| Title |
Importance of Estimated Functional Capacity as a Predictor of All-Cause Mortality Among Patients Referred for Exercise Thallium Single-Photon Emission Computed Tomography: Report of 3,400 Patients From a Single Center
|
|---|---|
| Published in |
JACC, July 1997
|
| DOI | 10.1016/s0735-1097(97)00217-9 |
| Pubmed ID | |
| Authors |
Claire E Snader, Thomas H Marwick, Fredric J Pashkow, Sharon A Harvey, James D Thomas, Michael S Lauer |
| Abstract |
We sought to determine the relative influence of estimated functional capacity and thallium-201 (Tl-201) single-photon emission computed tomographic (SPECT) findings on prediction of short-term all-cause and cardiac-related mortality. Decreased functional capacity and abnormal Tl-201 SPECT findings are predictive of increased cardiovascular risk and mortality. However, the relative importance of these variables as predictors of all-cause mortality is not well established. Analyses were based on 3,400 consecutive adults undergoing symptom-limited exercise Tl-201 SPECT testing at the Cleveland Clinic Foundation between September 1990 and December 1993; none had previous invasive procedures, heart failure or valve disease. Estimated functional capacity, classified by age and gender, and thallium perfusion defects, expressed as a stress extent thallium score on a 12-segment scale, were analyzed to determine their relative prognostic importance during 2 years of follow-up. Of 3,400 patients, 108 (3.2%) died during follow-up; 32 deaths were identified as cardiac related. On univariable analysis, estimated functional capacity was a strong predictor of death, with 62 (57%) deaths occurring in patients achieving < 6 metabolic equivalents (METs) (log-rank chi-square 86, p < 0.0001). On multivariable analysis, the strongest independent predictors of all-cause mortality were fair or poor functional capacity (adjusted relative risk [RR] 3.96, 95% confidence interval [CI] 2.36 to 6.64, chi-square 27, p < 0.0001) and age (adjusted RR for 10 years 2.25, 95% CI 1.80 to 2.80, chi-square 27, p < 0.0001). The presence of SPECT thallium perfusion defects was a less powerful predictor of death (for each two additional segments with defects, adjusted RR 1.21, 95% CI 1.03 to 1.43, chi-square 5, p = 0.02). Cardiac mortality was predicted by both fair or poor functional capacity (adjusted RR 4.37, 95% CI 1.59 to 12.00, chi-square 8, p = 0.004) and by stress extent thallium score (adjusted RR 1.62, 95% CI 1.25 to 2.11, chi-square 13, p = 0.0003). In this clinically low risk group, estimated functional capacity was a strong and overwhelmingly important independent predictor of all-cause mortality among patients undergoing exercise Tl-201 SPECT testing. The extent of myocardial perfusion defects was of comparable importance for the prediction of cardiac mortality. |
X Demographics
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Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 60 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 1 | 2% |
| Unknown | 59 | 98% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 10 | 17% |
| Other | 7 | 12% |
| Researcher | 7 | 12% |
| Student > Postgraduate | 6 | 10% |
| Student > Master | 6 | 10% |
| Other | 12 | 20% |
| Unknown | 12 | 20% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 28 | 47% |
| Agricultural and Biological Sciences | 6 | 10% |
| Nursing and Health Professions | 5 | 8% |
| Sports and Recreations | 3 | 5% |
| Biochemistry, Genetics and Molecular Biology | 2 | 3% |
| Other | 1 | 2% |
| Unknown | 15 | 25% |
Attention Score in Context
This research output has an Altmetric Attention Score of 4. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 30 June 2019.
All research outputs
#7,960,693
of 25,374,917 outputs
Outputs from JACC
#9,541
of 16,740 outputs
Outputs of similar age
#8,985
of 28,360 outputs
Outputs of similar age from JACC
#24
of 65 outputs
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We're also able to compare this research output to 65 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 63% of its contemporaries.