Coronary artery disease| Volume 103, ISSUE 5, P611-614, March 01, 2009

Usefulness of Abnormal Heart Rate Recovery on Exercise Stress Testing to Predict High-Risk Findings on Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging in Men

Published:January 12, 2009DOI:
      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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        • Barron H.V.
        • Lesh M.D.
        Autonomic nervous system and sudden cardiac death.
        J Am Coll Cardiol. 1996; 27: 1053-1060
        • Sandvik L.
        • Erikssen J.
        • Ellestad M.
        • Erikssen G.
        • Thaulow E.
        • Mundal R.
        • Rodahl K.
        Heart rate increase and maximal heart rate during exercise as predictors of cardiovascular mortality: a 16-year follow-up study of 1960 healthy men.
        Coron Artery Dis. 1995; 6: 667-679
        • Cole C.R.
        • Blackstone E.H.
        • Pashkow F.J.
        • Snader C.E.
        • Lauer M.S.
        Heart rate recovery immediately after exercise as a predictor of mortality.
        N Engl J Med. 1999; 341: 1351-1357
        • Nishime E.O.
        • Cole C.R.
        • Blackstone E.H.
        • Pashkow F.J.
        • Lauer M.S.
        Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG.
        JAMA. 2000; 284: 1392-1398
        • Klocke F.J.
        • Baird M.G.
        • Lorell B.H.
        • Bateman T.M.
        • Messer J.V.
        • Berman D.S.
        • O'Gara P.T.
        • Carabello B.A.
        • Russell Jr., R.O.
        • Cerqueira M.D.
        • et al.
        ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging).
        Circulation. 2003; 108: 1404-1418
        • Vivekananthan D.P.
        • Blackstone E.H.
        • Pothier C.E.
        • Lauer M.S.
        Heart rate recovery after exercise is a predictor of mortality, independent of the angiographic severity of coronary disease.
        J Am Coll Cardiol. 2003; : 42831-42838
        • Hansen C.L.
        • Goldstein R.A.
        • Berman D.S.
        • Churchwell K.B.
        • Cooke C.D.
        • Corbett J.R.
        • Cullom S.J.
        • Dahlberg S.T.
        • Galt J.R.
        • Garg R.K.
        • et al.
        • Quality Assurance Committee of the American Society of Nuclear Cardiology
        Myocardial perfusion and function single photon emission computed tomography.
        J Nucl Cardiol. 2006; 13: e97-e120
        • Ellestad M.H.
        Chronotropic incompetence.
        Circulation. 1996; 93: 1485-1487
        • Arai Y.
        • Saul J.P.
        • Albrecht P.
        • Hartley L.H.
        • Lilly L.S.
        • Cohen R.J.
        • Colucci W.S.
        Modulation of cardiac autonomic activity during and immediately after exercise.
        Am J Physiol. 1989; 256: H132-H141
        • Imai K.
        • Sato H.
        • Hori M.
        • Kusuoka H.
        • Ozaki H.
        • Yokoyama H.
        • Takeda H.
        • Inoue M.
        • Kamada T.
        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: 1529-1535
        • Lima R.S.
        • De Lorenzo A.
        • Soares A.J.
        Relation between postexercise abnormal heart rate recovery and myocardial damage evidenced by gated single-photon emission computed tomography.
        Am J Cardiol. 2006; 97: 1452-1454
        • Hachamovitch R.
        • Berman D.S.
        • Kiat H.
        • Cohen I.
        • Cabico J.A.
        • Friedman J.
        • Diamond G.A.
        Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification.
        Circulation. 1996; 93: 905-914
        • Hachamovitch R.
        • Berman D.S.
        • Shaw L.J.
        • Kiat H.
        • Cohen I.
        • Cabico J.A.
        • Friedman J.
        • Diamond G.A.
        Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction.
        Circulation. 1998; 97: 535-543