measures of health outcome but none of this information is available for patients who undergo pharmacologic stress tests because of lower extremity disabilities such as amputations, knee or other arthropathies, myopathies, claudication, spinal cord, or combat injuries. The major hypothesis of this project is that composite findings of arm ergometer exercise ECG stress testing, with selective myocardial perfusion imaging (MPI) in a subset of patients such as those with highly abnormal resting ECGs or blunted hemodynamic responses, provides prognostic, clinical, and diagnostic information equivalent to non-selective pharmacologic MPI at a fraction of the cost, time expenditure, radiation暴露于无法进行足够下肢运动的患者的机构设备和人员资源要求。为了调查这一假设，我们提出以下具体目的和目标：目标＃目标＃1是在人口统计学，基准临床特征，药物，压力测试，压力测试和MPI响应的数据上，在计算机化的研究数据库中从大约5800个独特的兽医中获得的计算机研究数据库中的计算机化研究数据库，以及360架3600型电流的disem impiem themear，and imple and impleem inswent 3600 Arm eRgimet，termedy termections termectimply and Armectization。 tests performed on patients at the St. Louis Veterans Administration Medical Center between 1997 and 2002. Objective # 2 is to determine by univariate and multivariate Cox regression analyses, Kaplan-Meier curves, and Wald G2 models, which exercise capacity, hemodynamic, symptomatic, ECG and MPI responses to arm ergometer, dipyridamole and treadmill stress tests independently predict survival or all-cause mortality,在调整人口，临床和药物变量之后，随后的心肌梗塞（MI）或冠状动脉血运重建，或在2009年12月31日的随访期间进行调整。 目标＃3是要比较独立预测组的ECG ECG应力测试变量与二吡啶胺MPI，跑步机ECG，ARM ERGOMETER和跑步机ECG和MPI结果的预后价值，使用接收机操作器特征（ROC）特征（ROC）策略分析，用于预测临床结果。 目标＃2的目标是开发一个类似于杜克跑步机评分的简单评分系统，以最好地预测死亡和来自独立预测的手臂测量器ECG ECG应力测试变量。 目的＃3目标＃1是在上述数据库中分层的亚组，具有高度异常的基线ECG，对压力的血液动力学反应钝化，异常压力ECG或低运动能力，可以认为MPI信息可能对结果的增量预后可能是最有益的。 目标＃2是在这些亚组中研究MPI的独立增量预后值，并使用COX回归和G2分析比较MPI在退伍军人的各个亚组中预测结果的增量值。 公共卫生相关性： 2007年，在退伍军人管理（VA）医院（VA）医院和每年近900万美国人进行了大约132,000名退伍军人，在整个美国进行此类研究，成本超过100亿美元。由于以前的作战，截肢，腿部或脚关节，脊髓，循环系统和其他下肢障碍，有20-40％的患者通过药理学而不是腿部运动压力测试评估了20-40％的患者，从而无法访问可从锻炼测试中获得强大的预后数据，以预测生存和其他健康结果。为了解决这种缺陷，在本项目中，我们建议继续我们先前发表的有关ARM运动的调查，以替代下肢残疾退伍军人的药物或跑步机运动测试。