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Want second opinion on MET calculation. Test stopped due to fatigue, dizziness and chest pain.

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Cardiologist, Interventional
Practicing since : 1996
Answered : 192 Questions
I recently had a Stress-Echo treadmill test done, as a Vietnam Infantry veteran, the MET score is one of the tools they look at to determine benefits for Ischemic Heart disease, which I have. Had stent in 06.
I have copy of results but wanted 2nd opinion on MET calculation. I did 4 min 30 seconds, I'm 65, wt 190#, My numbers were: Pretest HR 78 BP 134/88, stage 1 3 min HR 133 BP 116/70 stage 2
1 min 30 s HR 139 BP 141/64, the test was stopped due to fatigue, dizziness & minor chest pain. Do you need any other numbers? I would like to know what you calculate my MET score as. Thank you.
Posted Tue, 17 Apr 2012 in Hypertension and Heart Disease
Answered by Dr. Raja Sekhar Varma 11 hours later
Thank you for posting your query.

METS calculation also depends on what protocol of exercise testing you did. There are many standardised protocols like XXXXXXX modified XXXXXXX XXXXXXX Balke, XXXXXXX etc. The level of exercise depends on the protocol used.

Therefore, in order to tell you your METS score, I need to know what exercise protocol was used.

Kindly get back to me with the information so that I can give you the METS value.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
Follow-up: Want second opinion on MET calculation. Test stopped due to fatigue, dizziness and chest pain. 7 hours later
Sorry, it was the standard XXXXXXX protocal. Also, as a related question to the MET score, VA also uses the EF score. The report I recieved had two numbers, one, Under "dimensions" listed the EF(Teich) as 40%, however the report itself in the summary states: LV size, wall thickness and sys tolic function are normal, with an EF of 60%. As for several years my EF has been 47%, 45% and 49%, I'm also curious of your interpretation of the two different numbers. Thank you so much for your help.
Answered by Dr. Raja Sekhar Varma 19 hours later
Thank you for the clarification.

MET score reflects the "metabolic equivalent of task" or the energy costs of the activity. It also relates to the oxygen consumption (1 MET = 3.5 ml of O2 per kg per min) and approximately 1 kcal/kg/ hour.

Completion of stage 1 of XXXXXXX indicates a MET score of 4.7, while completion of stage 2 increases the MET score to 7.0. Since you have stopped after 1 min and 30 seconds of stage 2, your score will lie between 4.7 and 7.0.

There are equations which have been developed based on studies done on different people at different ages, races, gender, etc. These equations can be used to roughly estimate the exact MET score in your case.

As per this regression equation, your MET score will be approximately 5.97. However, there are certain limitations. In a given individual, this is a rough estimate and not as accurate as one would like. There are many equations, and the exact value will differ slightly depending on which equation has been used for the calculation. It would be better to use this value in conjuction with the previous values, if any, and as a basis for future test values. Thus, a serial change in the value would be more important than one specific value. It has also been seen that actual measured O2 consumption does vary widely even in a single individual at different times.

Thus, while the MET score is an important indicator, it is only one of the many variables that need to be considered. Interpretation should not be based on one value of MET and should also take into account the symptoms experienced, ST-T changes during the test, perceived exertion levels, BP and HR changes, etc.

EF stands for ejection fraction. This is the percentage of blood that is pumped out of the heart with each beat in relation to the blood volume in the heart at the end of diastole (relaxation). A normal value is between 55% and 75%.

There are many echocardiographic techniques to measure EF. Commonly used ones are the M-mode measurements with Teicholz equations and 2-D echo based measurements based on Area/length, Simpson's equations, etc. Many experts also rely on a 'visual' estimate of EF.

While M-mode measurements are commonly done, they have some limitations if there are regional wall motion abnormalities or non-uniform contractions. In such cases, there may be falsely low estimations of EF. 2D based values are more accurate in such cases. Also, if 3-D echo is available, you could get even more accurate values.

The discrepancy in the two values of EF could be because of the above factors. There could also be a technical error or a typographic error. In any case, I would suggest that you bring this to the notice of the echocardiographer or your physician and get a review of the images done to clarify things.

I hope this answers your query. Feel free to get back to me for any further clarifications that you want.
Please accept my answer in case you do not have follow up queries.

With regards,
Dr RS Varma
Above answer was peer-reviewed by
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