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PubMed1991

The prenatal inhalation toxicity of acrylic acid in rats.

Pregnant Sprague-Dawley rats (5 per groups) were exposed in a pretest to 0, 225, and 450 ppm acrylic acid (AA) and in a main study (30 per group) to 0, 40, 120, and 360 ppm acrylic acid. Exposures were for 6 hr/day, during Days 6 to 15 of gestation (period of organogenesis), with further observation up to Day 20 after mating. Maternal toxicity occurred in animals exposed at 450 and 225 ppm in the pretest. At 360 ppm in the main study maternal toxicity consisted of sensory irritation (discharge from the eyes, snout wiping, and restless behavior) with significant reductions in body weight (p less than 0.01), body weight gain (p less than 0.01), and food consumption (p less than 0.01) relative to that of chamber controls. Effects on body weight and body weight gain were dose-related and when corrected for uterus weight were significant in animals exposed to 120 ppm (p less than 0.01), with an effect on body weight gain also at 40 ppm (p less than 0.05), indicating a minimal maternal toxic effect. There were no signs of group-related trends or significant differences between groups in terms of numbers of preimplantation losses, live fetuses, or resorptions, and no signs of group-related differences in the incidences of abnormalities, variations, or retardations in the fetuses in terms of general appearance and the condition of the internal organs or the skeletons. It is concluded that under the experimental conditions of the main study acrylic acid vapor at concentrations between 40 and 360 ppm had no embryotoxic teratogenic effects on Sprague-Dawley rats. Maternal toxicity was minimal at 40 ppm, clearer at 120 ppm, and more pronounced at 360 ppm.

Abnormalities, Drug-Induced↗
PubMed1995

A pharmacokinetic approach to resolving spinal and systemic contributions to epidural alfentanil analgesia and side-effects.

A pilot study was conducted in 7 normal volunteers to demonstrate the feasibility of employing pharmacokinetic tailoring to achieve matching plasma opioid concentration-time curves after epidural (e.p.) and intravenous (i.v.) alfentanil administration. Each subject participated in 1 pretest and 2 test sessions. Our pain model was cutaneous electrical stimulation of the finger and toe, adjusted to produce a baseline pain report of 5 (strong pain on a 0-5 scale). On test day 1, subjects received e.p. alfentanil (750 micrograms) and an i.v. saline infusion. Serial measurements of analgesia, end tidal CO2, pupil size, subjective side effects, and plasma alfentanil concentrations were conducted before and at various time intervals over a 4-h period after alfentanil administration. On test day 2, subjects received e.p. saline and a pharmacokinetically tailored i.v. infusion (using individual pharmacokinetics determined on the pretest day) designed to achieve a plasma concentration-time profile identical to that observed on the epidural day. The same battery of effect measurements was administered as on the 1st test day. Plasma alfentanil was measured to verify the accuracy of the tailored infusion. Plasma alfentanil concentration profiles were nearly identical on both test days. Peak plasma alfentanil concentrations were near the reported minimum effective analgesic concentration (MEAC). Overall, analgesia was slightly greater with e.p. administration. Onset of pain relief was rapid, and duration was approximately 1.5 h with e.p. and 1 h with i.v. alfentanil. There were no differences in pupil size, ETCO2, or subjective side effects between e.p. versus i.v. administration. We conclude that systemic redistribution from the epidural space appears to account for most, but not all, of the analgesia.

Adult↗
PubMed1992

Development and validation of a logistic regression-derived algorithm for estimating the incremental probability of coronary artery disease before and after exercise testing.

OBJECTIVES: Our goals were to develop and validate a multivariate algorithm for estimating the incremental probability of the presence of coronary artery disease. BACKGROUND: Multivariate methods, including logistic regression analysis, have been extensively applied to diagnostic exercise testing. However, few previous studies have included both an incremental design and external validation. METHODS: A retrospective collection of clinical, exercise test and catheterization data was performed involving four U.S. referral medical centers. All patients had no prior history of coronary disease and had undergone coronary angiography < or = 3 months after exercise stress testing. An algorithm was developed in one center (590 patients with a 41% prevalence of coronary artery disease) with the use of logistic regression analysis and was validated in the other three centers (1,234 patients, 70% prevalence). The algorithm incorporated pretest variables (age, gender, symptoms, diabetes, cholesterol), exercise electrocardiographic (ECG) variables (mm of ST segment depression, ST slope, peak heart rate, metabolic equivalents [METs], exercise angina) and one thallium variable. Discrimination was measured with receiver operating characteristic curve analysis. Calibration (that is, reliability) was assessed from a comparison of probability estimates and the actual prevalence of disease. RESULTS: The overall incremental receiver operating characteristic curve areas for the validation group were pretest, -0.738 +/- 0.016; postexercise ECG, 0.78 (SE 0.017); and postthallium, 0.82 (SE 0.016); p < 0.01 for both increments. Within the three validation institutions, the institution with a disease prevalence closest to that of the derivation institution had the best incremental receiver operating characteristic curve areas. There was a stepwise incremental improvement in calibration especially from exercise ECG to thallium testing. CONCLUSIONS: An incremental multivariate algorithm derived in one center reliably estimated disease probability in patients from three other centers. The incremental value of testing was best demonstrated when the derivation and validation groups had a similar disease prevalence. This algorithm may be useful in decision making that relates to the diagnosis of coronary disease.

Algorithms↗
PubMed1995

Comparison of thallium-201 single-photon emission computed tomography and electrocardiographic response during exercise in patients with normal rest electrocardiographic results.

OBJECTIVES: This study compared the diagnostic accuracy of exercise thallium-201 single-photon emission computed tomography (SPECT) with the exercise electrocardiographic (ECG) response in patients with normal baseline ECG results. BACKGROUND: Previous studies comparing exercise thallium imaging with exercise electrocardiography have included patients with abnormal rest ECG results that may have biased the results in favor of thallium imaging. METHODS: Of 321 patients with a pretest likelihood of coronary artery disease of 70 +/- 29% (mean +/- SD) who underwent exercise stress testing and coronary angiography, 68 had no coronary artery disease; 94 had one-vessel disease; 79 had two-vessel disease; and 80 had three-vessel or left main coronary artery disease. RESULTS: The diagnostic accuracy of SPECT was higher than that of the ECG response (79% vs. 49%, p < 0.0001). Patients with extensive (left main or three-vessel) coronary artery disease were older and had a lower work load, lower heart rate, greater ST segment depression and more extensive perfusion abnormalities than patients with no disease or one- or two-vessel disease. Multivariate discriminant analysis of exercise and thallium variables identified multivessel thallium abnormalities (F = 35), exercise heart rate (F = 18) and extent of ST segment depression (F = 6) as independent predictors of extensive disease. Of the 80 patients with left main or three-vessel disease, 37 (46%) had > or = 2-mm ST segment depression, 44 (55%) had multivessel SPECT abnormalities, and 61 (76%) had either > or = 2-mm ST depression or multivessel SPECT abnormalities (p = 0.0005 vs. the ECG response; p = 0.01 vs. SPECT). CONCLUSIONS: In patients with an intermediate to high pretest probability of coronary artery disease and normal baseline ECG results, SPECT is superior to the ECG response in detecting coronary disease. Further, SPECT provides incremental power in identifying patients with extensive (left main or three-vessel) coronary disease.

Aged↗
PubMed1996

Meta-analysis of intravenous dipyridamole-thallium-201 imaging (1985 to 1994) and dobutamine echocardiography (1991 to 1994) for risk stratification before vascular surgery.

OBJECTIVES: This study evaluated the prognostic value of abnormal test results with pharmacologic stress with regard to perioperative and long-term outcomes in a large population of candidates for vascular surgery. BACKGROUND: Although numerous studies have demonstrated the prognostic value of dipyridamole-thallium-201 myocardial perfusion and dobutamine echocardiography in vascular surgery candidates, a synopsis of predictive estimates is difficult because of individual study variability in pretest clinical risk, sample size and study design. METHODS: A systematic review of published reports on preoperative pharmacologic stress risk stratification from the MEDLINE data base (1985 to 1994) identified 10 reports on dipyridamole-thallium-201 myocardial perfusion (1,994 patients) and 5 on dobutamine stress echocardiography (446 patients). Random effects models were used to calculate summary odds ratios and 95% confidence intervals. RESULTS: Summary odds ratios for death or myocardial infarction and secondary cardiac end points were greater for dobutamine echocardiographic dyssynergy (14- to 27-fold) than for dipyridamole-thallium-201 redistribution (4-fold); wider confidence intervals were noted with dobutamine echocardiography. Pretest coronary disease probability was correlated with the positive predictive value of a reversible thallium-201 defect (r=0.70), increasing sixfold from low to high risk patient subsets. Cardiac event rates were low in patients without a history of coronary artery disease (1% in 176 patients) compared with patients with coronary disease and a normal or fixed-defect pattern (4.8% in 83 patients) and one or more thallium-201 redistribution abnormality (18.6% in 97 patients, p=0.0001). CONCLUSIONS: Meta-analysis of 15 studies demonstrated that the prognostic value of noninvasive stress imaging abnormalities for perioperative ischemic events is comparable between available techniques but that the accuracy varies with coronary artery disease prevalence.

Adrenergic beta-Agonists↗
PubMedDate not supplied

Augmenting the critical care data base of junior medical students with an emergency medicine lecture curriculum: a controlled study.

A mandatory lecture course in emergency medicine, consisting of 13 lectures, was given to junior medical students over 3 years at Texas Tech University Regional Academic Health Center--El Paso. The performance of the students on a 25-question pretest and posttest was compared to a statistically similar group of their classmates on geographically separate campuses of Texas Tech University School of Medicine undergoing an otherwise comparable junior year clinical curriculum. Both groups exhibited improvement in posttest scores from pretest score values; additionally, students exposed to the lecture series at Texas Tech--El Paso performed significantly higher on the posttest, compared to the other campuses. We conclude that some emergency medicine material is successfully learned by junior medical students during their required third year clerkships; however, important learning objectives within the domain of emergency medicine can be most successfully taught if a mandatory junior year lecture course in emergency medicine is also incorporated into the third year curriculum.

Critical Care↗
PubMed1986

Effectiveness of self-instruction for arthritis patient education.

Self-instruction is one means of providing patient education, allowing the health professional to teach a larger number of persons than with one-to-one or group instruction and at a lower cost. The purpose of this study was to examine the effects of self-instruction on learning, satisfaction with the teaching approach, and health status of persons with rheumatoid arthritis (RA). A control-group pretest-posttest design was used. Thirty subjects receiving care at a rheumatology clinic who met study criteria were randomly assigned to two groups: self-instruction and control. One-way analysis of covariance on posttest Rheumatoid Arthritis Knowledge Inventory (RAKI) scores, with the pretest as covariate, was used to examine the difference in learning between the self-instruction and control groups. There was a significant difference between the groups (P = 0.01). Participants who completed the self-instructional program had improved scores on the posttest as compared to the control. Subjects rated self-instruction as an effective teaching strategy in terms of promoting learning about RA and patient acceptability. t-Test demonstrated no significant difference between the groups in health status. Significant correlations were found between subjects' test scores and selected variables.

Arthritis, Rheumatoid↗
PubMedDate not supplied

The efficacy of substance abuse education among dual-diagnosis patients.

The purpose of this study was to determine whether patient education programs were effective at improving knowledge of substance abuse among dual-diagnosis patients. Adult patients at a general psychiatry hospital were identified for a history of substance abuse. Of the 51 patients included in the study, 25 were on forensic units, 7 were in a private ward, and 19 were on the public unit. Patients were given a pretest at the beginning of the study and received an identical posttest prior to discharge or at the end of the study. The patients on the public unit received up to 16 h per week of Alcoholics Anonymous meetings, alcohol/drug education meetings, group therapy, and other forms of intervention. These patients demonstrated statistically significant improvements between pretest and posttest scores, while those on the forensic units who received only 2 h of intervention per week did not show improvements in substance abuse knowledge. These and other findings have been used to improve education programs for our dual-diagnosis patients across the institute.

Adult↗
PubMed1996

Changes in the breast milk fatty acids and plasma lipids of nursing mothers following consumption of n-3 polyunsaturated fatty acid enriched eggs.

The effect of chicken eggs enriched with n-3 fatty acids on breast milk and plasma fatty acids was determined in eight nursing women. The n-3 polyunsaturated fatty acid (PUFA) enriched eggs (n-3 eggs) contained 690 mg of n-3 fatty acid with 165 mg composed of longer chain n-3 fatty acid (C20:5 n-3, C22:5 n-3, and C22:6 n-3). Consuming two n-3 eggs as a part of their normal daily meal for 6 wk resulted in a significant (p < 0.05) deposition of total n-3 fatty acids at 3.6% compared with 1.9% for the pretest milk and a reduction in n-6:n-3 ratio (6.7 vs. 3.0). The C20 and C22 n-3 PUFA comprised 1.2% compared with 0.4% in the pretest milk (p < 0.05). Consuming n-3 eggs did not (p > 0.05) alter the C20:4 n-6 or the total n-6 fatty acid content of breast milk. Mean plasma total cholesterol and triglycerides were unchanged at the end of the 6-wk trial. Analysis of the breast milk lipids revealed increased (p < 0.05) predominance of n-6 and n-3 PUFA in the milk phospholipids over triglycerides. Positional distribution of phospholipid fatty acids indicated 20:4 n-6 and 20:5 n-3 in the sn-2 position, whereas the sn-1 position had increased levels of C16:0 and C18:0 (p < 0.05). The present study demonstrates that breast milk n-3 PUFA content can be increased without altering the plasma cholesterol or triglycerides when the n-3 PUFA eggs were consumed by nursing women.

Cholesterol↗
PubMed1992

An evaluation of a school-based AIDS/HIV education program for high school students.

The effect of a 1-hr school-based AIDS/HIV education program on the knowledge and attitudes of high school students was evaluated with a modified version of the Centers for Disease Control Health Risk Survey. One urban and one suburban school each were randomly assigned to an educational intervention (n = 535) or a control group (n = 659). All students received a posttest 2 weeks after the intervention. Knowledge was based on responses to 12 true-false questions (pretest alpha = .76, posttest alpha = 0.81). Principal components analysis was used to develop three attitude scales and risk-taking behavior was assessed by self-report. Data were analyzed with Kruskall-Wallis analysis of variance (ANOVA) and multivariate ANOVA. The groups did not differ in knowledge level at pretest. At posttest the education group had significantly (p < or = 0.006) higher knowledge even after controlling for the effects of previous AIDS education (p < or = 0.019), gender (p < or = 0.007), and Hispanic ethnicity (p < or = 0.048). After the education program, students were less worried about exposure to the AIDS virus, but were more worried (p < or = 0.048) about AIDS acquisition during their adult life. Although single school-based AIDS/HIV education programs may increase knowledge, more extensive education may be needed to change the behavior and attitudes of older high school students.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Computer-mediated intervention to prevent drug abuse and violence among high-risk youth.

This research evaluated a computer-mediated intervention for preventing drug abuse and violence. Research participants were economically disadvantaged youth, defined as early adolescents from households with family incomes below the Federal poverty line. Based on cognitive-behavioral skills approaches shown effective in past research, computer intervention was compared with conventionally delivered intervention in a pretest-posttest, control group design. Outcome findings revealed that youth assigned to the computer or conventional intervention arms achieved more positive pretest-to-posttest gain scores than youth in the control arm on several variables. These variables were: how youth regarded people who used drugs, strategies for avoiding trouble, and ways for controlling their tempers. One item, the ability to refuse drug offers, favored youth in the conventional intervention arm over those in the computer or control arms. Combined with prior work on computer-delivered interventions, data from this study lend added support to the viability of computer approaches for preventing drug abuse, violence, and other problem behavior among early adolescent youth.

Adolescent↗
PubMed2004

Prognostic value of exercise echocardiography in patients with classic angina pectoris.

The role of stress echocardiography in the prognostic evaluation of patients with angina pectoris is not well defined. This study included 437 patients (241 men and 196 women) with angina pectoris and a pretest probability of coronary artery disease (CAD) of > or = 0.7 who were referred for exercise echocardiography. No patient had a history of acute myocardial infarction or coronary revascularization. Mean age was 65 +/- 10 years. During a median follow-up of 2.7 years, hard cardiac events (cardiac death or nonfatal myocardial infarction) occurred in 19 patients and 53 patients underwent coronary revascularization. Event-free survival rates in patients with normal versus abnormal stress echocardiograms were 98% versus 83% at 1 year, 96% versus 75% at 3 years, and 87% versus 69% at 5 years, respectively. In a multivariate analysis of clinical, exercise stress, and echocardiographic parameters, independent predictors of hard cardiac events were Q waves on the electrocardiogram (chi-square 8.7, p = 0.003) and the presence of wall motion abnormalities during exercise in multivessel distribution (chi-square 5.3, p = 0.02). In an incremental model of clinical, exercise, and echocardiographic variables for the prediction of all cardiac events, the addition of echocardiographic data increased the chi-square of the model from 62 to 78 (p = 0.0003). Exercise echocardiography provides useful information in the risk stratification of patients with suspected CAD and a high pretest probability of CAD. Patients with normal exercise echocardiograms have a low event rate and therefore can be exempted from invasive procedures during the 3 years after a normal exercise echocardiogram.

Aged↗
PubMed2003

Likelihood ratios in the diagnosis of renal artery stenosis by magnetic resonance angiography compared with renal angiography.

BACKGROUND: Renal angiography (RA) is considered to be the gold standard for the diagnosis of renal artery stenosis (RAS). However, it is invasive and potentially harmful; hence there is a need for an optimal noninvasive test. Magnetic resonance angiography (MRA) is currently accepted as the optimal noninvasive test by many. However, its major drawback is its inability to grade quantitatively the degree of stenosis. In this study, likelihood ratios (LR) were used to compare the diagnostic accuracy of MRA with that of RA. METHODS: To test the hypothesis that semiquantitatively graded MRA would correlate with RA, a retrospective analysis was performed to determine the LR of MRA to diagnose RAS compared with RA. It was believed that LR > or = 10.0 or < or =0.1 might generate conclusive changes from pretest to post-test probabilities. In this study a total of 94 renal arteries from 48 patients were analyzed for RAS by MRA and RA. Stenoses were graded by MRA as mild (<50%), moderate (50% to 75%), or severe (>75%); and by RA as <75% or > or =75% stenosis. RESULTS: The LR was 0.13 (95% CI = 0.09 to 0.19) for mild stenosis, 0.11 (95% CI = 0.08 to 0.15) for moderate stenosis, and 2.2 (95% CI = 1.9 to 3.1) for severe stenosis by MRA. CONCLUSIONS: Nonsevere stenosis can be sufficiently diagnosed by MRA and may not warrant RA. However, it may be insufficiently precise to establish severe RAS based on LR results. Therefore, for severe RAS by MRA, the decision to obtain RA can be made with the help of post-test probability, which is determined using pretest probability and LR.

Adult↗
PubMed2004

The effect of helical computed tomography on diagnostic and treatment strategies in patients with suspected pulmonary embolism.

BACKGROUND: Helical computed tomography (CT) has been proposed as a first-line test for the diagnosis of pulmonary embolism. How the test affects the diagnostic evaluation of patients with suspected pulmonary embolism is unknown. METHODS: We examined a cohort of 360 patients evaluated for pulmonary embolism at a teaching hospital in the 4 years following the introduction of the helical CT scan. We collected patient demographic and clinical data to calculate the pretest likelihood of pulmonary embolism; we then read the test results and determined rates of further testing and treatment for pulmonary embolism. RESULTS: After the helical CT scan became available, the number of patients referred for pulmonary embolism testing increased markedly from 170 to 624 total evaluations during 1997 to 2000 (P <0.01). This rise was due to increased use of the helical CT scan (9% to 83% of evaluations, P <0.01) as the use of ventilation-perfusion scanning (79% to 17%, P = 0.03) and pulmonary angiography (12% to <1%, P <0.01) fell. There was no change in the pre-test likelihood of disease over time, but the percentage of scans that were positive for pulmonary embolism rose (14% to 32%, P =0.02). Clinicians treated all patients who had a positive CT scan, but became less likely over time to order further testing for patients who had a negative scan (30% to 12%, P = 0.02). CONCLUSION: At this academic medical center, introduction of the helical CT scan had a profound effect on the evaluation of pulmonary embolism, resulting in more frequent use of the CT scan, and more frequent diagnosis and treatment of pulmonary embolism, despite no change in the pretest probability of disease. Future studies should confirm our findings and determine whether increased detection of pulmonary emboli results in improved outcomes.

Aged↗
PubMed2006

Pulmonary embolism in patients with chronic obstructive pulmonary disease or congestive heart failure.

BACKGROUND: The diagnosis of pulmonary embolism (PE) is often unreliable in patients with chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). SUBJECTS AND METHODS: Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) is an ongoing registry of consecutive patients with acute venous thromboembolism. In this study, the clinical characteristics, laboratory findings, and clinical outcomes of all enrolled patients with acute PE, with or without underlying cardiopulmonary diseases, were compared and contrasted. In addition, the performance of 2 clinical models for the diagnosis of PE was retrospectively evaluated. RESULTS: As of January 2005, 4444 patients with symptomatic PE have been enrolled in RIETE. Of those, 632 patients (14%) had COPD and 422 (9.5%) had CHF. Significant differences were found in clinical presentation and 3-month outcomes among the 3 groups. With the Geneva model, there was a lower percentage of PE patients with COPD (relative risk [RR] 0.82; 95% confidence interval [CI], 0.66-1.02) or CHF (RR 0.73; 95% CI, 0.56-0.95) who fell into the low pretest probability category, compared with patients with neither. Besides, the percentage of patients with high probability of PE was similar among the 3 patient groups. The frequency of COPD (61%) and CHF (72%) patients with a high pretest probability for PE increased when using the Pisa score, but the percentage of COPD patients into the high probability group was lower (RR 0.60; 95% CI, 0.51-0.71). CONCLUSIONS: Significant differences exist in PE patients with and without underlying cardiopulmonary diseases. The performance of the 2 clinical prediction models varied according to the presence or absence of underlying COPD or CHF.

Diagnosis, Differential↗
PubMed2004

A senior elective designed to prepare medical students for surgical residency.

BACKGROUND: The transition from medical student to surgery internship can be stressful. The goal of this project was to design, implement, and evaluate a 1-month long elective course that would meet the majority of the American College of Surgeons Graduate Medical Education Committee prerequisites for graduate surgical education METHODS: The major elements of the curriculum included faculty- and resident-facilitated case-based sessions and cadaver dissections. In addition, the students participated in skills laboratory experiences, Intensive Care Unit rounds, and mock interviews and clinical pages. The students took a knowledge pretest and post-test that was compared with the performance of 8 surgical interns on the same examination. RESULTS: The highest rated elements of the course were those that provided hands-on experience or practical knowledge. The post-test knowledge examination scores were significantly higher than pretest scores and surgical intern scores. CONCLUSIONS: It was possible to develop a 1-month senior medical student elective course that provided students with the essential prerequisites believed to be essential for all surgical interns.

Curriculum↗
PubMed2004

CVD prevention strategies with urban and rural African American women.

Using Pender's Health Promotion Model, this study tested a work site cardiovascular disease (CVD) risk factor reduction intervention among low-income African American (LAAW) women. Individual CVD risk profiles were identified at the work site through (1) health risk appraisal, (2) blood pressure measurement, (3) body mass index calculation, (4) individual interviews about diet and exercise behaviors, and (5) total cholesterol analysis. Two LAAW groups, one urban and one rural, exhibited higher or similar pretest CVD relative risks (RR) when statistically compared with a national sample of African American women. The LAAW study samples were younger and more educated. Pretest cholesterol and fat intake for the rural women were higher than for the urban women (<.05). Posttest changes in cholesterol and fat intake risks were more significant in rural LAAW than in urban LAAW (<.05).

Adult↗
PubMed2006

Association of functional and health status measures in heart failure.

BACKGROUND: A wide variety of instruments have been used to assess the functional capabilities and health status of patients with chronic heart failure (HF), but it is not known how well these tests are correlated with one another, nor which one has the best association with measured exercise capacity. METHODS AND RESULTS: Forty-one patients with HF were assessed with commonly used functional, health status, and quality of life measures, including maximal cardiopulmonary exercise testing, the Duke Activity Status Index (DASI), the Veterans Specific Activity Questionnaire (VSAQ), the Kansas City Cardiomyopathy Questionnaire (KCCQ), and 6-minute walk distance. Pretest clinical variables, including age, resting pulmonary function tests (forced expiratory volume in 1 s and forced vital capacity), and ejection fraction (EF) were also considered. The association between performance on these functional tools, clinical variables, and exercise test responses including peak VO2 and the VO2 at the ventilatory threshold, was determined. Peak oxygen uptake (VO2) was significantly related to VO2 at the ventilatory threshold (r = 0.76, P < .001) and estimated METs from treadmill speed and grade (r = 0.72, P < .001), but had only a modest association with 6-minute walk performance (r = 0.49, P < .01). The functional questionnaires had modest associations with peak VO2 (r = 0.37, P < .05 and r = 0.26, NS for the VSAQ and DASI, respectively). Of the components of the KCCQ, peak VO2 was significantly related only to quality of life score (r = 0.46, P < .05). Six-minute walk performance was significantly related to KCCQ physical limitation (r = 0.53, P < .01) and clinical summary (r = 0.44, P < .05) scores. Among pretest variables, only age and EF were significantly related to peak VO2 (r = -0.58, and 0.46, respectively, P < .01). Multivariately, age and KCCQ quality of life score were the only significant predictors of peak VO2, accounting for 72% of the variance in peak VO2. CONCLUSION: Commonly used functional measures, symptom tools, and quality of life assessments for patients with HF are poorly correlated with one another and are only modestly associated with exercise test responses. These findings suggest that exercise test responses, non-exercise test estimates of physical function, and quality of life indices reflect different facets of health status in HF and one should not be considered a surrogate for another.

Aged↗