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Age-Stratified Prognostic Comparison of Three Chronotropic Incompetence Definitions in Patients with Suspected

Shuai Yang1,2, Ruijie Ma1, Qiting Sun3

  • 1Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China.

Clinical Interventions in Aging
|August 18, 2026
PubMed

Insights

Chronotropic incompetence (CI) definitions vary in exercise SPECT-MPI, impacting interpretation. All CI types predict major adverse cardiovascular events (MACE), with age-specific nuances for CI-APMHR in older adults.

Area of Science:

  • Cardiology
  • Exercise Physiology
  • Nuclear Cardiology

Background:

  • Chronotropic incompetence (CI) is an exercise marker of impaired heart rate response.
  • Its prognostic relevance in myocardial perfusion imaging is established but definition-dependent, especially in older patients.
  • This study compares three CI definitions in suspected coronary artery disease (CAD) patients undergoing exercise stress SPECT-MPI.

Purpose of the Study:

  • To compare the prevalence, agreement, and prognostic value of three different CI definitions.
  • To assess the incremental prognostic value of CI definitions beyond established markers like TPD and LVEF.
  • To investigate age-stratified performance and interactions of CI definitions in exercise SPECT-MPI.

Main Methods:

  • Retrospective analysis of 1,135 patients undergoing exercise stress SPECT-MPI.
  • Defined CI by failure to achieve 85% age-predicted maximal heart rate (CI-APMHR), heart rate reserve <80% (CI-HRR), or blunted heart rate reserve (CI-Blunted).
  • Assessed major adverse cardiovascular events (MACE) over a median follow-up of 63 months, analyzing prevalence, agreement, Cox associations, and incremental value.

Main Results:

  • CI prevalence varied significantly across definitions (CI-HRR 83.9%, CI-Blunted 72.2%, CI-APMHR 55.1%).
  • All three CI definitions were independently associated with MACE.
  • All definitions provided incremental prognostic value beyond Total Perfusion Deficit (TPD) and Left Ventricular Ejection Fraction (LVEF); CI-APMHR showed consistent incremental performance in patients aged ≥60 years.

Conclusions:

  • Chronotropic incompetence classification in exercise SPECT-MPI is definition-dependent.
  • While all definitions predict MACE, their incremental prognostic performance differs.
  • Age-informed interpretation is recommended, as CI-APMHR demonstrated consistent incremental value in older adults, though interactions were not significant.
Abstract

Keywords:
chronotropic incompetencecoronary artery diseaseexercise testingmyocardial perfusion imagingprognosisrisk reclassification

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