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.
- Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM, et al. American College of Cardiology, American Heart Association Task Force on practice guideline. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 1999;99:2829-48.
- Thomas GS, Miyamoto MI, Morello AP, Majmunder H, Thomas JJ, Sampson CH, et al. Technetium-99m sestamibi myocardial perfusion imaging predicts clinical outcome in the community outpatient setting. The nuclear utility in the community (NUC) study. J Am Coll Cardiol 2004;43:213-23. CrossRef
- Arai Y, Saul JP, Albrecht P, Hartley LH, Lilly LS, Cohen RJ, et al. Modulation of cardiac autonomic activity during and immediately after exercise. Am J Physiol 1989;256:H132-41.
- Lauer MS, Okin PM, Larson MG, Evans JC, Levy D. Impaired heart rate response to graded exercise. Prognostic implications of chronotropic incompetence in the Framingham Heart Study. Circulation 1996;93:1520-6.
- Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol 1994;24:1529-35. CrossRef
- Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Eng J Med 1999;341:1351-7. CrossRef
- Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA 2000;20:1392-8. CrossRef
- Myers J, Kaykha A, George S, Abella J, Zaheer N, Lear S, et al. Fitness versus physical activity patterns in predicting mortality in men. Am J Med 2004;117:912-8. CrossRef
- Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995;36:2138-47.
- Curb JD, Ford CE, Pressel S, Babcock C, Hawkins CM. Ascertainment of vital status through the National Death Index and the Social Security administration. Am J Epidemiol 1985;121:754-66. CrossRef
- Kaplan E, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Soc 1958;53:457-81.
- LeBlanc M, Crowley J. Relative risk trees for censored survival data. Biometrics 1992;48:411-25. CrossRef
- Cox D. Regression models and life tables. J R Stat Soc B 1972;34:187-220.
- Billman GE, Schwartz PJ, Stone HL. Baroreceptor reflex control of heart rate: A predictor of sudden death. Circulation 1982;66:874-80.
- Shetler K, Marcus R, Froelicher VF, Vora S, Kalisetti D, Prakash M, et al. Heart rate recovery: Validation and methodologic issues. J Am Coll Cardiol 2001;38:1980-7. CrossRef
- Cole CR, Foody JM, Blackstone EH, Lauer MS. Heart rate recovery after submaximal exercise testing as a predictor of mortality in a cardiovascularly healthy cohort. Ann Intern Med 2000;132:552-5.
- Victor RG, Seals DR. Reflex stimulation of sympathetic outflow during rhythmic exercise in human. Am J Physiol 1989;26:H2017-24.
- Robinson BF, Epstein SE, Beiser D, Braunwald E. Control of heart rate by the autonomic nerve system. Study in man on the interrelation between baroreceptor mechanism and exercise. Circ Res 1966;19:400-11.
- Victor RG, Seals DR, Mark AL. Differential control of heart rate and sympathetic nerve activity during dynamic exercise. J Clin Invest 1987;79:508-16. CrossRef
- Johnston DL, Hodge DO, Hopfenspirger MR, Gibbons RJ. Clinical determinants of hemodynamic and symptomatic responses in 2000 patients during adenosine scintigraphy. Mayo Clin Proc 1998;73:314-20. CrossRef
- Abidov A, Hachamovitch R, Hayers SW, Ng CK, Cohen I, Friedman JD, et al. Prognostic impact of hemodynamic response to adenosine in patients old age 55 years undergoing vasodilatator stress myocardial perfusion study. Circulation 2003;107:2894-9. CrossRef
- Conradson TB, Clark B, Dixon CM, Dalton RN, Barners PJ. Effects of adenosine on autonomic control of heart rate in man. Acta Physiol Scand 1987;131:525-31. CrossRef
- Rongen GA, Brooks SC, Pollard MJ, Ando S, Dajani HR, Notarius CF, et al. Effect of adenosine on heart rate variability in human. Clin Sci (Lond) 1999;96:597-604.
- Hashimoto A, Palmer EL, Scott JA, Abraham SA, Fischman AJ, Force TL, et al. Complications of exercise and pharmacologic stress tests: Differences in younger and elderly patients. J Nucl Cardiol 1999;6:612-9. CrossRef
- Elliot MD, Holly TA, Leonard SM, Hendel RC. Impact of an abbreviated adenosine protocol incorporating adjunctive treadmill exercise on adverse effects and image quality in patients undergoing stress myocardial perfusion imaging. J Nucl Cardiol 2000;7:584-9. CrossRef
- O’Keefe JH Jr, Bateman TM, Handlin LR, Barnhart LR. Four- versus 6-minute infusion protocol for adenosine thallium-201 single photon emission computed tomography imaging. Am Heart J 1995;129:482-7. CrossRef
- Moser GH, Schrader J, Deussen A. Turnover of adenosine in plasma of human and dog blood. Am J Physiol 1989;256:C799-806.
- Hachamovich R, Berman DS, Kiat H, Cohen I, Cabico JA, Friedman J, et al. Exercise myocardial perfusion SPECT in patients without known CAD. Incremental prognostic value and use in risk stratification. Circulation 1996;93:905-14.
- Lesile WD, Tully SA, Yogendran MS, Ward LM, Nour KA, Metge CJ. Prognostic value of automated quantification of 99m-Tc sestamibi myocardial perfusion imaging. J Nucl Med 2005;46:204-11.
- Berman DS, Kang X, Van Train KF, Lewin HC, Cohen I, Areeda J, et al. Comparative prognostic value of automatic quantitative analysis versus semiquantitative visual analysis of exercise myocardial perfusion single-photon emission computed tomography. J Am Coll Cardiol 1998;32:1987-95. CrossRef
- 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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- 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