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Association of exercise capacity and the heart rate profile during exercise stress testing with subclinical coronary atherosclerosis: data from the Heinz Nixdorf Recall study

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Abstract

Background

Exercise capacity and heart rate profile parameters obtained from exercise stress testing as well as the subclinical coronary atherosclerosis burden from cardiac CT have been suggested to improve cardiovascular (CV) risk stratification beyond traditional risk factors (RF) in persons at risk of CV events.

Aim

To study the association of exercise stress-test variables with the coronary artery calcium (CAC) burden in relation to age, sex and traditional RF in subjects without known coronary artery disease from the general population.

Methods

In 3,163 subjects, CV and RF were measured, a bicycle stress test was performed and the electron beam CT-based CAC-Agatston score was quantified.

Results

Exercise capacity, chronotropic response and an abnormal HR recovery were significantly and inversely related to CAC scores in men and women in univariate unadjusted analysis. This association was diminished after adjustment for age and sex and further after adjustment for traditional risk factors. In multivariate analysis, chronotropic response in men [estimate (95% CI): 0.94 (0.91–0.97), P = 0.0005] and an abnormal HR recovery (<15 bpm after 1 min) in women [estimate: 1.34 (1.07–1.70), P = 0.013] but not exercise capacity remained associated with CAC independent of traditional RF. In subjects not taking lipid-lowering, antiarrhythmic or antihypertensive drugs, estimates for the observed associations were essentially unchanged. The clinical ability of these variables to predict a high CAC score was limited.

Conclusion

The strong inverse association of exercise capacity, chronotropic response and abnormal HR recovery during exercise stress testing with the CAC burden in unadjusted univariate analysis is largely influenced by age, sex and cardiovascular RFs. The degree, to which exercise stress-test variables and the CAC burden independently contribute to the prediction of cardiovascular events, remains to be shown.

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Acknowledgments

We thank the Heinz Nixdorf Foundation, Germany, for their generous support of this study. This study is also supported by the German Ministry of Education and Science (BMBF), and the German Aerospace Center [Deutsches Zentrum für Luft- und Raumfahrt (DLR)], Bonn, Germany. GE Medical Systems provided hardware and technical help for acquisition of stress-ECG data and we thank Sebastian Gabler and Marvin Bovensiepen for their help in collecting the data. An additional research grant was received from Imatron Inc., South San Francisco, CA, which produced the EBCT scanners, and GE Imatron, South San Francisco, CA, after the acquisition of Imatron Inc. We are indebted to the all study participants and to the dedicated personnel of both the study centre of the Heinz Nixdorf Recall Study and the EBT-scanner facilities as well as to the investigative group.

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Authors and Affiliations

  1. Department of Cardiology, West-German Heart Center Essen, University Clinic Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany

    Stefan Möhlenkamp, Marcus Bauer, Hagen Kälsch & Raimund Erbel

  2. Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Essen, Germany

    Nils Lehmann, Ulla Roggenbuck, Susanne Moebus, Barbara Hoffmann & Karl-Heinz Jöckel

  3. Cardioangiological Center Bethanien (CCB), Frankfurt, Germany

    Axel Schmermund

  4. Institute of Medical Sociology, University Clinic Düsseldorf, Düsseldorf, Germany

    Nico Dragano

  5. Institute of Clinical Epidemiology, Medical Faculty, University Halle-Wittenberg, Halle, Germany

    Andreas Stang

  6. Division of Laboratory Research, Department of Endocrinology, University Clinic Essen, Essen, Germany

    Martina Bröcker-Preuss & Klaus Mann

  7. Klinik für Innere Medizin III & Kardiologie, Homburg/Saar, Germany

    Michael Böhm

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  1. Stefan Möhlenkamp
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Correspondence to Stefan Möhlenkamp.

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Möhlenkamp, S., Lehmann, N., Schmermund, A. et al. Association of exercise capacity and the heart rate profile during exercise stress testing with subclinical coronary atherosclerosis: data from the Heinz Nixdorf Recall study. Clin Res Cardiol 98, 665–676 (2009). https://doi.org/10.1007/s00392-009-0054-9

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