Heart 1998;80:383-386 ( October )
"Value" of improved treadmill exercise capacity: lessons from a study of rate responsive pacing
Department of Cardiovascular Medicine, Queen's Medical
Centre, University of Nottingham, Nottingham, UK
Correspondence to: Dr A D Staniforth, Department of Cardiology, Newham General Hospital, Glen Road, Plaistow, London E13 8SL, UK.
Accepted for publication 27 January 1998
Objectives
To compare the value of a series of
cardiovascular measurements in patients with symptomatic disease
receiving an effective treatment (rate responsive pacing).
Patients12 pacemaker dependent patients with VVIR units.
InterventionsSingle blind crossover between VVI
and VVIR.
Outcome measuresExercise capacity was assessed by
treadmill tests (modified Bruce protocol and a fixed workload protocol)
with respiratory gas analysis. Self paced corridor walk tests were also
undertaken. Quality of life (QOL) was assessed by questionnaire. Daily
activity was measured in the patients' homes using shoe and belt pedometers.
ResultsTreadmill tests and QOL questionnaires
correctly identified the clinical benefit associated with VVIR. The
modified Bruce protocol was superior to the fixed workload protocol as
it was better tailored to the fairly well preserved exercise capacity of the patients. Symptom scores, but not walking times, were improved with VVIR during corridor walk tests. VVIR did not improve daily activity measured using either the belt or shoe pedometers.
ConclusionsVVIR pacing improved some but not all
measures of exercise capacity. This finding illustrates the difficulty
of selecting an instrument to measure symptomatic improvement in
clinical research; and raises the question, what is the best way of
measuring exercise capacity?
© 1998 by Heart
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