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PREVENTION
Individuals with no known risk factors (family history, high blood pressure, diabetes, high cholesterol and smoking) can develop heart disease and individuals with one or more risk factor can be considered heart healthy if they have been adequately treated. This creates the dilemma of determining where on the cardiac disease spectrum one lies (normal, mild, moderate, severe) to reflect the net effect of genetics, aging, lifestyle and medications. Cardiac dysfunction during exercise from coronary artery disease is associated with bad outcomes. MET-TEST has the unique ability to identify this problem at a much earlier stage than traditional cardiac testing, thereby enabling more aggressive treatment before patients develop symptoms and events. This provides an earlier window to engage in risk factor modification to stop and reverse heart disease.
Cardiac Risk Stratification is based on the presence/absence of cardiac dysfunction as well as peak cardiac function reflected as exercise capacity (peak VO2):
BASELINE CPET
| LOW RISK | TREATMENT |
|---|---|
| Peak VO2 =/> 90% | 1 - Continue Current Strategy |
| No Cardiac Dysfunction |
| INCREASED RISK | TREATMENT |
|---|---|
| Peak VO2 =/> 70% | 1 - Intensify Medical Therapy |
| With Cardiac Dysfunction | 2 - Exercise Rehab |
| 3 - Consider Coronary CT Angiogram |
| HIGH RISK | TREATMENT |
|---|---|
| Peak VO2 < 70% | 1 - Coronary CT Angiogram |
| With Cardiac Dysfunction | 2 - Intensify Medical Therapy |
| 3 - Exercise Rehab |
The presence of cardiac dysfunction indicates that one or more risk factors are in need of attention. Some risk factors are genetic and poorly understood where as others are modifiable:
- Genetic (family history)
- Cholesterol
- Increased Inflammation (toxins)
- Diabetes
- HTN
- Smoking
- Obesity/Sedentary
- Sleep disorder (snoring)
- Steroids / Performance enhancing agents
- Drug Abuse: particularly cocaine and marijuana
With progression of coronary disease, peak cardiac function (peak VO2) will deteriorate over time with progressively decreasing values and increasing risk for heart attack, heart failure, arrhythmias, stroke and eventually death.
Intervention with lifestyle changes, increased physical exercise (in the moderate heart rate zone per the MET-TEST exercise prescription) and medications will stop and reverse heart disease progression.
The goal is to increase peak VO2 from baseline by 10% or more per test until the underlying cardiac dysfunction pattern is completely normalized (see case study below).
Increasing peak VO2 from baseline provides proof that long-term quality of life and prognosis are improving, and healthcare costs are headed down.
SERIAL COMPARISON
DATA OF AN INDIVIDUAL ACTING AS HIS OWN CONTROL; CV RISK FACTORS INCLUDED A STRONG FAMILY HISTORY
(ALMOST ALL MALE RELATIVES WITH CAD SHORTLY AFTER AGE 40), HYPERLIPIDEMIA AND SEDENTARY LIFESTYLE.
List of Services
- TEST #1
Baseline study at age 36 without symptoms demonstrating pronounced cardiac dysfunction with low peak VO2. Note the pronounced drop in SV response just after the AT resulting significantly reduced peak O2-pulse. HR-WR response accelerates concurrently with 98% increase in slope from baseline.
List Item 1 - TEST #2
Repeat study after 3.3 years of medical therapy with statin + niacin with no change in lifestyle. Lipids improved dramatically and repeat CPET demonstrates less cardiac dysfunction with improved SV response resulting in 12% higher peak VO2 (ml/kg/min) and peak O2-pulse (ml/min) with less acceleration of HR-WR slope (compensatory response has diminished).
List Item 2 - TEST #3
Motivated by improvement in test 2, this person started regular exercise with CrossFit regimen. Test 3 is 4.5 years after test 2 and represents effect of exercise in addition to continuing lipid therapy. Absolute peak VO2 increased 30%, peak O2-pulse increased 15% and there is borderline LV dysfunction with marginal acceleration of HR response after the AT. This individual has better CV function at age 42 than he did at 36 and has dramatically improved his long-term prognosis, quality of life and healthcare costs.
List Item 3
MET-TEST HEALTHCARE TECHNOLOGY | Customer Testimonial Video
