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The incremental prognostic value of percentage of heart rate reserve achieved over myocardial perfusion single-photon emission computed tomography in the prediction of cardiac death and all-cause mortality

Superiority over 85% of maximal age-predicted heart rate

Babak Azarbal, MD^*, Sean W. Hayes, MD^*, Howard C. Lewin, MD^*, Rory Hachamovitch, MD, MSc, FACC, Ishac Cohen, PhD and Daniel S. Berman, MD, FACC^*,*

^* Department of Medicine (Division of Cardiology), University of California, Los Angeles, School of Medicine, Los Angeles, California, USA
Department of Imaging (Division of Nuclear Medicine), University of California, Los Angeles, School of Medicine, Los Angeles, California, USA
CSMC Burns & Allen Research Institute, Cedars-Sinai Medical Center, University of California, Los Angeles, School of Medicine, Los Angeles, California, USA
Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA

View larger version (26K): [in a new window]   Figure 1 Survival free of cardiac death (CD) (A) and overall survival (B) as a function of percent heart rate reserve (%HR-R) and myocardial perfusion single-photon emission computed tomography (MPS) result. Abnl = abnormal; NL = normal.

View larger version (27K): [in a new window]   Figure 2 Survival free of cardiac death (CD) (A) and overall survival (B) as a function of the ability to achieve 85% maximal age-predicted heart rate (MPHR) and myocardial perfusion single-photon emission computed tomography (MPS) result. Abnl = abnormal; NL = normal.

View larger version (26K): [in a new window]   Figure 3 Adjusted risk of cardiac death (CD) (A) and all-cause mortality (B) as a function of percent heart rate (HR) reserve and summed stress score (SSS) categories. p < 0.001 across myocardial perfusion single-photon emission computed tomography (MPS) categories; p < 0.05 within MPS category for low versus normal %HR reserve.

View larger version (24K): [in a new window]   Figure 4 Adjusted risk of cardiac death (CD) (A) and all-cause mortality (B) as a function of percent heart rate reserve and exercise capacity. p < 0.001 across exercise capacity categories; p 0.05 within exercise tolerance category for low versus normal %HR reserve. MET = metabolic equivalent.