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: 8391097
• 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/8391097
• 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; public health relevance; 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.

描述(由申请人提供)： 跑步机运动能力和腿部运动的血流动力学、症状和心电图(ECG)反应是全因死亡率和其他重要健康结局指标的有力预测指标，但这些信息对于因截肢、膝盖或其他关节疾病、肌肉疾病、跛行、脊髓或战斗损伤等下肢残疾而接受药物压力测试的患者无效。该项目的主要假设是，在部分患者(如静息心电图高度异常或血流动力学反应迟钝的患者)中，手臂功率计运动心电负荷测试与选择性心肌灌注成像(MPI)的综合结果提供了与非选择性药物MPI相当的预后、临床和诊断信息，而对于不能进行足够的下肢运动的患者，其成本、时间支出、辐射暴露以及机构设备和人力资源需求只有一小部分。为了研究这一假设，我们提出了以下特定的目标和目标：目标1目标1是在计算机研究数据库中汇编关于人口统计学、基线临床特征、药物、压力测试和MPI对压力的反应以及随后的临床结果的数据，这些数据来自大约5800名退伍军人的电子记录，这些退伍军人在1997年至2002年期间在圣路易斯退伍军人管理医疗中心接受了360臂测功机、2000多名潘生丁和3400名跑步机负荷测试。第二个目标是通过单变量和多变量的Cox回归分析、Kaplan-Meier曲线和Wald G2模型来确定，在对死亡或12/31/2009的终点进行人口统计学、临床和药物变量调整后，运动能力、血流动力学、症状、心电图和MPI对手臂测功器、潘生丁和跑台负荷试验的反应独立地预测生存或全因死亡率、继发性心肌梗死(MI)或冠状动脉血运重建，并在对人口统计学、临床和药物变量进行调整后合并预测。目的#3利用受试者特征(ROC)曲线分析，比较臂测功仪负荷试验变量模型与潘生丁MPI、跑台心电图、臂测功仪和平板心电图加MPI结果在预测临床结果方面的预后价值。目的#2我们的目标是开发一个简单的评分系统，类似于Duke跑步机评分，从独立预测的臂测功仪心电负荷测试变量中最好地预测死亡和MI。目的#3目标#1是对上述数据库中基线心电图高度异常、对应激反应迟钝、应激异常心电图或低运动量的患者进行分组，假设MPI信息可能最有利于增加预后的预测。目的#2是探讨MPI在这些亚组中的独立增量预后价值，并用COX回归和G2分析比较MPI在预测退伍军人不同亚组预后中的增量价值。