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- Title
Predicting premature termination of exercise during Bruce protocol stress echocardiography.
- Authors
Loh, Julian; Amanullah, Mohammed Rizwan; See, Chai Keat; Tang, Hak Chiaw; Gunasegaran, Kurugulasigamoney; Hamid, Nadira; Lau, Jeffrey; Lee, Chung Yin; Ewe, See Hooi; Ding, Zee Pin; Sahlén, Anders
- 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 and results: 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.
- Subjects
ECHOCARDIOGRAPHY; EXERCISE tests; CARDIOPULMONARY system; AGE distribution; SEX distribution; EXERCISE; DECISION making; DESCRIPTIVE statistics; LOGISTIC regression analysis; PREDICTION models
- Publication
Echocardiography, 2021, Vol 38, Issue 9, p1612
- ISSN
0742-2822
- Publication type
Article
- DOI
10.1111/echo.15186