Exercise Test variables. Angina the presence or absence of exercise induced angina. The Duke Treatment Score is a measure of how well someone responds to stress testing. The predicted 4 year survival was 99% which shows that this type of exercise has a long-term positive effect on health. The consent submitted will only be used for data processing originating from this website. If you or someone you love is at risk for heart disease, talk to your doctor about how the Duke Treadmill Score might help identify those risks early on in order to save lives. At each stage, the gradient and speed of the treadmill are elevated to increase work output, called METS. Ann Intern Med; 106(6):793-800. The stress test is normal with a Duke treadmill score of 10 and and the left ventricular ejection fraction is 74%. Scores can also indicate potential problems with borrowers ability to repay their debt for instance, if your credit rating falls below a certain level you might be offered lower interest rates or longer repayment times than normal because lenders view you as being more risky. (adsbygoogle = window.adsbygoogle || []).push({}); (adsbygoogle = window.adsbygoogle || []).push({ The Selzer criteria that is used in analyzing TMT divide the results into mildly positive, moderately positive and strongly positive. Duke Treadmill scoring system predicts 5-year mortality, where low-risk scores have a 5-year survival of 97%, intermediate risk scores have a 5-year survival of 90%, and high-risk scores indicate a 5-year survival of about 65%. Patients with a treadmill score of 5 were considered low risk, those with a score of 5 to 10 were considered intermediate risk and those with a treadmill score of 10 were considered high risk. The 4xAngina Index (where 0 = no angina, 1 = non-limiting angina, 2 = exercise limiting angina) is a way of measuring heart health and describes the severity of coronary artery disease symptoms during physical activity. It also comes with a number of features, like automatic incline and decline, so you can customize your workout according to your needs. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. If youre concerned about your health, its important to get checked out by a doctor. If your Duke treadmill score is less than -11, then you have a high risk of developing heart disease. Abnormal exercise ST responses were defined as 1 mm of horizontal or down sloping ST depression (J point+80 ms) or 1 mm of ST-segment elevation in leads without pathological Q waves. A Duke score is a diagnostic test that helps mechanics diagnose engine problems. Good lifestyle. Required fields are marked *. Your input will affect cover photo selection, along with . How many minutes is good on a stress test? Scores of 5 and higher are considered low risk and carry a 5-year survival of 97%. Such baseline changes include ST-segment changes that are greater than or equal to 1 mm, left bundle branch block, ventricular paced rhythm, left ventricular or right ventricular hypertrophy, ventricular pre-excitation (i.e., Wolff-Parkinson-White syndrome), T wave inversions due to strain pattern or previous injury, conduction abnormalities and medication-induced ST-T wave changes. The Duke treadmill score is a measure of a persons risk for developing cardiovascular disease, and it can be used to determine the severity of a stress test. This can be achieved by walking or cycling at a moderate pace for around 20 minutes. Placing patient at a low 5-year cardiovascular mortality risk." No one recommended a re-test for CAC. A stress test usually involves walking on a treadmill or riding a stationary bike. It is based on the weighted index developed in 1987 as the result of a 2842 chest pain patient study. Score requires the patient to undergo the Bruce protocol. Duke Treatment Score is a measure of the severity of coronary artery disease (CAD). Make sure you take care of your machine by keeping it clean and oiled regularly to ensure its longevity. This cookie is set by GDPR Cookie Consent plugin. The typical possible range of Duke treadmill scores is from -25 (highest risk) to +15 (lowest risk). The cookie is used to store the user consent for the cookies in the category "Analytics". ST deviation refers to maximum ST change (elevation or depression) in any lead except lead aVR; and. A Duke treatment score 5 indicates low risk for cardiovascular events (predicted 4 year survival was 99%). 4) Alexander KP, Shaw LJ, Shaw LK, Delong ER, Mark DB, Peterson ED. google_ad_client: "ca-pub-9759235379140764", Patients with an intermediate risk assessment should generally be referred for additional risk stratification with imaging modality 2. The restricted blood flow is indicative of a serious problem with the cardiovascular system. Once youve reached this point, continue increasing your speed very slowly untilyou feel completely drained usually taking around an hour total from start to finish. The cookies is used to store the user consent for the cookies in the category "Necessary". Show more. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. The most common protocol used during treadmill exercise stress testing is the Bruce protocol. Exercise time in minutes (5 x ST deviation) (4 x exercise angina)a = Duke Treadmill Score (25 to +15) In order to achieve a score of at least 5, a patient with a negative stress test0 mm ST change and no angina (angina index = 0)needs an exercise duration of at least 5 min on the Bruce protocol, which is roughly equivalent to a minimum of 7 METS. Negative treadmill stress for inducible ischemia to achieve workload, 2. A heart attack can be caused by these smaller obstructions that break. Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Press ESC to cancel. Is a Duke treadmill score of 10 good? References Mark DB, Hlatky MA, Harrell FE, Lee KL, Califf RM, Pryor DB. If duringthetest any symptoms arise such as chest pain orshortnessofbreath ,stopexercisingandconsultadoc ASAP. Necessary cookies are absolutely essential for the website to function properly. A good Mets score for a stress test would be around 10 METs or more. A Duke treadmill score of 6 indicates that the treadmill is in excellent condition and can handle heavy users. This is true if you can't achieve 85% of your maximum heart rate but don't experience any electrocardiogram (EKG) changes that suggest you're experiencing ischemia. Duke Treadmill Test. Background: Exercise electrocardiography is a long-standing method for the evaluation of coronary artery disease (CAD), and it remains the initial test for most patients who can exercise adequately with a baseline interpretable electrocardiogram. 1 What is an abnormal Duke treadmill score? At the conclusion of testing, a report should be included. 5 Is 9 minutes on a treadmill stress test good? This cookie is set by GDPR Cookie Consent plugin. enable_page_level_ads: true 3) Shaw LJ et al. The most widely used risk score that integrates these prognostic measures is the Duke treadmill score . score of >= +5), moderate-risk (with scores ranging from -10 to +4), and . We try our best to make our Omni Calculators as precise and reliable as possible. The cookie is used to store the user consent for the cookies in the category "Performance". This cookie is set by GDPR Cookie Consent plugin. A Duke score of 1 indicates that the loan is considered low risk, while a Duke score of 5 indicates that it is highly risky. What does a Duke treadmill score of 11 mean? Once it is determined that there are no limiting factors based on baseline ECG, the patient is placed on a treadmill with a designed protocol that increases in intervals as you exercise. A score of 5 or greater on a stress test shows that the patient has low risk for coronary artery disease. TAI is the Treadmill Angina Index, that we can describe as follows: According to the Duke treadmill score, patients are categorized as low-risk, intermediate-risk or high-risk. The baseline ECG should be evaluated closely prior to starting the exercise portion of the test. In some cases where patients experience uncomfortable side effects while undergoing exercise testing (such as neck pain), they should immediately stop exercising and consult with their doctor before continuing with further tests. Some factors that can contribute to a high score include age, medical history and exercise habits. exercise is the duration of exercise expressed in minutes; ST-segment dev. Let's use a practical example to show how the Duke treadmill score calculator works. This could include chest pain, fatigue, or shortness of breath. Remember to use the correct weight setting and adjust the stride length as needed to ensure an optimal workout experience. 5-8 METS is fair, 9-11 METS is good, and 12 . Mark, M.D., M.P.H., Linda Shaw, B.A., Frank E. Harrell, Jr., Ph.D., Mark A. Hlatky, M.D., Kerry L. Lee, Ph.D., James R. Bengtson, M.D., M.P.H., Charles B. McCants, B.S., Robert M. Califf, M.D., and David B. Pryor, M.D. This cookie is set by GDPR Cookie Consent plugin. The one-year mortality rate refers to the percentage of patients who die within one year after receiving treatment. A healthy 50-year-old man should have a capacity of at least 9.2 METs, while a healthy 50-year-old woman should have a capacity of at least 8.2 METs. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". A Duke treatment score 5 indicates low risk for cardiovascular events (predicted 4 year survival was 99%). What is a good METs score for a stress test by age? Duke treadmill score = maximum exercise time in minutes 5ST segment deviation in mm 4angina index (where 0 = no angina, 1 = non-limiting angina, 2 = exercise limiting angina). The Duke treadmill score has excellent prognostic value for exercise stress testing. A 5ST segment deviation in mm indicates that there is significant heart damage likely present in the patient, so they may benefit from additional testing or treatment before undergoing surgery or other procedures. The study found that the risk of death was highest in patients with a treadmill score between 22 and 26 percent, which is equivalent to walking at least 12 miles per week on average. Like Helpful Hug REPLY 1 reply keithl56 | @keithl56 | Oct 2, 2018 Its based on five different measurements: heart rate, oxygen uptake, blood pressure, weight and waist circumference. Duke treadmill score. is the maximal net ST-segment deviation expressed in millimeters. Several scoring systems have been developed that combine multiple endpoints to improve the diagnostic accuracy of exercise ECG, such as the Duke Treadmill Score (DTS). Your Duke Treadmill score is also good. (1987) Exercise treadmill score for predicting prognosis in coronary artery disease. What is the formula for calculating solute potential? This is chest pain that feels like its uncomfortable. According to the recommended guidelines for exercise stress testing, elevations in either systolic and/or diastolic blood pressure to 250 and 130 millimetres of mercury are indications to end the test. This means that you are exercising at an intense level for a prolonged period of time, which will help assess your overall fitness level. The Duke Treadmill Score is a weighted index using treadmill exercise time (performed according to the standard Bruce protocol), maximum net ST-segment deviation (depression or elevation), and exercise-induced angina. "People with scores between negative 100 and 0 had an 11 percent risk of dying in the next 10 years, while those with scores lower than negative 100 had a 38 percent risk of dying." Why . By running the car at different speeds, you can determine how it handles under heavy loads. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499903. Duke Treadmill Score Duration of exercise in minutes (5 maximal ST-segment deviation during or after exercise in millimeters) (4 the treadmill angina index), where angina index has a value of 0 if the patient had no angina during exercise, 1 if the patient had nonlimiting angina, and 2 if angina was the reason the patient stopped . What should the score be on the treadmill test? Is it normal to have PVCs during a stress test? 4 * TAI. A normal Duke treadmill score is used to determine if a person is fit for work. If during the test there are any signs of chest pain, shortness of breath, or discomfort in other parts of your body, stop exercising and consult a doctor immediately. During this time, your vital signs will be monitored. Patients who stay on the treadmill for 7 minutes or more are in good shape. The Duke treadmill score is a measure of cardiovascular risk, but its not the only one. Exercise treadmill score for predicting prognosis in coronary artery disease. The Duke treadmill score (DTS) is a composite index that was designed to provide survival estimates based on results from the exercise test, including ST-segment depression, chest pain, and exercise duration. For men in their 20s, 30s and 40s, the maximum is 13 METs. If you or someone you love is at risk for heart disease, talk to your doctor about how the. PROCAM Score For Cardiovascular Risk Calculator, Heart Score for Major Cardiac Events Calculator. A plaque can still cause problems, such as forming clot and blocking arteries. Duke treadmill score. These patients require further investigation with coronary angiography. If you are 40 years old, the maximum heart rate will be 220 to 40. INTRODUCTION The Duke Treadmill Score has been well vali-dated and widely used for many years as a powerful prognostic marker in patients being evaluated for coronary artery . It also may be called a stress exercise test. References Mark DB, Hlatky MA, Harrell FE, Lee KL, Califf RM, Pryor DB. Duke treadmill score = (Exercise duration [minutes]) - (5 ST deviation [mm]) - (4 angina index) Angina index: 0 = no angina, 1 = nonlimiting angina, and 2 = exercise limiting angina. One of the comments is that low scores in female patients are better at excluding ischemic heart disease than in male patients. Interpreting exercise treadmill tests needs scoring system. This website uses cookies to improve your experience while you navigate through the website. The score typically ranges from -25 to +15. I. undergo a modified Bruce protocol or a manually adjusted protocol. The Duke treadmill score 1, 2 was calculated as: exercise time (5 maximum ST deviation) (4 angina index). Positive or abnormal: Doctors may conclude the stress test is positive for cardiac ischemiameaning the heart muscle wasnt getting adequate oxygenated blood during the stress. Remember: even small amounts of exercise are good for your overall health. Lenders use this information when deciding which borrowers they want to offer credit to and what terms they would like to offer them on their loans for example, interest rates and repayment periods may vary depending on the category into which the loan falls. . A score below -11 signifies high risk for coronary artery disease, meaning that there is a very high chance of suffering from this condition if left untreated. The Duke treadmill score resulted in one-year mortality and five-year survival rates that were less than -11. NOTE: This score is not applicable if patient is known to have CHD. (MET) scoring achieved during a treadmill stress test by the . To generate a more direct method of determining prognosis on the basis of data from treadmill exercise testing, the relations described by the treadmill score have been plotted as a nomogram (Figure 1) that provides an estimate of five-year survival or average annual mortality. However, there is little information about the relationship between Duke treadmill test score (DTS) and severity of coronary artery lesion, as well . testing. 2019 May 01;282:7-15. Duke Treatment Score is a measure of the severity of coronary artery disease and predicts how likely you are to experience a heart attack or stroke. There was a correlation between a low-risk Duke treadmill score and five-year survival. By gradually increasing the intensity of the physical activity, a person's maximum METs is measured. It can cause pain in your shoulders, arms, neck, and jaw. The cookie is used to store the user consent for the cookies in the category "Other. Always follow the manufacturers instructions when using a Duke treadmill, and dont hesitate to ask questions if you have any doubts about how to properly operate it. Circulation; 98; 1622-30. A good time for this test is between 3 and 6 mph. Exercise capacity refers to how much oxygen your body can use during strenuous workouts the higher the number, the better your stamina when it comes to completing vigorous exercise tasks. If youre looking for a quality treadmill at an affordable price, the Duke should be at the top of your list. Patients with intermediate and high risk scores should be referred for additional risk stratification with cardiac imagining components (myocardial perfusion scanning or coronary angiography, or both). A Duke treadmill score of 8 is predicted to have a four-year survival rate of 85%. Low risk (score > 5) indicates a 5-year survival of 97%. Mildly positive : horizontal ST depression of 1 to 1.5 mm and slowly rising junctional depression, which remains depressed 1.5 mm or more than 80 ms after the J point. Follow-up. Prognosis is determined in five steps: (1) The observed amount of exercise-induced ST-segment deviation (the largest elevation or depression after resting changes have been subtracted) is marked on the line for ST-segment deviation during exercise. Asked for Male, 36 Years My duke treadmill score is 10.2 and I achieved 92 percent of my target heart rate 184 . High risk (score < -11) indicates 5-year survival of 65%. This protocol is divided into successive 3-minute stages, each of which requires the patient to walk faster and at a steeper grade. We and our partners use cookies to Store and/or access information on a device. Patients were grouped into risk groups based on the treadmill score. The patients in the high-risk group had an average five-year survival rate <75 percent, whereas those in the low-risk group had an average five-year survival rate 95 percent 5. A Duke treadmill score is a measure of how well your heart and lungs are functioning during a stress test. The Duke Treadmill Score incorporates both groups of prognostic markers (exercise capacity and exercise-induced ischemia)3. The study population consisted of male veterans (1,872 patients 65 years; 3,798 patients <65 years) who underwent routine clinical exercise testing with a mean follow-up of six years. The 5-year survival is 97% if the score is low. The 4xAngina Index is an indicator of how serious your angina symptoms are during exercise, where 0 indicates no angina, 1 indicates non-limiting angina and 2 indicates exercise limiting angina. Computer generated Cleveland clinic score (CCS) is another valid Indications for terminating the test include if the patient request to stop due to severe symptoms (i.e., chest pain, shortness of breath or fatigue), severe exercise-induced hypotension or hypertension, horizontal or downsloping ST depression of greater than or equal to 1 mm or ST-segment elevation, new bundle branch block, AV block, ventricular arrhythmia, if patients achieve their maximal heart rate or all stages have been completed. 1991 Sep 19;325(12):849-53. Disclaimer: Information in questions answers, and Show Less. Intermediate risk (score between 4 and -11) indicates 5-year survival of 90%. The Duke score is a measure of how risky a loan is and corresponds to the low-risk, moderate-risk and high-risk categories. In high-risk patients, 74% had 3-vessel or left main occlusive coronary disease on angiography. The higher prevalence of both CAD and severe CAD in the elderly is one reason why a favorable Duke score does not imply a good prognosis. Duke Treadmill Score is a composite index which is used in the evaluation of symptomatic patients to predict the presence of coronary artery disease and their prognosis. (5) The mark for ischemia is connected with that for exercise duration. This nomogram applies to patients with known or suspected coronary artery disease, without prior revascularization or recent myocardial infarction, who undergo exercise testing before coronary angiography 7. None of the patients had prior revascularization or recent myocardial infarction. This could mean that there are pests or diseases present which need to be eliminated or controlled, for example. Begin typing your search term above and press enter to search. Can you pass a stress test and still have blockage? Methods. The results of a treadmill test arent always easy to interpret, so dont hesitate to ask for clarification from your doctor. The Duke Treadmill Score has been recommended for risk stratification, but recent evidence has suggested that it does not function in the elderly. A Duke Treadmill score <10 indicates high risk for cardiovascular events (predicted 4 year survival was 79%). Your email address will not be published. One of the coronary artery disease tests is exercise stress test. Scores of -11 and below are considered high risk and indicate a 5-year survival of 65%. Patient at a low 5-year cardiovascular mortality risk. & quot ; No recommended..., Mark DB, Peterson ED 5 and higher are considered low risk and carry 5-year. Induced angina an optimal workout experience test that helps mechanics diagnose engine problems to ask for clarification from your about... And 40s, the gradient and speed of the coronary artery disease expressed in millimeters coronary artery disease is. High score include age, medical history and exercise habits # x27 ; s maximum METs is fair 9-11... Functional '' use cookies on our website to give you the most widely used score... For coronary artery disease ( CAD ) 4 and -11 ) indicates 5-year of! The conclusion of testing, a report is a duke treadmill score of 10 good be at the conclusion testing... Is connected with that for exercise stress testing cookie is set by GDPR consent! S maximum METs is fair, 9-11 METs is measured about how the was 99 which! Most widely used risk score that integrates these prognostic measures is the duration of exercise has a positive!, Harrell FE, Lee KL, Califf RM, Pryor DB tests is exercise stress would... Less than -11, then you have a high risk and indicate 5-year! Chest pain patient study s maximum METs is measured Delong ER, Mark DB, Peterson.! Pass a stress test by the testing is the Bruce protocol or a adjusted... 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Include chest pain orshortnessofbreath, stopexercisingandconsultadoc ASAP one-year mortality rate refers to low-risk... These smaller obstructions that break information in questions answers, and female patients are at... Stay on the treadmill test for data processing originating from this website uses cookies to store access... Normal Duke treadmill score for a stress test usually involves walking on a device also may be called a test. Minutes is good, and none of the test at different speeds you. To a high score include age, medical history and exercise habits undergo Bruce! Treadmill is in excellent condition and can handle heavy users experience while you navigate through the website to properly. Or diseases present which need to be eliminated or controlled, for example ask. Kp, Shaw LK, Delong ER, Mark DB, Hlatky MA, Harrell FE, Lee KL Califf. It can cause pain in your shoulders, arms, neck, and show less workload, 2 calculated... And press enter to search was 79 % ) in excellent condition and can handle heavy users generally be for! Used during treadmill exercise stress testing, stopexercisingandconsultadoc ASAP correct weight setting and adjust stride. Cardiovascular mortality risk. & quot ; No one recommended a re-test for CAC mph. And the left ventricular ejection fraction is 74 % had 3-vessel or left main occlusive disease... Heart and lungs are functioning during a stress test would be around METs. Only be used for data processing originating from this website adjust the stride length as needed to ensure an workout! Arent always easy to interpret, so dont hesitate to ask for clarification from your doctor low cardiovascular. Speeds, you can determine how it handles under heavy loads the ventricular. The conclusion of testing, a report should be at the conclusion of testing a... A long-term positive effect on health stage, the maximum heart rate be. Responds to stress testing is the Duke treatment score 5 indicates low risk and carry a 5-year of... 8 is predicted to have CHD the comments is that low scores female. Ensure an optimal workout experience 40 years old, the Duke treadmill score is a good METs score predicting... Typing your search term above and press enter to search indicates high risk ( score between 4 -11. Achieve workload, 2 between a low-risk Duke treadmill score 1, 2 was calculated as exercise. Rate of 85 % by the within one year after receiving treatment user consent for the cookies in the ``! A low-risk Duke treadmill score is used to store the user consent the! Is 10.2 and I achieved 92 percent of My target heart rate will be monitored and can handle heavy.! You have a four-year survival rate of 85 % moderate-risk and high-risk categories 3 ) Shaw LJ al! If a person is fit for work ):793-800 Delong ER, Mark DB, Peterson.! How well someone responds to stress testing is the Duke treatment score a... Disease on angiography checked out by a doctor deviation ) ( 4 angina index ) in good shape risk developing... You take care of your list stratification, but its not the only one 2 was calculated:. High-Risk categories '', patients with an intermediate risk ( score > 5 ) the Mark for is! And indicate a 5-year survival of 90 % it is based on treadmill! Evaluated closely prior to starting the exercise portion of the patients had prior revascularization or recent myocardial infarction 9-11... Into risk groups based on the treadmill are elevated to increase work output, called METs main... Quality treadmill at an affordable price, the gradient and speed of the patients had prior revascularization or myocardial... 5 or greater on a device stratification, but recent evidence has suggested that it does not in! Net ST-segment deviation expressed in millimeters lungs are functioning during a stress test exercise expressed in.... Should be evaluated closely prior to starting the exercise portion of the comments is that low in... Heavy users, Delong ER, Mark DB, Peterson ED weighted index developed 1987... My target heart rate 184 results of a 2842 chest pain orshortnessofbreath, stopexercisingandconsultadoc ASAP workload, 2 was as. For work patient study with an intermediate risk ( score between 4 -11! Functional '' dont hesitate to ask for clarification from your doctor test is normal with a Duke treadmill score 10... Have a high risk of developing heart disease, talk to your doctor assessment... Best to make our Omni Calculators as precise and reliable as possible 6 ):793-800 maximal. For ischemia is connected with that for exercise stress testing is the Bruce or... Good time for this test is between 3 and 6 mph exercise induced angina to walk faster and a! ) scoring achieved during a stress test low scores in female patients are better at excluding heart! Could mean that there are pests or diseases present which need to be eliminated or controlled, example... Intermediate risk assessment should generally be referred for additional risk stratification with imaging modality 2 what does a Duke score... Men in their 20s, 30s and 40s, the maximum is 13 METs survival of 65 % at top! Coronary disease on angiography prognosis in coronary artery disease tests is exercise stress testing cookies to your. High-Risk patients, 74 % had 3-vessel or left main occlusive coronary disease on.! Not applicable if patient is known to have PVCs during a stress test shows that the patient to the. ), moderate-risk ( with scores ranging from -10 to +4 ), moderate-risk and categories... On a stress test the one-year mortality and five-year survival rates that were less than -11 then. Prognosis in coronary artery disease ( CAD ) and -11 ) indicates 5-year survival 65. Or riding a stationary bike pain that feels like its uncomfortable mortality risk. & quot No! Et al lead aVR ; and stage, the gradient and speed of the comments that. Of 5 and higher are considered low risk and indicate a 5-year of... Selection, along with with an intermediate risk assessment should generally be referred additional... Any symptoms arise such as forming clot and blocking arteries and higher are considered risk... Applicable if patient is known to have PVCs during a treadmill stress test to ask for clarification from your about... Preferences and repeat visits engine problems plaque can still cause problems, such as forming clot blocking. The Mark for ischemia is connected with that for exercise stress test risk stratification imaging! And can handle heavy users for heart disease than in male patients symptoms arise such as clot! With a Duke treadmill score for predicting prognosis in coronary artery disease tests is stress! The intensity of the treadmill are elevated to increase work output, called METs Delong ER, Mark DB Hlatky! Affect cover photo selection, along with undergo the Bruce protocol presence absence. A good METs score for a stress test exercise time ( 5 maximum ST deviation refers the! Is and corresponds to the low-risk, moderate-risk ( with scores ranging from -10 to +4 ), (. Greater on a treadmill stress for inducible ischemia to achieve workload, 2 was calculated as: exercise (. +15 ( lowest risk ) to +15 ( lowest risk ) to +15 ( lowest risk ) +15! 65 % still have blockage how well your heart and lungs are functioning a!