IJCS | Volume 32, Nº1, January/ February 2019

21 Baroncini et al. Ergometric test and echocardiography in the elderly Int J Cardiovasc Sci. 2019;32(1)19-27 Original Article during exercise; f) marked ST-segment depression (≥ 3mm); g) exercise-limiting symptoms such as angina, dyspnea, exhaustion, or the subjects’ request to stop the test; and h) technical difficulties in monitoring the ECG or systolic blood pressure. An abnormal response of the ST-segment to exercise was defined as horizontal or downsloping ST-segment depression ≥ 1 mm measured at 80 ms after the J point or an elevated ST-segment ≥ 1 mm in leads without pathological Q-wave (excluding lead aVR). Measurements of left ventricular systolic and diastolic dysfunction, left atrial volume, valve disease, and systolic pulmonary artery pressure were performed according to recommendations of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. 13-14 The study was approved by the local ethics committee and written informed consent was obtained from each participant to undergo the ergometric tests (treadmil ECG testing or bike ECG testing) , bidimensional transthoracic echocardiography and carotid ultrassonography, and to participate in the study. Statistical analysis Quantitative variables were described as means, medians, minimum and maximum values, quartiles and standarddeviations, and categorical variables as frequency and percentiles. Associations between quantitative variables were analyzed by Pearson and Spearman correlation coefficients. Comparisons of quantitative variables between the two groups were made using the Student’s t test for independent samples. Statistical testing of data normality was performed using the Kolmogorov- Smirnov test. Associations between categorical variables were assessed by the Fisher’s exact test. A p-value ≤ 0.05 indicated statistical significance. Data were analyzed by means of the SPSS statistical software, version 20. Results Patients’ baseline characteristics andechocardiographic and ergometric results are shown in Tables 1, 2 and 3. Only five patients (1.3%) performed cycle ergometer test, and then were excluded from the final analysis. Three hundred seventy-six patients performed treadmill test (Bruce protocol 203, 53.4%; Kattus 113, 29.7%; Ramp 28, 7.4%; modified Bruce 15, 3.9%; Naughton 12, 3.2%; Ellestad 5, 1.3%; Balke 3, 0.8%; Balke male 1, 0.3%). Nineteen (5%) patients did not achieve the submaximal heart rate (HR) expected for the age and 58 (15%) had previous ECG at resting conditions showing left bundle branch block and ST segment alterations. Forty (10.5%) of the patients tested positive for myocardial ischemia and 79 (21.8%) showed abnormal heart rate response in the first minute. As age increased, the distance covered by participants decreased (p = 0.021), as well the expected increase in HR (p < 0.001), VO 2 max (p < 0.001) andMETs (p < 0.001) (Tables 3 and 4; Figure 1) in men and women. Women showed lower values of VO 2 max and METs when compared to men (Table 2). Inverse correlation was noted of the distance covered, VO 2 max and METs with the BMI (Table 3 and 4). Only 4 patients (1%) showed systolic pressure in the pulmonary artery above 40 mmHg in the echocardiogram at rest, which did not influence the distance covered by the subjects, HR at the first minute (p = 1), VO 2 max (p = 0.5), MET (p = 0.5) or ischemia (p = 1.0) (data not shown). The volume of the left atrium and left ventricular mass had no influence on the ergometric test variables (Table 5). Ischemia at stress test did not correlatewith any echocardiographic variable (Table 5). In 198 patients (67.3%), atherosclerotic plaques in the extracranial carotid arteries were detected, which also did not correlate with any of the variables analyzed (data not shown). Severity of stenosis was not considered relevant, only the presence of the atherosclerotic plaque. Discussion The present study showed that relatively healthy patients aged 75-81 years, with similar demographic and echocardiographic characteristics, showed a progressive decrease in METs and VO 2 max, associated with a decrease in the distance covered during ergometric test with increasing age. These findings corroborate previous studies showing a marked decrease in VO 2 max with aging. 15-18 Considering that only individuals with preserved left ventricular systolic function was studied, we did not expect an influence of this parameter on the results. Similarly, no influence of left ventricular diastolic function was expected, 19 as individuals with grade II and III diastolic dysfunction were excluded from the study. Regarding the left atrial volume, since there was no significant variation in its values among the patients, its influence on the ergometric parameters was not expected either, unlike previous studies that reported a worsening of functional capacity due to the increase in left atrial volume. 20-23 The same was observed with left ventricular mass and left ventricular mass index. 24 Therefore, no correlation between ergometric and echocardiographic variables was found, which