Chronotropic incompetence and mortality in middle-aged men with known or suspected coronary heart disease
Kai P Savonen1, Vesa Kiviniemi, Jari A Laukkanen
1Kuopio Research Institute of Exercise Medicine, Haapaniementie 16, 70100 Kuopio, Finland. savonen@hytti.uku.fi
Insights
An attenuated heart rate (HR) increase during exercise, specifically in the latter half, independently predicts mortality in men with coronary heart disease (CHD). Lower HR increase indicates a higher risk of death.
Area of Science:
- Cardiology
- Exercise Physiology
- Preventive Medicine
Background:
- Coronary heart disease (CHD) poses a significant mortality risk.
- Exercise testing is a common diagnostic tool for CHD.
- Heart rate (HR) response during exercise may offer prognostic information.
Purpose of the Study:
- To determine if the heart rate increase from 40% to 100% of maximal work capacity (HR40-100) independently predicts mortality.
- To investigate the association between HR response during exercise and mortality risk in men with known or suspected CHD.
Main Methods:
- A cohort of 294 men (42-61 years) with known or suspected CHD in Finland were studied.
- Heart rate was measured at rest and during a maximal exercise test.
- Cox-multivariable models were used to analyze mortality risk over an 11.0-year follow-up.
Main Results:
- A 1-SD decrement in HR40-100 was associated with a 41% increase in mortality.
- HR increase from rest to 40% of maximal capacity was not linked to mortality risk.
- Synergistic adverse prognostic effects were observed for low HR40-100 and low workload at HR of 100 b.p.m.
Conclusions:
- An attenuated heart rate increase, especially in the latter half of a maximal exercise test, is an independent predictor of death.
- This finding is significant for risk stratification in men with known or suspected CHD.
Aims:
The objective is to study whether a heart rate (HR) increase from 40 to 100% of maximal work capacity in the exercise test (HR40-100) independently predicts mortality in men with known or suspected coronary heart disease (CHD).
Methods And Results:
The subjects were 294 men, 42-61 years of age, from eastern Finland with known or suspected CHD but without use of HR-lowering medication at baseline. HR was measured at rest and during a maximal, symptom-limited exercise test. During an average follow-up of 11.0 years, there were 61 all-cause deaths. In Cox-multivariable model, mortality increased by 41% (95% confidence interval, 12-79%) with a 1-SD (15 b.p.m.) decrement in HR40-100. HR increase from rest to 40% of maximal work capacity was not associated with an increased risk of death. Synergism was observed between HR40-100 and workload achieved at HR of 100 b.p.m. so that men having low values for both these HR variables had a particularly adverse prognosis compared with men with high values for these variables.
Conclusion:
An attenuated HR increase particularly during the latter half of a maximal exercise test is an independent predictor of death in men with known or suspected CHD.
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