In:
Echocardiography, Wiley, Vol. 38, No. 9 ( 2021-09), p. 1612-1617
Abstract:
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.
Type of Medium:
Online Resource
ISSN:
0742-2822
,
1540-8175
Language:
English
Publisher:
Wiley
Publication Date:
2021
detail.hit.zdb_id:
2041033-5
