Exercise Capacity and Heart Rate Responses to Exercise as Predictors of Short-Term Outcome Among Patients With Stable Coronary Artery Disease

Kiviniemi, Antti M.; Lepojärvi, Samuli; Kenttä, Tuomas; Junttila, Juhani; Perkiömäki, Juha S.; Piira, Olli-Pekka; Ukkola, Olavi; Hautala, Arto J.; Tulppo, Mikko P.; Huikuri, Heikki V.

doi:10.1016/j.amjcard.2015.08.014

Cited by 14 publications

(13 citation statements)

References 31 publications

(27 reference statements)

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“…Exercise capacity is strongly associated in health outcomes in various populations, thus, being a most potent factor explaining the association between cardiovascular risk and LTPA 10,[21][22][23] . In the present study, inclusion of basal exercise capacity in the regression model considerably decreased the significance of association between the changes in LTPA and cardiac mortality.…”

Section: Discussionmentioning

confidence: 99%

“…An incremental symptom-limited maximal exercise test on a bicycle ergometer started at 30 W, and the work rate was increased by 15 W in men and 10 W in women every minute until voluntary exhaustion. Exercise was calculated as metabolic equivalents (METs) from the mean workload during the last minute of the test and normalized according to age and sex 10 . SYNTAX score before and after revascularization preceding enrolment (SYNTAX Score website, version 2.11, http://www.syntaxscore.com).…”

Section: Methodsmentioning

confidence: 99%

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Effect of Changes in Physical Activity on Risk for Cardiac Death in Patients With Coronary Artery Disease

Lahtinen

Toukola

Junttila

et al. 2018

The American Journal of Cardiology

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Leisure-time physical activity (LTPA) is associated with longevity in patients with coronary artery disease (CAD). However, less is known about prognostic significance of longitudinally assessed LTPA in patients with stable CAD. The present study assessed the relationship between changes in LTPA and cardiac mortality in patients with CAD. Patients with angiographically documented CAD (n = 1,746) underwent clinical examination and echocardiography at the baseline. Lifestyle factors, including LTPA (inactive, irregularly active, active, highly active), were surveyed at baseline and after 2 years' follow-up. Thereafter, the patients entered the follow-up (median: 4.5 years; first to third quartile: 3.4 to 5.8 years) during which cardiac deaths were registered (n = 68, 3.9%). The patients who remained inactive (n = 114, 18 events, 16%) and became inactive (n = 228, 18 events, 8%) had 7.6- (95% confidence interval [CI] 4.2 to 13.6) and 3.7-fold (95% CI 2.1 to 6.7) univariate risk for cardiac death compared with those who remained at least irregularly active (n = 1,351, 30 events, 2%), respectively. After adjustment for age, gender, body mass index, diabetes, previous myocardial infarction, left ventricular ejection fraction, angina pectoris grading, cardiovascular event during initial 2-year follow-up, smoking and alcohol consumption, the patients who remained inactive and became inactive still had 4.9- (95% CI 2.4 to 9.8, p <0.001) and 2.4-fold (95% CI 1.3 to 4.5, p <0.01) risk for cardiac death, respectively, compared with patients remaining at least irregularly active. In conclusion, LTPA has important prognostic value for cardiac death in patients with stable CAD. Even minor changes in LTPA over 2 years were related to the subsequent risk for cardiac death.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Effect of Changes in Physical Activity on Risk for Cardiac Death in Patients With Coronary Artery Disease

Lahtinen

Toukola

Junttila

et al. 2018

The American Journal of Cardiology

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“…Predictive value of RPP response to exercise has been reported in patients with diabetes and known or suspected CAD, albeit not independently of other factors [9]. Delayed heart rate (HR) recovery (HRR) is associated with impaired prognosis in patients with CAD [10][11][12] and T2D [13,14]. Also, high systolic blood pressure (SBP) during recovery has been associated with risk for cardiovascular morbidities without assessment of the SBP change during recovery in these studies [15][16][17].…”

Section: Introductionmentioning

confidence: 81%

“…Characteristics of patients with coronary disease and type 2 diabetes according to specific endpoint-groups. Resting heart rate (bpm) 64 (10) 65 (11) 65 (11) Resting systolic blood pressure (mmHg) 148 (24) 143 (24) 143 (25) Resting diastolic blood pressure (mmHg) 81 (12) 80 (11) 74 12 Hazard ratio per…”

mentioning

confidence: 99%

Recovery of rate-pressure product and cardiac mortality in coronary artery disease patients with type 2 diabetes

Kiviniemi

Kenttä

Lepojärvi

et al. 2019

Diabetes Research and Clinical Practice

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Aims: To investigate prognostic significance of post-exercise recovery of rate-pressure product (RPP) in patients with stable coronary artery disease (CAD) and type 2 diabetes (T2D). Methods: Patients with angiographically documented CAD and T2D (n=697) underwent symptomlimited bicycle exercise test. Exercise capacity (EC), heart rate, blood pressure and RPP responses to peak exercise and recovery (2' and 5' after cessation of exercise) were analyzed. Cardiac death was the primary and sudden cardiac death (SCD) secondary endpoint. Results: During a median follow-up of 76 months, 49 cardiac deaths (7.0%) and 28 SCDs (4.0%) were observed. The recovery of RPP at 5' was the strongest univariate predictor of cardiac death (hazard ratio [HR]: 2.55 per SD decrease, 95%CI: 1.82-3.58, p<0.001) and SCD (HR: 2.34, 95%CI: 1.51-3.62, p<0.001). In multivariate analysis, it remained significantly associated to cardiac death and SCD

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“…Similarly, in our study population, approximately 80% of all SCDs occurred among subjects with LVEF >35%. Previously, the combination of reduced CRF and HRR has been shown to predict cardiovascular death and hospitalisation due to congestive heart failure despite LVEF 18. HRR has been also shown to associate with mortality independently of angiographic severity of CAD which is the underlying condition in most SCD cases and a significant contributor to LVEF reduction in the post-MI setting 19.…”

Section: Discussionmentioning

confidence: 99%

Cardiorespiratory fitness and heart rate recovery predict sudden cardiac death independent of ejection fraction

Hernesniemi

Sipilä

Tikkakoski

et al. 2019

Heart

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ObjectiveTo evaluate whether cardiorespiratory fitness (CRF) and heart rate recovery (HRR) associate with the risk of sudden cardiac death (SCD) independently of left ventricular ejection fraction (LVEF).MethodsThe Finnish Cardiovascular Study is a prospective clinical study of patients referred to clinical exercise testing in 2001–2008 and follow-up until December 2013. Patients without pacemakers undergoing first maximal or submaximal exercise testing with cycle ergometer were included (n=3776). CRF in metabolic equivalents (METs) was estimated by achieving maximal work level. HRR was defined as the reduction in heart rate 1 min after maximal exertion. Adjudication of SCD was based on death certificates. LVEF was measured for clinical indications in 71.4% of the patients (n=2697).ResultsPopulation mean age was 55.7 years (SD 13.1; 61% men). 98 SCDs were recorded during a median follow-up of 9.1 years (6.9–10.7). Mean CRF and HRR were 7.7 (SD 2.9) METs and 25 (SD 12) beats/min/min. Both CRF and HRR were associated with the risk of SCD in the entire study population (HRCRF0.47 (0.37–0.59), p<0.001 and HRHRR0.57 (0.48–0.67), p<0.001 with HR estimates corresponding to one SD increase in the exposure variables) and with CRF, HRR and LVEF in the same model (HRCRF0.60 (0.45–0.79), p<0.001, HRHRR0.65 (0.51–0.82), p<0.001) or adjusting additionally for all significant risk factors for SCD (LVEF, sex, creatinine level, history of myocardial infarction and atrial fibrillation, corrected QT interval) (HRCRF0.69 (0.52–0.93), p<0.01, HRHRR0.74 (0.58–0.95) p=0.02).ConclusionsCRF and HRR are significantly associated with the risk of SCD regardless of LVEF.

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Exercise Capacity and Heart Rate Responses to Exercise as Predictors of Short-Term Outcome Among Patients With Stable Coronary Artery Disease

Cited by 14 publications

References 31 publications

Effect of Changes in Physical Activity on Risk for Cardiac Death in Patients With Coronary Artery Disease

Effect of Changes in Physical Activity on Risk for Cardiac Death in Patients With Coronary Artery Disease

Recovery of rate-pressure product and cardiac mortality in coronary artery disease patients with type 2 diabetes

Cardiorespiratory fitness and heart rate recovery predict sudden cardiac death independent of ejection fraction

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