Key result
Peak RPP remains static across age groups during normal stress echocardiograms despite reduced exercise time.
Why the study?
Reference ranges for exercise capacity during supine bicycle stress echocardiography are not well described.
Observational (n=260)
No
Absolute Event Rate: 23881% vs 24343%
p-value: p=0.988
Peak rate pressure product remains static across age groups during supine bicycle stress echocardiography, suggesting it may be a better standardized measure of effort than exercise time alone.
Peak RPP may better standardize effort assessment than exercise time in stress echo; hypothesis-generating and needs prospective validation before clinical adoption.
Reference ranges for exercise capacity during supine bicycle stress echocardiography (SBSE) are not well described. The aim of this study was to define supine bicycle exercise parameters in patients with normal stress echocardiograms in an unselected chest pain population. 260 normal SBSE tests were analysed, recording baseline and peak measurements of heart rate, systolic and diastolic blood pressure, workload in Watts, peak rate pressure product (RPP) and total exercise time during a standardised 25 W ramp protocol. There were sex-related differences in physiological response to exercise; peak HR was lower in men than women (men 141+/- 11 bpm vs. women 145+/-11 bpm, p < 0.01) and peak blood pressure higher in men than women (men 185+/-29mmHg vs. women 169+/-30mmHg, p < 0.05). Men exercised for 20.5% longer than women with a 6.8% greater peak rate pressure product (both p < 0.05). Age was also associated with differences in peak heart rate (< 40 156 +/- 9 bpm vs. > 70 129+/-6 bpm, p < 0.05), peak systolic blood pressure (153+/-27mmHg vs. > 70 188+/-24mmHg, p < 0.05) and reduced exercise time across both sexes (< 40 609+/-158 s vs. > 70 475+/- 126 s, p < 0.05). Although exercise time reduced with age, higher peak systolic blood pressure measurements meant peak rate pressure product was not different according to age (< 40 23881 +/- 4310 vs. > 70 24343 +/- 3058, p = 0.988). This study established reference values for systolic blood pressure, rate pressure product, workload in Watts and total exercise time during stress echocardiography using a 25 W bicycle ergometer protocol. Despite exercise time reducing with age, peak rate pressure product remains static, suggesting peak rate pressure product may be a better standardised measure of effort than exercise time alone.
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Flynn et al. (2026) conducted an observational in Normal stress echocardiograms in an unselected chest pain population (n=260). Supine bicycle stress echocardiography (SBSE) vs. Age and sex comparisons was evaluated on Peak rate pressure product (RPP) in patients <40 years vs >70 years (p=0.988). In patients with normal stress echocardiograms, peak rate pressure product remained static across age groups despite reduced exercise time, suggesting it is a consistent measure of maximal effort.
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