Coronary artery diseasePredictive Value of Heart Rate Recovery and Peak Oxygen Consumption for Long-Term Mortality in Patients With Coronary Heart Disease
Section snippets
Methods
The Institutional Review Board of the Mayo Clinic, Rochester, Minnesota approved the study protocol. The study population consisted of a cohort of consecutive patients with stable CHD who entered the Phase II cardiac rehabilitation program at the Mayo Clinic, Rochester from July 1, 1992 through June 30, 1995 and ultimately performed cardiopulmonary exercise testing at the completion of the program. All patients were clinically stable without evidence of uncontrolled hypertension, unstable or
Results
A total of 388 patients with CHD entered cardiac rehabilitation during the study period. Of these patients, 282 (73%) with defined CHD were included in the analyses. Exclusions included failure to complete the program (n = 53), an inability to perform maximal cardiopulmonary exercise testing (n = 21), and the need for a nuclear imaging test at program conclusion (n = 32). The program length for those performing cardiopulmonary exercise testing was 53 ± 28 days. The clinical characteristics are
Discussion
This long-term follow-up study evaluated the relationship among peak VO2, abnormal HR recovery after exercise, and total mortality in a cohort of patients with stable CHD completing Phase II cardiac rehabilitation. The principal finding of our study was that despite a mild correlation between HR recovery and peak VO2, HR recovery provided additional prognostic value to the exercise test beyond the powerful influence of peak VO2 in patients with stable CHD. HR recovery is of potentially greater
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Cited by (22)
Added value of exercise test findings beyond traditional risk factors for cardiovascular risk stratification
2019, International Journal of CardiologyCitation Excerpt :Although the CIs overlap, the differences in the HRs were not statistically significant. Numerous papers have reported that low FAC and abnormal heart rate recovery are independently associated with increased HRs for total and CV death [12,21–28], including studies from our institution [21,29,30]. Aijaz et al. [21] studied results for patients who had treadmill exercise tests between 1993 and 2003 and found that multiple exercise test abnormalities might constitute a “CV disease risk equivalent,” with a long-term mortality rate equal to that of patients with CV disease without TMET abnormalities.
The prognostic value of heart rate recovery in patients with coronary artery disease: A systematic review and meta-analysis
2018, American Heart JournalCitation Excerpt :First, heterogeneity did not allow pooling of individual-level patient data. Second, in one of the studies, the unadjusted hazard ratio was not available even after contacting the authors.22 Third, there was heterogeneity in covariates, study outcome, and exercise and recovery protocols such as the application of either treadmill testing or the cycle ergometer to measure HRR in the included studies.
Echocardiographic determinants of peak aerobic capacity and breathing efficiency in patients with undifferentiated dyspnea
2014, American Journal of CardiologyCitation Excerpt :A VE/VCO2 nadir of ≥33 was considered abnormal.12,13 A previous study from our institution showed a curvilinear relation between mortality and peak VO2 and identified increased mortality for a peak VO2 of <19 ml/kg/min in men and <15 ml/kg/min in women.14 Therefore, peak VO2 <19 ml/kg/min in men and <15 ml/kg/min in women was considered “low VO2.”
Cardiopulmonary responses to exercise and its utility in patients with aortic stenosis
2014, American Journal of CardiologyCitation Excerpt :Kaplan-Meier survival curves after dividing patients based on absolute peak VO2 cutoff of 19 ml/kg/min for men and 15 ml/kg/min for women, age and gender–adjusted peak VO2 of ≥80% or <80%, and oxygen pulse cutoff of 13 ml/beat for men and 11 ml/beat for women are shown in Figure 2. Absolute peak VO2 cut-off values of ≥19 ml/kg/min for men and ≥15 ml/kg/min for women and oxygen pulse cut-off values of ≥13 ml/beat for men and ≥11 ml/beat for women were used based on previously reported normal values, which also approximately dichotomize the cohort.4,14 In 83 patients who did not undergo AVR, higher peak VO2 was associated with better survival (HR 0.83, 95% CI 0.71 to 0.97, p = 0.024) during the follow-up period of 4.5 ± 4.2 years.