Document Detail

Heart-rate profile during exercise as a predictor of sudden death.
MedLine Citation:
PMID:  15888695     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Changes in heart rate during exercise and recovery from exercise are mediated by the balance between sympathetic and vagal activity. Since alterations in the neural control of cardiac function contribute to the risk of sudden death, we tested the hypothesis that among apparently healthy persons, sudden death is more likely to occur in the presence of abnormal heart-rate profiles during exercise and recovery. METHODS: A total of 5713 asymptomatic working men (between the ages of 42 and 53 years), none of whom had clinically detectable cardiovascular disease, underwent standardized graded exercise testing between 1967 and 1972. We examined data on the subjects' resting heart rates, the increase in rate from the resting level to the peak exercise level, and the decrease in rate from the peak exercise level to the level one minute after the termination of exercise. RESULTS: During a 23-year follow-up period, 81 subjects died suddenly. The risk of sudden death from myocardial infarction was increased in subjects with a resting heart rate that was more than 75 beats per minute (relative risk, 3.92; 95 percent confidence interval, 1.91 to 8.00); in subjects with an increase in heart rate during exercise that was less than 89 beats per minute (relative risk, 6.18; 95 percent confidence interval, 2.37 to 16.11); and in subjects with a decrease in heart rate of less than 25 beats per minute after the termination of exercise (relative risk, 2.20; 95 percent confidence interval, 1.02 to 4.74). After adjustment for potential confounding variables, these three factors remained strongly associated with an increased risk of sudden death, with a moderate but significantly increased risk of death from any cause but not of nonsudden death from myocardial infarction. CONCLUSIONS: The heart-rate profile during exercise and recovery is a predictor of sudden death.
Xavier Jouven; Jean-Philippe Empana; Peter J Schwartz; Michel Desnos; Dominique Courbon; Pierre Ducimetière
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  352     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-05-12     Completed Date:  2005-05-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1951-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2005 Massachusetts Medical Society.
Service de Cardiologie, Faculté René Descartes, Université Paris-5, Hôpital Européen Georges Pompidou, Paris, France.
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MeSH Terms
Analysis of Variance
Baroreflex / physiology
Death, Sudden, Cardiac / etiology*
Exercise / physiology*
Exercise Test
Follow-Up Studies
Heart Rate / physiology*
Middle Aged
Myocardial Infarction / mortality
Proportional Hazards Models
Rest / physiology
Risk Factors
Sympathetic Nervous System / physiology
Vagus Nerve / physiology
Comment In:
N Engl J Med. 2005 Aug 18;353(7):734-5; author reply 734-5   [PMID:  16108141 ]
N Engl J Med. 2005 Aug 18;353(7):734-5; author reply 734-5   [PMID:  16107629 ]

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