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European Heart Journal Advance Access originally published online on April 26, 2005
European Heart Journal 2005 26(14):1394-1401; doi:10.1093/eurheartj/ehi278
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Reasons for terminating an exercise test provide independent prognostic information: 2014 apparently healthy men followed for 26 years

Johan Bodegard1,*, Gunnar Erikssen2, Jørgen V. Bjørnholt1, Knut Gjesdal3, Knut Liestøl4 and Jan Erikssen1

1Department of Clinical Epidemiology, University of Oslo, Akershus University Hospital, PO Box 75, NO-1474 Nordbyhagen, Norway
2Hjerteavdelingen, Rikshospitalet, Oslo, Norway
3Department of Cardiology, Ulleval University Hospital, Oslo, Norway
4The Department of Informatics, University of Oslo, Norway

Received 29 November 2004; revised 7 March 2005; accepted 18 March 2005; online publish-ahead-of-print 26 April 2005.

* Corresponding author. Tel: +47 67927806; fax: +47 67927803. E-mail address: l.j.bodegard{at}klinmed.uio.no

See page 1353 for the editorial comment on this article (doi:10.1093/eurheartj/ehi303)

Aims We wanted to study whether reasons for terminating an exercise test might influence long-term mortality of healthy men, a previously unreported subject.

Methods and results During 1972–75, 2014 men aged 40–59, free from somatic diseases and not using drugs, underwent an examination programme including case history, clinical examination, various blood tests, and a symptom limited exercise ECG-test. The following reasons for test termination were noted: impaired breathing, lower limb fatigue, exhaustion (=combined lower limb fatigue and impaired breathing), high heart rate, abnormal blood pressure response, heart arrhythmias, increasing chest pain during exercise, marked ST-depressions during the test, and refusal to continue. Follow-up was 26 years. When adjusting for age, men who stopped exercising exclusively because of impaired breathing (n=178) had a 1.86-fold increased risk (95% CI 1.34–2.60; P=0.0002) of dying from coronary heart disease (CHD), a 1.64-fold increased risk (95% CI 1.32–2.03; P<0.0001) of dying from any cause, and a 3.47-fold increased risk (95% CI 2.24–5.12; P<0.0001) of dying from pulmonary causes compared with men having defined exhaustion (n=1376). After adjustment for age, smoking, total serum cholesterol, fasting blood glucose, systolic blood pressure, and physical fitness, impaired breathing remained significantly associated to an increased risk of dying from CHD, pulmonary disease, or any causes.

Conclusion Healthy men who stop bicycle exercising only because of impaired breathing have a high long-term CHD-, pulmonary-, and total-mortality, and such men may need further diagnostic scrutiny and follow-up.

Key Words: Long term prognosis • Exercise testing • Coronary heart disease mortality • Termination reason • Pulmonary disease mortality • Total mortality


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