Parth S. Patel MD , Samuel Heller Jr. BA , Kathryn F. Larson MD , Nadia M. Elfessi PA-C , Nora Sydo MD, PhD , Karina Gonzalez Carta MD, MS , Nasir Hussain MD , Thomas G. Allison PhD, MPH , Darrell B. Newman MD
{"title":"Fitness and Mortality Outcomes Associated With Supramaximal Peak Heart Rate on Treadmill Exercise Stress Testing","authors":"Parth S. Patel MD , Samuel Heller Jr. BA , Kathryn F. Larson MD , Nadia M. Elfessi PA-C , Nora Sydo MD, PhD , Karina Gonzalez Carta MD, MS , Nasir Hussain MD , Thomas G. Allison PhD, MPH , Darrell B. Newman MD","doi":"10.1016/j.amjcard.2025.05.004","DOIUrl":null,"url":null,"abstract":"<div><div>Inability to reach age-predicted peak heart rate (APPHR) on treadmill exercise testing (TMET) is associated with lower fitness and increased mortality. The significance of a “supramaximal” heart rate (≥105% of APPHR) is poorly understood; as such, we sought to investigate this relationship. We queried the Mayo Stress database from 1993 to 2010 for patients >30 years old without cardiovascular disease and not on antichronotropic therapy. Patients were stratified into groups based on APPHR: <75%, 75% to 84%, 85% to 94%, 95% to 104%, and ≥105%, with 105% to 114% and ≥115% subgroups. Functional aerobic capacity (FAC) was assessed by ANOVA and all-cause mortality by cox hazard regression; we adjusted for confounders. In total, 18,961 patients were included; 1150 (6.1%) died. 2,144 (11.3%) of patients achieved submaximal APPHR (<85%), 2,917 achieved supramaximal APPHR (≥105%). Patients with submaximal APPHR had significantly lower FAC: 76.4% (p <0.0001) [<75%], 83.5% (p <0.0001) [≥75% to <85%]. Those with supramaximal APPHR had significantly higher FAC: 102.0% (p <0.0001). Patients with submaximal APPHR had significantly higher mortality risks: <75% (adjusted HR 2.36 [1.83 to 3.04], p <0.0001) and ≥75 to <85% (adjusted HR 1.93 [1.62 to 2.31], p <0.0001). Those with supramaximal APPHR, after adjustment for cardiac risk factors and resting heart rate, had significantly lower mortality risk (adjusted HR 0.83 [0.70 to 0.99], p = 0.0414). In conclusion, supramaximal heart rate on TMET was associated with significantly higher FAC and lower all-cause mortality risk.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"250 ","pages":"Pages 54-60"},"PeriodicalIF":2.3000,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0002914925002917","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Inability to reach age-predicted peak heart rate (APPHR) on treadmill exercise testing (TMET) is associated with lower fitness and increased mortality. The significance of a “supramaximal” heart rate (≥105% of APPHR) is poorly understood; as such, we sought to investigate this relationship. We queried the Mayo Stress database from 1993 to 2010 for patients >30 years old without cardiovascular disease and not on antichronotropic therapy. Patients were stratified into groups based on APPHR: <75%, 75% to 84%, 85% to 94%, 95% to 104%, and ≥105%, with 105% to 114% and ≥115% subgroups. Functional aerobic capacity (FAC) was assessed by ANOVA and all-cause mortality by cox hazard regression; we adjusted for confounders. In total, 18,961 patients were included; 1150 (6.1%) died. 2,144 (11.3%) of patients achieved submaximal APPHR (<85%), 2,917 achieved supramaximal APPHR (≥105%). Patients with submaximal APPHR had significantly lower FAC: 76.4% (p <0.0001) [<75%], 83.5% (p <0.0001) [≥75% to <85%]. Those with supramaximal APPHR had significantly higher FAC: 102.0% (p <0.0001). Patients with submaximal APPHR had significantly higher mortality risks: <75% (adjusted HR 2.36 [1.83 to 3.04], p <0.0001) and ≥75 to <85% (adjusted HR 1.93 [1.62 to 2.31], p <0.0001). Those with supramaximal APPHR, after adjustment for cardiac risk factors and resting heart rate, had significantly lower mortality risk (adjusted HR 0.83 [0.70 to 0.99], p = 0.0414). In conclusion, supramaximal heart rate on TMET was associated with significantly higher FAC and lower all-cause mortality risk.
期刊介绍:
Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.