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Impaired Chronotropic Response to Exercise Stress Testing as a Predictor of Mortality
Abstract
CONTEXT: Chronotropic incompetence, an attenuated heart rate response to exercise, is a predictor of all-cause mortality in healthy populations. This association may be independent of exercise-induced myocardial perfusion defects. OBJECTIVE: To examine the prognostic significance of chronotropic incompetence in a low-risk cohort of patients referred for treadmill stress testing with thallium imaging. DESIGN: Prospective cohort study conducted between September 1990 and December 1993. SETTING: Tertiary care academic medical center. PATIENTS: Consecutive patients (1877 men and 1076 women; mean age, 58 years) who were not taking beta-blockers and who were referred for symptom-limited treadmill thallium testing. MAIN OUTCOME MEASURES: Association of chronotropic incompetence, defined as either failure to achieve 85% of the age-predicted maximum heart rate or a low chronotropic index, a heart rate response measure that accounts for effects of age, resting heart rate, and physical fitness, with all-cause mortality during 2 years of follow-up. RESULTS: Three hundred sixteen patients (11%) failed to reach 85% of the age-adjusted maximum heart rate, 762 (26%) had a low chronotropic index, and 612 (21%) had thallium perfusion defects. Ninety-one patients died during the follow-up period. After adjustment for age, sex, thallium perfusion defects, and other confounders, failure to reach 85% of the age-predicted maximum heart rate was associated with increased risk of death (adjusted relative risk [RR], 1.84; 95% confidence interval [CI], 1.13-3.00; P=.01), as was a low chronotropic index (adjusted RR, 2.19; 95% CI, 1.43-3.44; P<.001). CONCLUSION: Among patients with known or suspected coronary disease, chronotropic incompetence is independently predictive of all-cause mortality, even after considering thallium perfusion defects. Incorporation of chronotropic response into the routine interpretation of stress thallium studies may improve the prognostic power of this test.
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Lauer, M. S., Pashkow, F. J., Harvey, S. A., Marwick, T. H., & Thomas, J. D. (1995) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(95)00388-6 · Cited by 127
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Fletcher, G. F., Ades, P. A., Kligfield, P., Arena, R., Balady, G. J., Bittner, V. A., Coke, L. A., Fleg, J. L., Forman, D. E., Gerber, T. C., et al. (2013) · Circulation · doi:10.1161/cir.0b013e31829b5b44 · Cited by 2,235
Heart-rate Recovery Immediately After Exercise as a Predictor of Mortality
Cole, C. R., Blackstone, E. H., Pashkow, F. J., Snader, C. E., & Lauer, M. S. (1999) · New England Journal of Medicine · doi:10.1056/nejm199910283411804 · Cited by 1,935
Self-citationFletcher, G. F., Balady, G. J., Amsterdam, E. A., Chaitman, B., Eckel, R., Fleg, J., Froelicher, V. F., Leon, A. S., Piña, I. L., Rodney, R., et al. (2001) · Circulation · doi:10.1161/hc3901.095960 · Cited by 1,923
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.10.044 · Cited by 1,008
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Circulation · doi:10.1161/cir.0000000000000628 · Cited by 603
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.10.043 · Cited by 337
Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., Edgerton, J. R., Ellenbogen, K. A., Gold, M. R., Goldschlager, N. F., Hamilton, R. M., Joglar, J. A., Kim, R. J., et al. (2019) · Heart Rhythm · doi:10.1016/j.hrthm.2018.10.037 · Cited by 131
Adabag, A. S., Grandits, G. A., Prineas, R. J., Crow, R. S., Bloomfield, H. E., & Neaton, J. D. (2008) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2008.01.021 · Cited by 85
Kim, E. S. H., Ishwaran, H., Blackstone, E., & Lauer, M. S. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.08.003 · Cited by 77
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The prognostic value of exercise testing in elderly men.
Spin, J. M., Prakash, M., Froelicher, V. F., Partington, S., Marcus, R., Do, D., & Myers, J. (2002) · The American Journal of Medicine · doi:10.1016/s0002-9343(02)01065-3 · Cited by 64
Maddox, T. M., Ross, C., Ho, P. M., Masoudi, F. A., Magid, D., Daugherty, S. L., Peterson, P., & Rumsfeld, J. S. (2008) · American Heart Journal · doi:10.1016/j.ahj.2008.05.025 · Cited by 50
Chronotropic incompetence and autonomic dysfunction in patients without structural heart disease
Kawasaki, T., Kaimoto, S., Sakatani, T., Miki, S., Kamitani, T., Kuribayashi, T., Matsubara, H., & Sugihara, H. (2010) · Europace · doi:10.1093/europace/eup433 · Cited by 47
Maximal heart rate declines linearly with age independent of cardiorespiratory fitness levels
Ozemek, C., Whaley, M. H., Finch, W. H., & Kaminsky, L. A. (2017) · European Journal of Sport Science · doi:10.1080/17461391.2016.1275042 · Cited by 25
Exercise Enhances the Effect of Bariatric Surgery in Markers of Cardiac Autonomic Function
Gil, S., Peçanha, T., Dantas, W. S., Murai, I. H., Merege-Filho, C. A. A., de Sá-Pinto, A. L., Pereira, R. M. R., de Cleva, R., Santo, M. A., Rezende, D. A. N., et al. (2021) · Obesity Surgery · doi:10.1007/s11695-020-05053-7 · Cited by 22
Exercise testing parameters associated with post lung transplant mortality
Armstrong, H. F., Garber, C. E., & Bartels, M. N. (2012) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2012.02.003 · Cited by 18
Araújo, C. G. S. D., & Pinto, V. L. M. (2005) · Arquivos Brasileiros de Cardiologia · doi:10.1590/s0066-782x2005001400009 · Cited by 13
Metadata
- Authors
- Lauer, M. S.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 1999-02-10
- Volume
- 281
- Issue
- 6
- Pages
- 524
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2069884759
- Cited by
- 625
- References
- 1
- FWCI
- 42.44
- Type
- journal article
- Language
- en
- Open access
- closed
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