Elsevier

American Heart Journal

Volume 122, Issue 5, November 1991, Pages 1423-1431
American Heart Journal

The prognostic value of exercise capacity: A review of the literature

https://doi.org/10.1016/0002-8703(91)90586-7Get rights and content

Abstract

While there is still much debate in the literature regarding the specific MET levels at which there are differences in survival, the following points have become clear with the growing body of reports in the literature. Exercise capacity seems to be an independent predictor of mortality, and when it is combined with other clinical, exercise, or angiographic data, it becomes very powerful in this regard. This relates to both overall mortality and to that from cardiovascular disease. There is still a need for the establishment of mortality data related to MET levels adjusted for age and activity status.

A low exercise capacity of less than 6 METs indicates a higher mortality group, probably regardless of the underlying extent of coronary disease or left ventricular function. Analysis of the CASS data has indicated that these patients benefit from coronary artery bypass surgery with respect to survival. An exercise capacity of greater than 10 METs designates an excellent survival group, again despite the extent of coronary artery disease or left ventricular function. If 10 METs truly exerts a “protective effect” that obviates any survival benefit from coronary artery bypass surgery, this has enormous implications for cost containment and medical care. It is nonetheless important to remember that this level of exercise capacity does not imply the absence of either coronary disease or triple-vessel coronary disease.

Exercise capacity is related to more than just cardiovascular fitness and integrity. It is dependent upon a combination of other physiologic components as well, including pulmonary function, health status of other organ systems, nitrogen balance, nutritional status, medications, orthopedic limitations, and others. Nonetheless, exercise capacity has been established as a powerful predictor of survival and deserves equal emphasis with that of ST segment interpretation in the evaluation of exercise test responses.

References (28)

  • GR Dagenais et al.

    Survival with painless strongly positive exercise electrocardiogram

    Am J Cardiol

    (1988)
  • P Bogaty et al.

    Prognosis in patients with a strongly positive exercise electrocardiogram

    Am J Cardiol

    (1989)
  • MH Ellestad et al.

    Predictive implications of stress testing

    Circulation

    (1975)
  • American College of Sports Medicine

    Guidelines for exercise testing and prescription

    (1986)
  • Cited by (188)

    • What are the prognostic implications and factors relating to exercise induced electrocardiographic ST segment changes in the setting of a non-ischemic stress echocardiogram?

      2022, International Journal of Cardiology
      Citation Excerpt :

      A further aim of the study was to investigate the association between intensity of exercise achieved and subsequent cardiovascular events. A number of risk factors have been associated with ECG changes with stress testing. [9,10] It was planned to evaluate these and their influence on prognosis.

    • Using Metabolic Equivalents in Clinical Practice

      2018, American Journal of Cardiology
    • Noncardiac surgery in adult congenital heart disease

      2018, Diagnosis and Management of Adult Congenital Heart Disease: Third Edition
    View all citing articles on Scopus
    View full text