IJCS | Volume 32, Nº1, January/ February 2019

20 Baroncini et al. Ergometric test and echocardiography in the elderly Int J Cardiovasc Sci. 2019;32(1)19-27 Original Article an underlying disease such as significant CAD or just poor functional capacity in a sedentary old person. An individual’s functional capability may be assessed by means of the maximum oxygen uptake (VO 2 max) that represents themaximumamount of oxygen an individual can take in with incremental exercise. The amount of exercise can be measured using the metabolic equivalent (MET); 1 MET is the amount of oxygen consumption at rest and is equivalent to approximately 3.5 ml kg - 1 min -1 (measured in a healthy, 40-year old man, 70 kg). VO 2 max decreases about 10% per decade in healthy individuals, and such decrease is evenmore pronounced in individuals older than 70 years. With the increase in life expectancy, many patients aged 75 years or older seek medical care for chest pain and presurgical evaluation for several elective surgeries. Individuals that feel fit enough to perform a physical stress test are submitted to treadmill or bicycle ergometric tests. However, although sensitivity to noninvasive stress testing increases with aging, specificity tends to decline. 5 The objective of the current study is to correlate exercise test variables with echocardiographic parameters in patients over 75 years old, including functional capacity, measured in MET and VO 2 max (with or without myocardial ischemia at the physical stress test), left ventricular ejection fraction (LVEF), left ventricular mass and left ventricle mass index, left atrial volume and presence of pulmonary arterial hypertension. Methods We assessed 381 patients (205 women; 53.8%), mean age of 79 ± 3.7 years, who underwent exercise test and bidimensional transthoracic echocardiography (2DEcho) in a private cardiologic clinic. Subjects were selected by convenience. Each patient had results of blood tests and imaging tests to be analyzed before the exercise test. Before the study, data on demographic characteristics and risk factors were collected from the private cardiologist’s records and blood test results. Body mass index (BMI) was calculated by dividing the subjects’ weight (kg) by the square of their height (m). Patients were queried about the presence of hypertension, diabetes mellitus, dyslipidemia, coronary artery disease, and current smoking habit. Hypertension was defined as a history of treated hypertension or the presence of systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, measured by the private cardiologist. Smoking history was coded as never or current smoker. 8 Subjects were classified as having diabetes when treated for insulin-dependent or non- insulin-dependent diabetes or having elevated fasting glucose levels (≥ 126 mg/dL). The use of lipid-lowering drugs or the presence of total cholesterol > 200 mg/dL, HDL-cholesterol < 40 mg/dL, LDL - cholesterol > 100 mg/dL or triglycerides > 150 mg/dL was recorded. 9-10 A history of myocardial infarction, angioplasty, or coronary artery bypass surgery was recorded, and the presence of any of these conditions was considered a positive CAD history. Indications for the 2DEcho included referral from a physician, information from close relatives, or patients’ complaints. We analyzed echocardiographic and carotid ultrasonography data, including left ventricular ejection fraction, left ventricular diastolic function, left atrial volume, left ventricular mass and the presence of pulmonary arterial hypertension and carotid plaque. Exclusion criteria included the presence of left ventricular systolic dysfunction (ejection fraction < 50% on echocardiogram), left ventricular diastolic dysfunction grade II and III, significant valve disease such as mitral and aortic regurgitation or stenosis, CAD with left ventricular systolic dysfunction or dilatation, unstable cardiovascular or metabolic disease, and major orthopedic/neurological disability. Subjects underwent treadmill electrocardiogram (ECG) testing (TET) or bike ECG testing (BET), according to the private physician request. Treadmill ECG test included Ellestad, Kattus, Naughton, Ramp, Bruce and modified Bruce protocols, and Balke and male Balke protocols, following standard recommendations. 11,12 The distance covered on the treadmill was automatically calculated by the protocol, according to the number of laps covered by each patient. Blood pressure and a 12-lead ECG were recorded before the test, during the test (during the last minute of each stage), and every 3minutes in the recovery phase. During the test, three ECG leadswere continuously monitored. The test was stopped in case of a) ST-segment elevation (> 1.0mm) in leads without preexistingQwaves due to prior myocardial infarction (other than aVR, aVL, and V1); b) drop in systolic blood pressure > 10 mmHg despite an increase in workload, when accompanied by any other evidence of ischemia; c) moderate to severe angina; d) central nervous system symptoms (e.g. ataxia, dizziness, near syncope); signs of poor perfusion (cyanosis or pallor); e) sustained ventricular tachycardia or other arrhythmias, including second- or third-degree atrioventricular block, which may affect cardiac output