Delayed heart rate recovery after adenosine stress testing with supplemental arm exercise predicts mortality
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Delayed heart rate (HR) recovery after treadmill exercise testing predicts mortality. Patients with suspected ischemic heart disease who cannot perform adequate treadmill exercise are typically evaluated with pharmacological stress myocardial perfusion imaging (MPI) studies, but little prognostic significance has been attributed to the hemodynamic response to vasodilator stress testing with low-level exercise. We hypothesized that a delay in HR recovery after adenosine stress testing with arm exercise is associated with increased mortality.
Methods and Results
Technetium 99m-Sestamibi MPI was performed in 1,455 consecutive patients (70 ± 12 years, 50.2% men) with adenosine stress and supplemental arm exercise. HRs were recorded at rest, continuously during infusion, and then 5 minutes post-infusion. Delayed HR recovery was defined as a decline of ≤12 bpm from peak HR at 5 minutes after discontinuation of the infusion. Of 1,356 patients during 5 years of follow up, there were 135 deaths (10%). Delayed HR recovery was strongly predictive of all-cause mortality (16.5% vs 5.3% in those with normal HR recovery, P < .001) with an adjusted hazard ratio of 2.5 (95% CI, 1.7-3.6; P < .001).
Delayed HR recovery after adenosine stress testing with arm exercise is a readily available and powerful predictor of all-cause mortality.
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- Delayed heart rate recovery after adenosine stress testing with supplemental arm exercise predicts mortality
Journal of Nuclear Cardiology
Volume 16, Issue 1 , pp 54-62
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- heart rate recovery
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- 1. Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Yawkey 5E 55 Fruit Street, Boston, MA, 02114, USA
- 2. Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, Japan
- 3. Mission Internal Medical Group, Mission Viejo, CA, USA