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Association of heart rate profile during exercise with the severity of coronary artery disease
Serkan Cay1, Sezgin Ozturk, Funda Biyikoglu
1Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital, Ankara, Turkey. cayserkan@yahoo.com
Insights
Abnormal heart rate patterns during exercise stress tests, including higher resting heart rate and lower heart rate increment/decrement, are strongly linked to severe coronary artery disease. These findings highlight the role of autonomic nervous system dysfunction in cardiovascular health.
Area of Science:
- Cardiology
- Autonomic Nervous System Function
- Exercise Physiology
Background:
- Coronary artery disease (CAD) is a primary global cause of illness and death.
- Autonomic nervous system (ANS) dysfunction is implicated in CAD development and complications.
- Exercise stress tests are crucial for diagnosing CAD.
Purpose of the Study:
- To investigate the association between heart rate (HR) patterns during exercise and the severity of coronary artery stenosis.
- To determine if HR parameters during exercise can predict CAD severity.
Main Methods:
- 160 patients with abnormal exercise treadmill tests underwent selective coronary angiography.
- Resting HR, maximum HR during exercise, and post-exercise HR were measured.
- HR increment and decrement were calculated; patients were grouped by stenosis severity (<50% vs. ≥50%).
Main Results:
- Patients with severe CAD (≥50% stenosis) exhibited higher resting HR, lower maximum HR, lower HR increment, and lower HR decrement.
- Elevated resting HR, low HR increment, and low HR decrement were independently associated with increased odds of severe coronary atherosclerosis.
Conclusions:
- Autonomic nervous system dysregulation significantly impacts HR profiles during exercise.
- Altered HR patterns, specifically increased resting HR and decreased HR increment/decrement, are strongly and independently associated with the severity of coronary artery disease.
Background:
Coronary artery disease is the leading cause of morbidity and mortality around the world. Autonomic nervous system abnormalities are associated with coronary artery disease and its complications. Exercise stress tests are routinely used for the detection of the presence of coronary artery disease. In this study, we observed the association between heart rate profile during exercise and the severity of coronary artery disease.
Method And Results:
One hundred and sixty patients with abnormal exercise treadmill test (> or =1 mm horizontal or downsloping ST-segment depression; 119 men, 41 women; mean age = 57 +/- 9 years) were included in the study. Use of any drug affecting heart rate was not permitted. Resting heart rate before exercise, maximum heart rate during exercise, and resting heart rate after exercise (5 min later) were measured and two parameters were calculated: heart rate increment (maximum heart rate - resting heart rate before exercise) and heart rate decrement (maximum heart rate - resting heart rate after exercise). All patients underwent selective coronary angiography and subclassified into two groups according to stenotic lesion severity. Group 1 had at least 50% of stenotic lesion and group 2 had less than 50%. Patients in the first group had increased resting heart rate, decreased maximum heart rate, decreased heart rate increment, and decreased heart rate decrement compared with second group. All patients were classified into tertiles of resting heart rate, heart rate increment, and heart rate decrement level to evaluate whether these parameters were associated with severity of coronary artery stenosis in the study. The multiple-adjusted odds ratio of the risk of severe coronary atherosclerosis was 21.888 (95% confidence interval 6.983-68.606) for the highest tertile of resting heart rate level compared with the lowest tertile. In addition, the multiple-adjusted odds ratio of the risk of severe coronary atherosclerosis was 20.987 (95% confidence interval 6.635-66.387) for the lowest tertile of heart rate increment level compared with the highest tertile and 2.360 (95% confidence interval 1.004-5.544) for the lowest tertile of heart rate decrement level compared with the highest tertile.
Conclusion:
Altered autonomic nervous system regulation affects heart rate profile, increased resting heart rate, decreased heart rate increment, and decreased heart rate decrement, during exercise and this effect is strongly and independently associated with the severity of coronary artery disease.
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Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes