Why the study?
The accuracy of the 220-age formula and using 85% of age-predicted maximum heart rate as an exercise stress testing endpoint is questioned, and alternative measurements may better predict cardiovascular outcomes.
Do comprehensive measurements (%HRR, MRPP, METs) provide better prediction of cardiovascular outcomes than reaching 85% of APMHR during exercise stress testing?
Do comprehensive measurements (%HRR, MRPP, METs) provide better prediction of cardiovascular outcomes than reaching 85% of APMHR during exercise stress testing?
Comprehensive measurements such as percentage heart rate reserve, maximum rate pressure product, and METs may improve the diagnostic and prognostic capabilities of exercise stress testing compared to the traditional 85% age-predicted maximum heart rate endpoint.
Exercise stress testing (EST) is commonly used to evaluate chest pain, with some labs using 85% of age-predicted maximum heart rate (APMHR) as an endpoint for EST. The APMHR is often calculated using the formula 220-age. However, the accuracy of this formula and 85% APMHR as an endpoint may be questioned. Moreover, failing to reach 85% APMHR (known as chronotropic insufficiency) may also indicate poor cardiovascular prognosis, but measurements, such as percentage heart rate reserve (%HRR), maximum rate pressure product (MRPP), and the maximum metabolic equivalent of tasks (METs) reached during EST may provide better prediction of cardiovascular outcomes than not reaching 85% of APMHR. There is a need to incorporate comprehensive measurements to improve the diagnostic and prognostic capabilities of EST.
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Almaadawy et al. (2024) studied this question.
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