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Chronotropic incompetence in clinical exercise testing.

R D Wiens, P Lafia, C M Marder

    The American Journal of Cardiology
    |July 1, 1984
    PubMed
    Summary
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    Chronotropic incompetence, an impaired heart rate response during exercise, is a specific indicator of obstructive coronary artery disease (CAD). This finding can help identify patients with CAD, especially those with unclear exercise test results.

    Area of Science:

    • Cardiology
    • Exercise Physiology

    Background:

    • Chronotropic incompetence (CI) is a known predictor of obstructive coronary artery disease (CAD).
    • A clear definition of normal heart rate response to exercise is lacking, hindering CI diagnosis.
    • This study aimed to define normal heart rate responses and evaluate CI in patients undergoing exercise stress tests.

    Purpose of the Study:

    • To establish normal heart rate responses to progressive exercise.
    • To define chronotropic incompetence based on these normal responses.
    • To assess the prevalence and specificity of chronotropic incompetence in patients with and without coronary artery disease.

    Main Methods:

    • Evaluated 312 patients undergoing exercise stress tests and coronary angiography.
    • Defined normal heart rate response using data from 140 healthy subjects (mean +/- 2 standard deviations).

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  • Analyzed exercise heart rates in 172 patients with CAD to identify those with CI.

    • Main Results:

    • Chronotropic incompetence was identified in 16 of 172 patients (9.3%) with CAD.
    • Among patients without significant ST-segment changes and not reaching 85% of predicted heart rate, 13 of 65 (20%) exhibited CI.
    • Patients with CI and CAD exercised longer (9.4 METs) than those without CI (7.0 METs), p < 0.01.

    Conclusions:

    • Chronotropic incompetence is infrequent but specific for coronary artery disease.
    • CI can aid in detecting CAD in patients with indeterminate exercise stress tests.
    • Establishing normal heart rate response parameters is crucial for accurate CI diagnosis.