Poor responsiveness of heart rate to treadmill exercise in vasospastic angina

Heart rate response to submaximal graded treadmill exercise was measured in 45 patients with vasospastic angina, 31 with effort angina, and 40 normal controls. There was no difference of resting heart rate among the three groups. Vasospastic angina showed significantly poor responsiveness of heart rate to exercise at every stage: stage 1, 2.5 km/h (10%), stage 3, 4.5 km/h (10%), stage 5, 5.5 km/h (14%), stage 7, 5.5 km/h (22%), when compared with those in normal controls. The effort angina group also showed lower heart rates at stages 3 and 5 than those in control subjects, although their heart rate at stage 1 was not different from that in normals. When abnormal response suggesting vasospastic angina was defined as heart rate at each stage lower than values of mean heart rate +/- 1 SD in normal controls, positive test results were obtained in 15 of 45 patients (33%). The use of heart rate criteria in addition to ischemic criteria raises sensitivity from 27 to 51% (p less than 0.02).