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ACC/AHA 2008 Performance Measures for Adults With ST-Elevation and Non-ST-Elevation Myocardial Infarction

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease
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J Am Coll Cardiol, 2004; 43:925, doi:10.1016/j.jacc.2003.12.020
© 2004 by the American College of Cardiology Foundation
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LETTER TO THE EDITOR

Reply

Michael S. Lauer, MD, FACC

Cleveland Clinic Foundation, Desk F25, 9500 Euclid Ave., Cleveland, OH 44195, USA

Lauerm{at}ccf.org

Dr. Gaibazzi is correct in stating that current evidence linking heart rate recovery with death has been derived from cohorts of patients undergoing treadmill-exercise testing. As previous work has shown that heart rate responses during exercise are different when using a bicycle (1), it will be important to perform future research involving very large cohorts of patients undergoing this type of test modality. Of note, recent work has shown that vagal activity plays an important role in heart rate recovery after mental stress (2), suggesting that the concept linking heart rate recovery with prognosis may transcend the type of stress.


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  1. Badruddin SM, Ahmad A, Mickelson J, et al. Supine bicycle versus post-treadmill exercise echocardiography in the detection of myocardial ischemia: a randomized single-blind crossover trial. J Am Coll Cardiol. 1999;33:1485–1490[Abstract/Free Full Text]
  2. Mezzacappa ES, Kelsey RM, Katkin ES, Sloan RP. Vagal rebound and recovery from psychological stress. Psychosom Med. 2001;63:650–657[Abstract/Free Full Text]




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