Abnormal heart rate recovery (HRR) after maximal exercise treadmill testing predicts
adverse cardiac outcomes, although whether abnormal HRR on exercise treadmill testing
should prompt further diagnostic cardiac testing is unknown. The aim of this study
was to determine the prevalence of high-risk stress single-photon emission computed
tomography myocardial perfusion imaging (MPI) findings in patients with abnormal HRR.
A total of 509 men who had been referred for exercise stress MPI and were without
other abnormal exercise treadmill testing findings (ischemic electrocardiographic
changes or exercise treadmill testing–induced angina) were included in this study.
Abnormal HRR was defined as a decrease in heart rate ≤12 beats at 1 minute after maximal
exercise. Overall, 11% had abnormal HRR. Patients with abnormal HRR had significantly
more mild or greater coronary heart disease (summed stress score [SSS] ≥4, 49% vs
27%; p = 0.001), severe coronary heart disease (SSS >8, 36% vs 7%; p <0.001), left
ventricular (LV) dysfunction (LV ejection fraction <50%; 25% vs 6%; p <0.001), and
composite high-risk MPI findings (SSS >8 or LV ejection fraction <40%; 40% vs 9%;
p <0.001) compared with those without abnormal HRR. On multivariate logistic regression
analysis, abnormal HRR was found to be an independent predictor of mild or greater
coronary heart disease (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.4 to 4.3,
p = 0.003), severe coronary heart disease (OR 5.5, 95% CI 2.7 to 11.0, p <0.001),
and composite high-risk MPI findings (OR 4.3, 95% CI 2.1 to 8.6, p <0.001). In conclusion,
abnormal HRR on exercise treadmill testing was associated with a high prevalence of
abnormal and high-risk stress MPI findings, even in patients without other exercise
treadmill testing findings that traditionally would prompt further testing. These
findings suggest that further testing with stress MPI should be considered in patients
with abnormal HRR on routine exercise treadmill testing.
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Article info
Publication history
Published online: January 12, 2009
Accepted:
November 9,
2008
Received in revised form:
November 9,
2008
Received:
September 26,
2008
Footnotes
The database used study in this study was collected with the support of an unrestricted independent medical grant from Pfizer Pharmaceuticals, New York, New York.
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
