Document Detail

Delayed heart rate recovery after adenosine stress testing with supplemental arm exercise predicts mortality.
MedLine Citation:
PMID:  19152129     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Delayed heart rate (HR) recovery after treadmill exercise testing predicts mortality. Patients with suspected ischemic heart disease who cannot perform adequate treadmill exercise are typically evaluated with pharmacological stress myocardial perfusion imaging (MPI) studies, but little prognostic significance has been attributed to the hemodynamic response to vasodilator stress testing with low-level exercise. We hypothesized that a delay in HR recovery after adenosine stress testing with arm exercise is associated with increased mortality. METHODS AND RESULTS: Technetium 99m-Sestamibi MPI was performed in 1,455 consecutive patients (70 +/- 12 years, 50.2% men) with adenosine stress and supplemental arm exercise. HRs were recorded at rest, continuously during infusion, and then 5 minutes post-infusion. Delayed HR recovery was defined as a decline of < or = 12 bpm from peak HR at 5 minutes after discontinuation of the infusion. Of 1,356 patients during 5 years of follow up, there were 135 deaths (10%). Delayed HR recovery was strongly predictive of all-cause mortality (16.5% vs 5.3% in those with normal HR recovery, P < .001) with an adjusted hazard ratio of 2.5 (95% CI, 1.7-3.6; P < .001). CONCLUSION: Delayed HR recovery after adenosine stress testing with arm exercise is a readily available and powerful predictor of all-cause mortality.
Yasushi Akutsu; Shawn A Gregory; Arash Kardan; Gerasimos D Zervos; Gregory S Thomas; Henry Gewirtz; Tsunehiro Yasuda
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Publication Detail:
Type:  Journal Article     Date:  2009-01-20
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  16     ISSN:  1532-6551     ISO Abbreviation:  J Nucl Cardiol     Publication Date:    2009 Jan-Feb
Date Detail:
Created Date:  2009-01-19     Completed Date:  2009-07-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  54-62     Citation Subset:  IM    
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Yawkey 5E 55 Fruit Street, Boston, MA 02114, USA.
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MeSH Terms
Adenosine / diagnostic use*
Exercise Test / statistics & numerical data*
Heart Rate / drug effects*
Myocardial Ischemia / mortality*,  radionuclide imaging*
Radiopharmaceuticals / diagnostic use
Reproducibility of Results
Risk Assessment / methods
Risk Factors
Sensitivity and Specificity
Survival Analysis
Survival Rate
Technetium Tc 99m Sestamibi / diagnostic use*
United States / epidemiology
Vasodilator Agents / diagnostic use
Reg. No./Substance:
0/Radiopharmaceuticals; 0/Vasodilator Agents; 109581-73-9/Technetium Tc 99m Sestamibi; 58-61-7/Adenosine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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