Large prospective study: treadmill test urged for asymptomatic women.(Clinical Rounds)

NEW ORLEANS -- Exercise stress testing as a screening tool in asymptomatic women provides valuable prognostic information, according to a major new study.

"We believe that our findings will impact the American College of Cardiology/American Heart Association exercise testing guidelines. We think that in addition to screening for traditional cardiac risk factors, performing an exercise stress test in asymptomatic women will assist in our risk assessment and prognosis," Dr. Martha Gulati said at the annual meeting of the American College of Cardiology.

She presented the findings of the St. James Women Take Heart Project, a prospective study aimed at determining the value of exercise stress testing specifically in asymptomatic women. The project involved 5,721 asymptomatic Chicagoarea women who underwent treadmill testing using the Bruce protocol in 1992. Through the year 2000, all-cause mortality was 3% among these women, including 1% who died of cardiac causes.

The investigators evaluated the predictive value of exercise stress testing in two ways, by using the Duke Treadmill Score and by expressing exercise capacity in metabolic equivalents (METs) achieved during testing.

For each 1 MET above 5 reached during testing, a woman had a 12% reduction in all-cause mortality and a 22% decrease in cardiac mortality after controlling for standard risk factors using the Framingham Risk Score, said Dr. Gulati of Rush University Medical Center, Chicago.

The Duke Treadmill Score also proved predictive of mortality. For each unit of increase in a woman's score, her adjusted risk of all-cause mortality declined by 9% and her cardiac mortality risk fell by 13%.

The Duke Treadmill Score is easily calculated based upon exercise time. ECG changes, and the ...