Comparison of the chronotropic response to exercise and heart rate recovery in predicting cardiovascular mortality
Key result
Chronotropic incompetence predicted cardiovascular mortality more strongly than abnormal heart rate recovery (HR 2.8, 95% CI 1.7-4.8 vs HR 2.0, 95% CI 1.1-3.5).
Why the study?
Does chronotropic incompetence or abnormal heart rate recovery better predict cardiovascular mortality in male veterans undergoing exercise testing?
Population
1910 male veterans referred for routine symptom-limited exercise treadmill tests at the Palo Alto Veterans…
Comparison
Chronotropic incompetence and abnormal heart… vs Normal chronotropic response and normal heart…
Design
Cohort
Follow-up
mean 5.1+/-2.1 years
Authors
Discussion
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Member takes
Implication
Supports prioritizing chronotropic incompetence in exercise testing for CV risk stratification in veterans; observational data leaves open prospective validation.
Study Design
Type
Cohort (n=1,910)
Multicenter
No
Structured PICO
Does chronotropic incompetence or abnormal heart rate recovery better predict cardiovascular mortality in male veterans undergoing exercise testing?
P
Population
1910 male veterans referred for routine symptom-limited exercise treadmill tests at the Palo Alto Veterans Affairs Medical Center from 1992 to 2002
I
Intervention
Chronotropic incompetence (inability to achieve ≥80% of heart rate reserve) and abnormal heart rate recovery (decrease of <22 beats/min at 2 min in recovery)
C
Comparator
Normal chronotropic response and normal heart rate recovery
O
Outcome
Cardiovascular mortalityhard clinical
Main Result
Effect estimate: HR 2.8 (95% CI 1.7-4.8)
Chronotropic incompetence is a stronger predictor of cardiovascular mortality than heart rate recovery, but their combination provides the most powerful risk stratification during exercise testing.
Cite This Study
Myers et al. (2007) conducted a cohort in Patients referred for exercise testing (n=1,910). Chronotropic incompetence vs. Normal chronotropic response was evaluated on Cardiovascular mortality (HR 2.8, 95% CI 1.7-4.8). Chronotropic incompetence predicted cardiovascular mortality more strongly than abnormal heart rate recovery (HR 2.8, 95% CI 1.7-4.8 vs HR 2.0, 95% CI 1.1-3.5).