Journal of Nuclear Cardiology

, Volume 16, Issue 1, pp 54–62

Delayed heart rate recovery after adenosine stress testing with supplemental arm exercise predicts mortality

  • Yasushi Akutsu
  • Shawn A. Gregory
  • Arash Kardan
  • Gerasimos D. Zervos
  • Gregory S. Thomas
  • Henry Gewirtz
  • Tsunehiro Yasuda
Original Article

DOI: 10.1007/s12350-008-9014-4

Cite this article as:
Akutsu, Y., Gregory, S.A., Kardan, A. et al. J. Nucl. Cardiol. (2009) 16: 54. doi:10.1007/s12350-008-9014-4

Abstract

Background

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).

Conclusion

Delayed HR recovery after adenosine stress testing with arm exercise is a readily available and powerful predictor of all-cause mortality.

Keywords

SestamibiadenosineTechnetium-99mheart rate recoverymortality

Copyright information

© American Society of Nuclear Cardiology 2008

Authors and Affiliations

  • Yasushi Akutsu
    • 1
    • 2
  • Shawn A. Gregory
    • 1
  • Arash Kardan
    • 1
  • Gerasimos D. Zervos
    • 1
  • Gregory S. Thomas
    • 3
  • Henry Gewirtz
    • 1
  • Tsunehiro Yasuda
    • 1
  1. 1.Cardiology DivisionMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  2. 2.Division of Cardiology, Department of MedicineShowa University School of MedicineTokyoJapan
  3. 3.Mission Internal Medical GroupMission ViejoUSA