ArticleJournal of the American College of Cardiology2009
Achieving an exercise workload of > or = 10 metabolic equivalents predicts a very low risk of inducible ischemia: does myocardial perfusion imaging have a role?
Article in Journal of the American College of Cardiology, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 1 of them a synthesis that pooled it.
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Who cites it
62 citing papers in PubMed, 1 synthesis or guideline pooled it, 152 citations in OpenAlex.
- Utility of Exercise Electrocardiography in Pre-participation Screening in Asymptomatic Athletes: A Systematic Review.Sports medicine (Auckland, N.Z.) · 2016Pooled it
- Repositioning of exercise treadmill testing in contemporary chest pain management.The international journal of cardiovascular imaging · 2026Review
- CT Attenuation Map-Derived Body Composition Is Associated with Cardiorespiratory Fitness in Multicenter External Validation.medRxiv : the preprint server for health sciences · 2026Article
- Risk stratification with pre-operative myocardial perfusion imaging.European journal of nuclear medicine and molecular imaging · 2026Article
- Target Heart Rate Formulas for Exercise Stress Testing: What Is the Evidence?Journal of clinical medicine · 2024Review
- Position Statement on Ischemic Heart Disease - Women-Centered Health Care - 2023.Arquivos brasileiros de cardiologia · 2023Article
- Prognostic value of peak work rate indexed by left ventricular diameter.Scientific reports · 2023Article
- Quality metrics for single-photon emission computed tomography myocardial perfusion imaging: an ASNC information statement.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2023Review
- Cardiovascular Risk Factors and Physical Fitness Among Subjects with Asymptomatic Colonic Diverticulosis.Digestive diseases and sciences · 2023Article
- Exercise Stress Echocardiography for Stable Coronary Artery Disease: Succumbed to the Modern Conceptual Revolution or Still Alive and Kicking?Reviews in cardiovascular medicine · 2022Review
- Ten things to know about ten cardiovascular disease risk factors - 2022.American journal of preventive cardiology · 2022Review
- Beyond traditional cardiovascular risk factors: Could frailty and other morbidities explain the worse prognosis in patients undergoing pharmacologic stress?Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2022Article
- Rise and fall, and provisional rebirth of exercise stress testing at the dawn of the third millennium.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2021Article
- The additional prognostic value of myocardial perfusion SPECT in patients with known coronary artery disease with high exercise capacity.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2021Article
- Long-term outcomes in patients with normal coronary arteries, nonobstructive, or obstructive coronary artery disease on invasive coronary angiography.Clinical cardiology · 2021Article
- Ten things to know about ten imaging studies: A preventive cardiology perspective ("ASPC top ten imaging").American journal of preventive cardiology · 2021Review
- Ten things to know about ten cardiovascular disease risk factors.American journal of preventive cardiology · 2021Review
- Lead aVR predicts early revascularization but not long-term events in patients referred for stress electrocardiography.PloS one · 2021Article
- Rate pressure product, age predicted maximum heart rate or heart rate reserve. Which one better predicts cardiovascular events following exercise stress echocardiography?American journal of cardiovascular disease · 2021Article
- High-frequency QRS analysis to supplement ST evaluation in exercise stress electrocardiography: Incremental diagnostic accuracy and net reclassification.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2020Article
2 more citing papers are in PubMed but not listed here.
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Funding
Abstract
objectivesWe sought to identify prospectively the prevalence of significant ischemia (> or =10% of the left ventricle [LV]) on exercise single-photon emission computed tomography (SPECT) imaging relative to workload achieved in consecutive patients referred for myocardial perfusion imaging (MPI).
backgroundHigh exercise capacity is a strong predictor of a good prognosis, and the role of MPI in patients achieving high workloads is questionable.
methodsProspective analysis was performed on 1,056 consecutive patients who underwent quantitative exercise gated (99m)Tc-SPECT MPI, of whom 974 attained > or =85% of their maximum age-predicted heart rate. These patients were further divided on the basis of attained exercise workload (<7, 7 to 9, or > or =10 metabolic equivalents [METs]) and were compared for exercise test and imaging outcomes, particularly the prevalence of > or =10% LV ischemia. Individuals reaching > or =10 METs but <85% maximum age-predicted heart rate were also assessed.
resultsOf these 974 subjects, 473 (48.6%) achieved > or =10 METs. This subgroup had a very low prevalence of significant ischemia (2 of 473, 0.4%). Those attaining <7 METs had an 18-fold higher prevalence (7.1%, p < 0.001). Of the 430 patients reaching > or =10 METs without exercise ST-segment depression, none had > or =10% LV ischemia. In contrast, the prevalence of > or =10% LV ischemia was highest in the patients achieving <10 METs with ST-segment depression (14 of 70, 19.4%).
conclusionsIn this referral cohort of patients with an intermediate-to-high clinical risk of coronary artery disease, achieving > or =10 METs with no ischemic ST-segment depression was associated with a 0% prevalence of significant ischemia. Elimination of MPI in such patients, who represented 31% (430 of 1,396) of all patients undergoing exercise SPECT in this laboratory, could provide substantial cost-savings.
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