An exercise test in intermittent claudication.

STUDY OBJECTIVES: Primary graft failure (PGF) is a severe acute lung injury syndrome that occurs following lung transplantation. We compared the clinical outcomes of patients who developed PGF with those who did not. METHODS: We conducted a retrospective cohort study including 255 consecutive lung transplant procedures. PGF was defined as (1) diffuse alveolar opacities developing within 72 h of transplantation, (2) an arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio of < 200 beyond 48 h postoperatively, and (3) no other secondary cause of graft dysfunction. PGF was tested for acceptance with 30-day and all-cause hospital mortality rates, overall survival, hospital length of stay (HLOS), duration of mechanical ventilation, and best 6-min walk test (6MWT) distance achieved within 12 months. SETTING: Academic medical center. RESULTS: The overall incidence of PGF was 11.8% (95% confidence interval [CI], 7.9 to 15.9%). The all-cause mortality rate at 30 days was 63.3% in patients with PGF and 8.8% in patients without PGF (relative risk [RR], 7.15; 95% CI, 4.34 to 11.80%; p < 0.001). A total of 73.3% of patients with PGF died during hospitalization vs 14.2% of patients without PGF (RR, 5.18%; 95% CI, 3.51 to 7.63; p < 0.001). The median HLOS in 30-day survivors was 47 days in patients with PGF vs 15 days in those without PGF (p < 0.001), and the mean duration of mechanical ventilation was 15 days in patients with PGF vs 1 day in those without PGF (p < 0.001). By 12 months, a total of 28.5% of survivors with PGF achieved a normal age-appropriate 6MWT distance vs 71.4% of survivors without PGF at 12 months (p = 0.014). The median best 6MWT distance achieved within the first 12 months was 1,196 feet in patients with PGF vs 1,546 feet in those without PGF (p = 0.009). CONCLUSIONS: PGF has a significant impact on mortality, HLOS, and duration of mechanical ventilation following lung transplantation. Survivors of PGF have a protracted recovery with impaired physical function up to 1 year following transplantation.

Exercise Test↗

PubMed2005

Prediction of death and nonfatal myocardial infarction in high-risk patients: a comparison between the Duke treadmill score, peak exercise radionuclide angiography, and SPECT perfusion imaging.

UNLABELLED: Radionuclide exercise testing provides prognostic information in patients with known or suspected coronary artery disease (CAD). The relative contribution of 3 noninvasive tests--the Duke treadmill score (DTS), first-pass radionuclide angiography with calculation of the ejection fraction (RNA-EF), and perfusion SPECT--has not been comparatively assessed in a high-risk population undergoing all 3 tests. METHODS: We identified 997 patients (75% male; median age, 60 y) who underwent exercise treadmill testing with RNA-EF and SPECT perfusion imaging as a single test. The relative prognostic power of each test was evaluated in both an unadjusted manner and after adjustment for differences in baseline characteristics using Cox proportional hazards models. RESULTS: During a median follow-up of 4.1 y, 175 patients experienced outcome events. Without adjustment for baseline patient characteristics, each of the modalities proved highly predictive of the composite endpoint of cardiovascular death or nonfatal myocardial infarction (MI) (DTS chi(2) = 18.9, P = 0.0001; RNA-EF chi(2) = 34, P = 0.0001; SPECT chi(2) = 11.5, P = 0.0007). In clinically risk-adjusted models, RNA-EF was the most powerful predictor of cardiovascular death compared with the DTS and SPECT (chi(2) = 40.5, 27.6, and 19.8, respectively). Conversely, exercise SPECT perfusion was a stronger predictor of nonfatal MI than the DTS or RNA-EF (chi(2) = 26.7, 15.7, and 16.7, respectively). CONCLUSION: The DTS, perfusion SPECT, and RNA-EF are each significant predictors of cardiovascular events in high-risk patients. The optimal risk stratification of patients for CAD may include all 3 modalities.

Exercise Test↗