CLINICAL STUDY
Prognostic significance of impairment of heart rate response to exercise
Impact of left ventricular function and myocardial ischemia
Abdou Elhendy, MD, PhD*,
Douglas W. Mahoney, MSc ,
Bijoy K. Khandheria, MD, FACC*,
Kelli Burger, BSc and
Patricia A. Pellikka, MD, FACC*,*
* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
Department of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
Manuscript received September 11, 2002;
revised manuscript received May 8, 2003,
accepted May 13, 2003.
* Reprint requests and correspondence: Dr. Patricia A. Pellikka, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, 200 1st Street SW, Rochester, Minnesota 55905, USA.
pellikka.patricia{at}mayo.edu
OBJECTIVES: The goal of this research was to study the association between heart rate (HR) response to exercise and the risk of death and myocardial infarction (MI) after adjustment for left ventricular (LV) function and myocardial ischemia.
BACKGROUND: Chronotropic incompetence during exercise testing is associated with increased mortality. It is unknown whether LV dysfunction or ischemia accounts for this.
METHODS: We studied 3,221 patients (age 59 ± 12 years; 1,701 men) who underwent treadmill exercise echocardiography. We considered two markers of chronotropic incompetence: 1) failure to achieve 85% of the maximal predicted HR, and 2) low (<0.8) chronotropic index. The independent association between HR response and end points was evaluated by an adjusted risk (AR) model, which included clinical parameters, ejection fraction, and the severity of ischemic wall motion abnormalities.
RESULTS: Target HR was not achieved in 495 (15%) patients. Low chronotropic index was observed in 793 (25%) patients. There were 129 deaths (41 cardiac) during a median follow-up of 3.2 years. Myocardial infarction occurred in 65 patients. Low chronotropic index was associated with cardiac death (AR, 1.54; 95% confidence interval [CI], 1.18 to 2.04; p = 0.002) and MI (AR, 1.37; 95% CI, 1.09 to 1.69; p = 0.007). Failure to achieve 85% of maximal predicted HR was associated with increased mortality (AR, 1.49; 95% CI, 1.02 to 2.22; p = 0.04) and cardiac death (AR, 2.13; 95% CI, 1.10 to 4.17; p = 0.03).
CONCLUSIONS: Impaired chronotropic response to exercise is associated with increased mortality and cardiac events even after adjusting for LV function and the severity of exercise-induced myocardial ischemia.
|
Abbreviations and Acronyms
| | AR | | adjusted risk | | CAD | | coronary artery disease | | CI | | confidence interval | | ECG | | electrocardiographic/electrocardiogram | | HR | | heart rate | | LV | | left ventricular | | METS | | metabolic equivalents | | MI | | myocardial infarction | | WMSI | | wall motion score index |
|
This article has been cited by other articles:
|
|
|
|
 
J. M. Bourque, B. H. Holland, D. D. Watson, and G. A. Beller
Achieving an exercise workload of > or = 10 metabolic equivalents predicts a very low risk of inducible ischemia: does myocardial perfusion imaging have a role?
J. Am. Coll. Cardiol.,
August 4, 2009;
54(6):
538 - 545.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Palatini
Exercise testing in asymptomatic subjects: from diagnostic test to prognostic tool?
Eur. Heart J.,
August 1, 2008;
29(15):
1803 - 1806.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Ugur-Altun, A. Altun, S. Guldiken, E. Tatli, M. Kara, and A. Tugrul
Silent Myocardial Ischemia in Middle-Aged Asymptomatic Patients With Type 2 Diabetes in Turkish Population
Angiology,
November 1, 2007;
58(5):
535 - 542.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. F. E. Praet and L. J. C. van Loon
Optimizing the therapeutic benefits of exercise in Type 2 diabetes
J Appl Physiol,
October 1, 2007;
103(4):
1113 - 1120.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Anand, B. W. McCrindle, C. C. Chiu, R. M. Hamilton, J. A. Kirsh, E. A. Stephenson, and G. J. Gross
Chronotropic incompetence in young patients with late postoperative atrial flutter: a case-control study
Eur. Heart J.,
September 1, 2006;
27(17):
2069 - 2073.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P-H Huang, H-B Leu, J-W Chen, T-C Wu, T-M Lu, Y-A Ding, and S-J Lin
Comparison of endothelial vasodilator function, inflammatory markers, and N-terminal pro-brain natriuretic peptide in patients with or without chronotropic incompetence to exercise test
Heart,
May 1, 2006;
92(5):
609 - 614.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. De Sutter, N. Van de Veire, and I. Elegeert
Chronotropic incompetence: are the carotid arteries to blame?
Eur. Heart J.,
April 2, 2006;
27(8):
897 - 898.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K K A Witte, J G F Cleland, and A L Clark
Chronic heart failure, chronotropic incompetence, and the effects of {beta} blockade
Heart,
April 1, 2006;
92(4):
481 - 486.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. S. Lauer
Chronotropic incompetence: Ready for prime time
J. Am. Coll. Cardiol.,
July 21, 2004;
44(2):
431 - 432.
[Full Text]
[PDF]
|
|
|
|
