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European Heart Journal Advance Access published online on April 26, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi278
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received November 29, 2004
Revised March 7, 2005
Accepted March 18, 2005

Clinical research

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

Johan Bodegard 1*, Gunnar Erikssen 2, Jørgen V. Bjørnholt 1, Knut Gjesdal 3, Knut Liestøl 4, and Jan Erikssen 1

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

* To whom correspondence should be addressed.
Johan Bodegard, E-mail: l.j.bodegard{at}klinmed.uio.no


  Abstract

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.

Keywords: Long term prognosis; Exercise testing; Coronary heart disease mortality; Termination reason; Pulmonary disease mortality; Total mortality.
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