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Cited by 50Cardiovascular and exercise physiologyCardiac Imaging and DiagnosticsHeart rate and cardiovascular health

The prognostic importance of abnormal heart rate recovery and chronotropic response among exercise treadmill test patients

Maddox, Thomas M., Ross, Colleen, Ho, P. Michael, Masoudi, Frederick A., Magid, David, Daugherty, Stacie L., Peterson, Pam, Rumsfeld, John S.·2008·American Heart Journal
DOI 10.1016/j.ahj.2008.05.025
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Abstract

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.

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  • Abnormal heart rate recovery and chronotropic response to exercise identify patients with higher rates of all-cause mortality or nonfatal myocardial infarction and provide additional risk stratification among patients who were low-risk according to the Duke Treadmill Score.

    “Abnormal heart rate recovery and chronotropic response to exercise identified patients with higher rates of all-cause mortality or nonfatal myocardial infarction and provided additional risk stratification among patients who were low-risk according to the Duke Treadmill Score.53”

    From The Year of 2008 in Electrocardiology (2010) · cites this paper as [53]

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Authors
Maddox, T. M., Ross, C., Ho, P. M., Masoudi, F. A., Magid, D., Daugherty, S. L., Peterson, P., & Rumsfeld, J. S.
Affiliations
  • Denver VA Medical Center (US)
  • Kaiser Permanente (US)
  • Denver Health Medical Center (US)
  • University of Colorado Denver (US)
Corresponding author
Maddox, Thomas M.
ORCID
Venue
American Heart Journal
Publisher
Elsevier BV
Published
2008-10
Volume
156
Issue
4
Pages
736-744
ISSN
0002-8703 (ISSN-L)
DOI
10.1016/j.ahj.2008.05.025
OpenAlex
W2070042863
Cited by
50
References
30
Citations by year
2025: 1 · 2023: 1 · 2022: 1 · 2021: 4 · 2019: 5 · 2018: 3 · 2017: 2 · 2016: 4 · 2015: 6 · 2014: 10 · 2013: 2 · 2012: 3
FWCI
7.81
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Heart Journal (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
Keywords
heart rate recovery, chronotropic response, treadmill exercise testing, Duke treadmill score, all-cause mortality, nonfatal myocardial infarction, prognostic stratification, cardiovascular risk prediction
MeSH terms
Adult, Cause of Death, Exercise Test, Female, Heart Rate, Humans, Male, Mortality, Myocardial Infarction, Predictive Value of Tests, Prognosis, Exercise, Proportional Hazards Models, Treatment Outcome, Recovery of Function

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