Predicting premature termination of exercise during Bruce protocol stress echocardiography.
Echocardiography
; 38(9): 1612-1617, 2021 09.
Article
in En
| MEDLINE
| ID: mdl-34505312
ABSTRACT
AIMS:
Clinical guidelines recommend that the exercise protocol of a stress echocardiogram is selected to induce volitional exhaustion after a target duration of at least 8 minutes. While the Bruce protocol is very commonly used for clinical stress tests, it is known to be "steep", and many patients therefore fail to reach 8 minutes. We studied predictors of failure and developed a method for identifying patients not suitable for Bruce protocol which was accurate and yet simple enough to be used as a point-of-care decision support tool. METHODS ANDRESULTS:
We studied data out-patients undergoing Bruce protocol stress echocardiograms (n = 11 086) and analyzed predictors of inappropriate early termination (defined as test duration < 8 min as per current practice guidelines) using logistic regression. A prediction model was constructed as follows .5 points were given for each of hypertension, diabetes, smoking, and E/e' > 7.9 in the resting echocardiogram; .1 point was added for each 1-unit increment in body mass index; 1 point was added for patient age by decade; 2.0 points were subtracted for male sex (p for all < 0.001). In tests on held-out validation data, the model was well calibrated (in plots of predicted vs actual risk) and discriminated failure versus non-failure well (C-statistic .86 for a score of 6.0 points; p < 0.001).CONCLUSION:
These data may help to standardize protocol selection in stress echocardiography, by identifying patients pre-hoc where Bruce protocol will be inappropriately steep.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Echocardiography, Stress
/
Exercise Test
Type of study:
Guideline
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Humans
/
Male
Language:
En
Journal:
Echocardiography
Journal subject:
CARDIOLOGIA
/
DIAGNOSTICO POR IMAGEM
Year:
2021
Type:
Article
Affiliation country:
Singapore