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Abnormally high exertional breathlessness predicts mortality in people referred for incremental cycle exercise testing

Elmberg, Viktor LU orcid ; Zhou, Xingwu ; Lindow, Thomas LU ; Hedman, Kristofer ; Malinovschi, Andrei LU ; Lewthwaite, Hayley ; Jensen, Dennis ; Brudin, Lars and Ekström, Magnus LU orcid (2024) In PLoS ONE 19(12).
Abstract

Background Exertional breathlessness is a key symptom in cardiorespiratory disease and can be quantified using incremental exercise testing, but its prognostic significance is unknown. We evaluated the ability of abnormally high breathlessness intensity during incremental cycle exercise testing to predict all-cause, respiratory, and cardiac mortality. Study design and methods Longitudinal cohort study of adults referred for exercise testing followed prospectively for mortality assessed using the Swedish National Causes of Death Registry. Abnormally high exertional breathlessness was defined as a breathlessness intensity response (Borg 0–10 scale) > the upper limit of normal using published reference equations. Mortality was analyzed... (More)

Background Exertional breathlessness is a key symptom in cardiorespiratory disease and can be quantified using incremental exercise testing, but its prognostic significance is unknown. We evaluated the ability of abnormally high breathlessness intensity during incremental cycle exercise testing to predict all-cause, respiratory, and cardiac mortality. Study design and methods Longitudinal cohort study of adults referred for exercise testing followed prospectively for mortality assessed using the Swedish National Causes of Death Registry. Abnormally high exertional breathlessness was defined as a breathlessness intensity response (Borg 0–10 scale) > the upper limit of normal using published reference equations. Mortality was analyzed using multivariable Cox regression, unadjusted and adjusted for age, sex, and body mass index. A further mortality analysis was also done adjusted for select common comorbidities in addition to age, sex and body mass index. Results Of the 13,506 people included (46% female, age 59±15 years), 2,867 (21%) had abnormally high breathlessness during exercise testing. Over a median follow up of 8.0 years, 1,687 (12%) people died. No participant was lost to follow-up. Compared to those within normal predicted ranges, people with abnormally high exertional breathlessness had higher mortality from all causes (adjusted hazard ratio [aHR] 2.3, [95% confidence interval] 2.1–2.6), respiratory causes (aHR 5.2 [3.4–8.0]) and cardiac causes (aHR 3.0 [2.5–3.6]). Even among people with normal exercise capacity (defined as peak Watt ≥75% of predicted exercise capacity, n = 10,284) those with abnormally high exertional breathlessness were at greater risk of all-cause mortality than people with exertional breathlessness within the normal predicted range (aHR 1.5 [1.2–1.8]). Conclusion Among people referred for exercise testing, abnormally high exertional breathlessness, quantified using healthy reference values, independently predicted all-cause, respiratory and cardiac mortality.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
PLoS ONE
volume
19
issue
12
article number
e0302111
publisher
Public Library of Science (PLoS)
external identifiers
  • pmid:39693378
  • scopus:85212684878
ISSN
1932-6203
DOI
10.1371/journal.pone.0302111
language
English
LU publication?
yes
id
e53f2597-dcf6-4d4a-b2a5-c799b3fda8ef
date added to LUP
2025-01-17 12:51:30
date last changed
2025-07-05 03:08:26
@article{e53f2597-dcf6-4d4a-b2a5-c799b3fda8ef,
  abstract     = {{<p>Background Exertional breathlessness is a key symptom in cardiorespiratory disease and can be quantified using incremental exercise testing, but its prognostic significance is unknown. We evaluated the ability of abnormally high breathlessness intensity during incremental cycle exercise testing to predict all-cause, respiratory, and cardiac mortality. Study design and methods Longitudinal cohort study of adults referred for exercise testing followed prospectively for mortality assessed using the Swedish National Causes of Death Registry. Abnormally high exertional breathlessness was defined as a breathlessness intensity response (Borg 0–10 scale) &gt; the upper limit of normal using published reference equations. Mortality was analyzed using multivariable Cox regression, unadjusted and adjusted for age, sex, and body mass index. A further mortality analysis was also done adjusted for select common comorbidities in addition to age, sex and body mass index. Results Of the 13,506 people included (46% female, age 59±15 years), 2,867 (21%) had abnormally high breathlessness during exercise testing. Over a median follow up of 8.0 years, 1,687 (12%) people died. No participant was lost to follow-up. Compared to those within normal predicted ranges, people with abnormally high exertional breathlessness had higher mortality from all causes (adjusted hazard ratio [aHR] 2.3, [95% confidence interval] 2.1–2.6), respiratory causes (aHR 5.2 [3.4–8.0]) and cardiac causes (aHR 3.0 [2.5–3.6]). Even among people with normal exercise capacity (defined as peak Watt ≥75% of predicted exercise capacity, n = 10,284) those with abnormally high exertional breathlessness were at greater risk of all-cause mortality than people with exertional breathlessness within the normal predicted range (aHR 1.5 [1.2–1.8]). Conclusion Among people referred for exercise testing, abnormally high exertional breathlessness, quantified using healthy reference values, independently predicted all-cause, respiratory and cardiac mortality.</p>}},
  author       = {{Elmberg, Viktor and Zhou, Xingwu and Lindow, Thomas and Hedman, Kristofer and Malinovschi, Andrei and Lewthwaite, Hayley and Jensen, Dennis and Brudin, Lars and Ekström, Magnus}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  number       = {{12}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLoS ONE}},
  title        = {{Abnormally high exertional breathlessness predicts mortality in people referred for incremental cycle exercise testing}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0302111}},
  doi          = {{10.1371/journal.pone.0302111}},
  volume       = {{19}},
  year         = {{2024}},
}