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Titolo:
Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG
Autore:
Nishime, EO; Cole, CR; Blackstone, EH; Pashkow, FJ; Lauer, MS;
Indirizzi:
Cleveland Clin Fdn, Dept Cardiol, Clin Res & Exercise Lab, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 se Lab, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Cardiothorac Surg, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 c Surg, Cleveland, OH 44195 USA Cleveland Clin Fdn, Dept Biostat & Epidemiol, Cleveland, OH 44195 USA Cleveland Clin Fdn Cleveland OH USA 44195 demiol, Cleveland, OH 44195 USA
Titolo Testata:
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
fascicolo: 11, volume: 284, anno: 2000,
pagine: 1392 - 1398
SICI:
0098-7484(20000920)284:11<1392:HRRATE>2.0.ZU;2-8
Fonte:
ISI
Lingua:
ENG
Soggetto:
CORONARY-ARTERY DISEASE; MEDICALLY TREATED PATIENTS; CHRONOTROPIC INCOMPETENCE; PROGNOSTIC INFORMATION; MYOCARDIAL-INFARCTION; VITAL STATUS; DEATH; ASSOCIATION; SURVIVAL;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
33
Recensione:
Indirizzi per estratti:
Indirizzo: Lauer, MS Cleveland Clin Fdn, Dept Cardiol, Clin Res & Exercise Lab, Desk F25, Cleveland, OH 44195 USA Cleveland Clin Fdn Desk F25 Cleveland OH USA 44195 OH 44195 USA
Citazione:
E.O. Nishime et al., "Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG", J AM MED A, 284(11), 2000, pp. 1392-1398

Abstract

Context Both attenuated heart rate recovery following exercise and the Duke tread mill exercise score have been demonstrated to be independent predictors of mortality, belt their prognostic value relative to each other has not been studied. Objective To assess the associations among abnormal heart rate recovery, treadmill exercise score, and death in patients referred specifically for exercise electrocardiography. Design and Setting Prospective cohort study conducted in an academic medical center between September 1990 and December 1997, with a median follow-upof 5.2 years. Patients A total of 9454 consecutive patients (mean [SD] age, 53 [11] years; 78% male) who underwent symptom-limited exercise electrocardiographic testing. Exclusion criteria included age younger than 30 years, history of heart failure or valvular disease, pacemaker implantation, and uninterpretable electrocardiograms. Main Outcome Measures All-cause mortality, as predicted by abnormal heart rate recovery, defined as failure of heart rate to decrease by more than 12/min during the first minute after peak exercise, and by treadmill exercisescore, defined as (exercise time) - (5 x maximum ST-segment deviation) - (4 x treadmill angina index). Results Three hundred twelve deaths occurred in the cohort. Abnormal heartrate recovery and intermediate- or high-risk treadmill exercise score werepresent in 20% (n =1852) and 21% (n =1996) of patients. respectively. in univariate analyses, death was predicted by both abnormal heart rate recovery (8% vs 2% in patients with normal heart rate recovery; hazard ratio [HR],4.16; 95% confidence interval [CI], 3.33-5.19; chi(2)=158; P<.001) and intermediate- or high-risk treadmill exercise score (8% vs 2% in patients withlow-risk scores; HR, 4.28; 95% CI, 3.43-5.35; chi(2)=164; P<.001). After adjusting for age, sex, standard cardiovascular risk factors, medication use, and other potential confounders, abnormal heart rate recovery remained predictive of death (among the 8549 patients not taking p-blockers, adjusted HR, 2.13; 95% CI, 1.63-2.78; P<.001), as did intermediate- or high-risk treadmill exercise score (adjusted HR, 1.49, 95% CI, 2.15-1.92; P=.002). Therewas no interaction between these 2 predictors. Conclusions in this cohort of patients referred specifically for exercise electrocardiography, both abnormal heart rate recovery and treadmill exercise score were independent predictors of mortality. Heart rate recovery appears to provide additional prognostic information to the established treadmill exercise score and should be considered for routine incorporation into exercise test interpretation.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 29/09/20 alle ore 23:13:54