From the Laboratory of Cardiovascular Science, Gerontology Research
Center, National Institute on Aging, Baltimore, Md.
Correspondence to Jerome L. Fleg, MD, Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute on Aging, NIH, 5600 Nathan Shock Dr, Baltimore, MD 21224.
Background—Although exercise-induced
ST depression is an independent predictor of future coronary
events in asymptomatic populations, the predictive value of
ST depression beginning after exercise cessation is unknown.
Methods and Results—We analyzed the treadmill exercise
tests of 825 healthy volunteers who were 22 to 89 years of age from the
Baltimore Longitudinal Study of Aging. All subjects were free from
coronary heart disease by history, physical examination, and
resting ECG. From 825 participants, 611 (group 0) had no
ischemic ST-segment changes during or after treadmill exercise,
while 214 subjects developed
Conclusions—Thus, ischemic ST-segment changes developing
during recovery from treadmill exercise in apparently healthy
individuals have adverse prognostic significance similar to those
appearing during exercise.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Independent Prognostic Significance of Ischemic ST-Segment Response Limited to Recovery From Treadmill Exercise in Asymptomatic Subjects
1-mm flat or downsloping ST depression:
151 (group 1) had ST changes starting during exercise, and 63 (group 2)
had changes limited to recovery. Groups 1 and 2 were similar in age,
sex, smoking status, hypertension prevalence, fasting plasma glucose,
and serum cholesterol (CHOL). However, both groups were
older and had higher CHOL and prevalence of hypertension than group 0.
Treadmill exercise duration, peak oxygen consumption, and maximal heart
rate were similar between groups 1 and 2 but were lower than in group 0
(each P<0.05). During a mean follow-up time of 9 years,
55 subjects developed coronary events (angina pectoris,
myocardial infarction, or coronary death): 21 of 611 (3.4%) in
group 0, 22 of 151 (14.6%) in group 1, and 12 of 63 (19%) in group 2
(P=0.001). By survival analysis, the risk of
coronary events was similar in groups 1 and 2 but significantly
higher than in group 0 (P<0.0001). Multiple logistic
regression showed that age (odds ratio [OR]=1.07 per year,
P=0.00001), CHOL (OR=1.02 per 1 mg,
P=0.0001), and presence of ST-segment depression
(OR=2.59, P=0.007 and OR=2.38, P=0.04 for
groups 1 and 2, respectively) were independent predictors of
events.
Key Words: exercise • electrocardiography • ischemia • prognosis
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