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Previous Volume 353:468-475 August 4, 2005 Number 5 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Kraus, W. E. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Recent studies have demonstrated that exercise capacity is an independent predictor of mortality in women. Normative values of exercise capacity for age in women have not been well established. Our objectives were to construct a nomogram to permit determination of predicted exercise capacity for age in women and to assess the predictive value of the nomogram with respect to survival.

Methods A total of 5721 asymptomatic women underwent a symptom-limited, maximal stress test. Exercise capacity was measured in metabolic equivalents (MET). Linear regression was used to estimate the mean MET achieved for age. A nomogram was established to allow the percentage of predicted exercise capacity to be estimated on the basis of age and the exercise capacity achieved. The nomogram was then used to determine the percentage of predicted exercise capacity for both the original cohort and a referral population of 4471 women with cardiovascular symptoms who underwent a symptom-limited stress test. Survival data were obtained for both cohorts, and Cox survival analysis was used to estimate the rates of death from any cause and from cardiac causes in each group.

Results The linear regression equation for predicted exercise capacity (in MET) on the basis of age in the cohort of asymptomatic women was as follows: predicted MET = 14.7 – (0.13 x age). The risk of death among asymptomatic women whose exercise capacity was less than 85 percent of the predicted value for age was twice that among women whose exercise capacity was at least 85 percent of the age-predicted value (P<0.001). Results were similar in the cohort of symptomatic women.

Conclusions We have established a nomogram for predicted exercise capacity on the basis of age that is predictive of survival among both asymptomatic and symptomatic women. These findings could be incorporated into the interpretation of exercise stress tests, providing additional prognostic information for risk stratification.

Source Information

From the Department of Preventive Medicine, Rush University Medical Center, Chicago (M.G., H.R.B.); the Division of Cardiology, Department of Medicine, Cedars–Sinai Research Institute, Cedars–Sinai Medical Center, Los Angeles (L.J.S., C.N.B.M.); the Departments of Medicine (M.F.A.) and Health Studies (R.A.T.), University of Chicago, Chicago; the Department of Cardiology, Cleveland Clinic Foundation, Cleveland (M.S.L.); the Department of Medicine, Princess Alexandra Hospital, Brisbane, Australia (T.H.M.); the Department of Neurology, University of Illinois, Chicago (D.K.P.); and the Division of Cardiology, St. James Hospital and Health Centers, Chicago Heights, Ill. (R.H.W.).

Address reprint requests to Dr. Gulati at Northwestern University, Bluhm Cardiovascular Institute, 201 E. Huron St., Chicago, IL 60611, or at mgulati{at}nmff.org.

Full Text of this Article

Related Letters:

Nomogram for Exercise Capacity in Women
Hossack K. F., Haas F., Byrne N. M., Rey M., Pletcher M. J., McCulloch C., Gulati M., Shaw L. J., Arnsdorf M. F.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:2301-2303, Nov 24, 2005. Correspondence

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