Coronary artery disease
Predictive Value of Heart Rate Recovery and Peak Oxygen Consumption for Long-Term Mortality in Patients With Coronary Heart Disease

https://doi.org/10.1016/j.amjcard.2009.02.013Get rights and content

Poor exercise capacity and abnormal heart rate (HR) recovery during exercise testing predict poor long-term outcomes. The relationship between these parameters in patients with coronary heart disease (CHD) is unknown. Whether abnormal HR recovery adds to the prognostic value of poor exercise capacity in patients with CHD is unclear. A total of 282 patients (17% women) with stable CHD underwent cardiopulmonary treadmill testing at the end of Phase II cardiac rehabilitation and were followed for a mean of 9.8 ± 2.9 years. Cox proportional hazards regression with adjustment for low peak oxygen consumption ([peak VO2] <19 ml/kg/min for men, <15ml/kg/min for women), age, and gender was used to test the prognostic significance of HR recovery (HR recovery = peak − 1-minute after peak HR). HR recovery and peak VO2 correlated mildly (r = 0.35, p <0.001). Both an abnormal HR recovery (<13 beats/min) and a low peak VO2 were significantly associated with greater mortality in a model including age, gender, low peak VO2, and abnormal HR recovery (hazard ratio for abnormal HR recovery = 2.16, 95% confidence interval 1.14 to 4.09; hazard ratio for low peak VO2 = 3.63, 95% confidence interval 2.09 to 6.32). Despite a preserved peak VO2, the 10-year mortality rate was significantly greater in patients with a HR recovery of <13 beats/min compared with those with a HR recovery of ≥13 beats/min (13.6% vs 5.6%, respectively; p <0.05). In conclusion, in patients with stable CHD undergoing cardiac rehabilitation, the rate of HR recovery provides additional prognostic information beyond the peak VO2. An abnormal HR recovery identifies a subset of patients at intermediate risk despite a preserved peak VO2.

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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