Document Detail

The prognostic importance of abnormal heart rate recovery and chronotropic response among exercise treadmill test patients.
MedLine Citation:
PMID:  18926155     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Heart rate recovery (HRR) and chronotropic response to exercise (CR) each have prognostic value among patients undergoing exercise treadmill testing (ETT). However, little is known about their prognostic use in combination and in addition to the Duke Treadmill Score (DTS). METHODS: We studied 9,519 outpatients undergoing ETT between 2001 and 2004. Patients were categorized by HRR and CR. The primary outcome was all-cause mortality or nonfatal myocardial infarction (MI). Cox proportional hazards modeling was used to control for demographics, clinical history, and DTS. RESULTS: After multivariable adjustment for DTS and other demographic and clinical variables, patients with abnormal HRR and CR had higher rates of all-cause mortality or nonfatal MI, as compared to patients with normal HRR and CR (hazard ratio [HR] = 1.90, 95% CI 1.35-2.69). Addition of the HRR and CR to the DTS improved outcome prediction (c-statistic improved from 0.61 to 0.68). Low-risk DTS patients with abnormal HRR and CR had significantly higher rates of all-cause mortality or nonfatal MI (HR 2.59, 95% CI 1.55-4.32), compared to low-risk DTS patients with normal HRR and CR. CONCLUSIONS: Abnormal HRR and CR identified ETT patients with higher rates of all-cause mortality or nonfatal MI and provided additional risk stratification among low-risk DTS patients. These results support the routine incorporation of HRR and CR in ETT reporting and suggest the need to evaluate whether further testing and/or more intensive treatment of these higher risk patients can improve outcomes.
Thomas M Maddox; Colleen Ross; P Michael Ho; Frederick A Masoudi; David Magid; Stacie L Daugherty; Pam Peterson; John S Rumsfeld
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  156     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-17     Completed Date:  2008-11-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  736-44     Citation Subset:  AIM; IM    
Denver VAMC/University of Colorado Denver, Denver, CO 80209, USA.
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MeSH Terms
Cause of Death
Exercise / physiology*
Exercise Test*
Heart Rate / drug effects*,  physiology*
Myocardial Infarction / epidemiology*,  mortality,  physiopathology*
Predictive Value of Tests
Proportional Hazards Models
Recovery of Function / drug effects*
Treatment Outcome

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

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