Poor Exercise Capacity on Stress Echo in Women Predicts Death From CVD

Higher functional capacity assessed by exercise stress echocardiography is associated with a lower risk of cardiovascular mortality in women, as well as with a lower risk of death from cancer and other causes, according to a study presented last week at the European Society of Cardiology’s EuroEcho 2019.

During an average of 4.6 years follow-up, the annualized rate of death from cardiovascular causes was approximately four times lower in women who achieved a maximal workload of 10 metabolic equivalents (METs) or greater when compared with women who couldn’t achieve this standard (0.6% vs 2.2%; P < 0.001). Similarly, annualized rates of cancer deaths were twofold lower in the women with good functional capacity (0.4% vs 0.9%; P < 0.001).

The equivalent of 10 METs is roughly the ability to walk up four flights of stairs in approximately 45 seconds without stopping or to walk “very fast” up three flights, according to lead investigator Jesús Peteiro-Vazquez, MD, PhD (University Hospital A Coruña, Spain). 

Exercise stress echocardiography allows physicians to capture not only clinical and ECG information, but also resting and exercise echocardiographic data, Peteiro-Vazquez said.

“For a long time, it’s been known that this kind of test predicts cardiovascular mortality, but less is known about other types of mortality,” he told TCTMD.

Additionally, the data underpinning the link between exercise capacity and longevity is not as robust in women as it is in men, since male subjects have dominated prior studies, he said.   

In their retrospective analysis, which included 4,714 adult women (mean age 64 years) referred for treadmill exercise echocardiography for known or suspected coronary artery disease, clinical characteristics and echocardiographic variables (eg, abnormal wall motion abnormalities indicating ischemia or valvular/myocardial disease) were associated with an increased risk of cardiovascular mortality, as was the maximal achieved workload as measured by METs.

Exercise capacity as expressed by the maximal workload also predicted the risk of cancer mortality and deaths from noncancer/noncardiovascular causes. The annualized rate of death from these other causes was 0.3% in those with good exercise capacity (≥ 10 METs) versus 1.4% in those with poor capacity. Ischemia on exercise echocardiography was not associated with an increased risk of cancer mortality or deaths from noncancer/noncardiovascular causes, nor were any other echocardiographic variables.

“The imaging is very important to predict cardiovascular mortality, but the time the patients spent walking on the treadmill is also important for predicting other types of death, including deaths from cancer and noncardiovascular- and noncancer-related causes,” said Peteiro-Vazquez.

The study, he added, suggests that exercise stress echocardiography can provide useful information for patients and physicians about the risk of death from noncardiovascular causes. Even if the echocardiogram suggests normal heart function, women are still at risk of death from cancer and other causes if the exercise capacity is poor, according to Peteiro-Vazquez.