Exercise heart rate gradient: A novel index to predict all-cause mortality

Duarte, Carlos Vieira; Myers, Jonathan; Araújo, Cláudio Gil Soares de

doi:10.1177/2047487314520784

Cited by 12 publications

(8 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It was further demonstrated that an index combining HR reserve and HRR, termed as exercise HR gradient, is a better indicator of mortality risk than either response alone. 39 However, the exercise HR gradient score was defined according to the summing of quintiles of both HR measures, and is less intuitive for routine clinical application. Collectively, these findings provide evidence for the prognostic interplay of HR response to exercise and recovery, in addition to CRF, aiming to more effectively stratify the risk for future CVD events and mortality during ET.…”

Section: Discussionmentioning

confidence: 99%

Heart Rate Response to Exercise and Recovery

Tabachnikov

Saliba

Aker

et al. 2022

Journal of Cardiopulmonary Rehabilitation and Prevention

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Heart Rate Response to Exercise and Recovery

Tabachnikov

Saliba

Aker

et al. 2022

Journal of Cardiopulmonary Rehabilitation and Prevention

View full text Add to dashboard Cite

show abstract

“…Considering our previous studies, it is worth adding a comment regarding two other CPX variables – exercise heart rate gradient (56) and maximal oxygen pulse,(57, 58) both previously shown to be associated with all-cause mortality and in principle could have been predictors of mortality in the current study. However, a more recent study has shown that the exercise heart rate gradient was not useful to predict mortality in patients using ß-blockers (59), as was the case for 56% of our participants, and its use was discarded for this study.…”

Section: Discussionmentioning

confidence: 83%

Mortality during the COVID-19 pandemic: findings from the CLINIMEX exercise cohort in the year of 2020

Araújo¹,

Cg²,

Clb³

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

Background and Objective: The COVID-19 pandemic has heavily hit Brazil and, in particular, our Clinic's current location in Copacabana, Rio de Janeiro city, where, as of mid-February 2021, resulting in one 1 death per 266 inhabitants. After having recently updated the vital status and mortality data in our exercise population (CLINIMEX cohort), we hypothesized that reviewing their evaluation reports would offer a unique opportunity to unearth some relevant information about the association between selected variables assessed in our comprehensive Exercise Medicine evaluation protocol; in particular, aerobic and musculoskeletal (MUSK) fitness, clinical variables, and death due to COVID-19. Methods: A retrospective study using data from the CLINIMEX cohort that included 6,101 non-athletic men and women aged >30 years who were alive as of March 12th, 2020 and who's vital status was followed up to December 14th, 2020. For data analysis, two approaches were used: 1) comparison of frequency of deaths and relative % of underlying causes of death between the last 18-months pre-pandemic and 9-month pandemic periods; and 2) data from 51 variables from the participant's most recent evaluation, including sex, age and clinical profile plus other variables obtained from physical examination, spirometry, (MUSK) fitness (e.g., sitting-rising test) and maximal cycling leg cardiopulmonary testing (e.g. maximal VO2 and cardiorespiratory optimal point) were selected for comparison between groups of non-COVID-19 and COVID-19 deaths. Results: Age at death varied from 51 to 102 years [mean = 80 years]. Only 4 participants that died, 3 COVID-19 and 1 non-COVID-19, were healthy at the time of their evaluation [p=.52]. COVID-19 was the most frequent (n=35; 36.5%) cause among the 96 deaths during this 9-month period. Comparing pre-pandemic and pandemic periods, there was a 35% increase in deaths and proportionately fewer deaths due to neoplasia and other causes but not from cardiovascular or endocrine diseases. Results of aerobic and MUSK fitness tests indicated that the majority of the study participants were relatively unfit when compared to available age and sex-reference values. Indeed, there were few differences in the 51 selected variables between the two groups, suggesting a somewhat healthier profile among COVID-19 death participants; lower body mass index [p=.04], higher % of predicted forced vital capacity [p=.04], lower number of previous percutaneous coronary interventions [p=.04] and lower resting supine diastolic blood pressure [p=.03], with no differences for aerobic/MUSK fitness variables or past history of exercise/sports [p>.05]. Conclusion: Our data support that COVID-19 was a frequent and premature cause of death in a convenience sample of primarily white, unhealthy, middle-age and elderly individuals and that data from exercise/sport history and physical fitness testing obtained some years earlier were unable to distinguish non-COVID-19 and COVID-19 deaths.

show abstract

“…A series of sensitivity analyses were conducted to assess whether the predictive ability of the M-DASI would change after: (a) combining gender (given that males may have a higher average exercise capacity); (b) removing the question on the ability to have sexual relations (given the potential sensitivity of the question to patients); (c) analysing for a satisfactory peak HR response to exercise (given the importance of chronotropic response to predicting perioperative complications 23 and longevity 24 ); or (d) adding ASA physical status (allowing comorbid disease to be factored into the score). All statistical analyses were conducted using MedCalc Statistical Software (version 18.11.3, Ostend, Belgium) and SPSS for Windows (version 23, IBM, Chicago, IL, USA), taking a two-sided alpha-error <0.05 as statistically significant.…”

Section: Discussionmentioning

confidence: 99%

A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study

Lee

Cuthbertson

et al. 2021

British Journal of Anaesthesia

View full text Add to dashboard Cite

Background: Accurate assessment of functional capacity, a predictor of postoperative morbidity and mortality, is essential to improving surgical planning and outcomes. We assessed if all 12 items of the Duke Activity Status Index (DASI) were equally important in reflecting exercise capacity. Methods: In this secondary cross-sectional analysis of the international, multicentre Measurement of Exercise Tolerance before Surgery (METS) study, we assessed cardiopulmonary exercise testing and DASI data from 1455 participants. Multivariable regression analyses were used to revise the DASI model in predicting an anaerobic threshold (AT) >11 ml kg À1 min À1 and peak oxygen consumption (VO 2 peak) >16 ml kg À1 min À1 , cut-points that represent a reduced risk of postoperative complications. Results: Five questions were identified to have dominance in predicting AT>11 ml kg À1 min À1 and VO 2 peak>16 ml.kg À1 min À1 . These items were included in the M-DASI-5Q and retained utility in predicting AT>11 ml.kg À1 .min À1 (area under the receiver-operating-characteristic [AUROC]-AT: M-DASI-5Q¼0.67 vs original 12-question DASI¼0.66) and VO 2 peak (AUROC-VO2 peak: M-DASI-5Q 0.73 vs original 12-question DASI 0.71). Conversely, in a sensitivity analysis we removed one potentially sensitive question related to the ability to have sexual relations, and the ability of the remaining four questions (M-DASI-4Q) to predict an adequate functional threshold remained no worse than the original 12-question DASI model. Adding a dynamic component to the M-DASI-4Q by assessing the chronotropic response to exercise improved its ability to discriminate between those with VO 2 peak>16 ml.kg À1 .min À1 and VO 2 peak<16 ml.kg À1 .min À1 . Conclusions: The M-DASI provides a simple screening tool for further preoperative evaluation, including with cardiopulmonary exercise testing, to guide perioperative management.

show abstract

Exercise heart rate gradient: A novel index to predict all-cause mortality

Abstract: EHRG, a novel index combining HR reserve and HR recovery, is a better indicator of mortality risk than either response alone.

Cited by 12 publications

References 31 publications

Heart Rate Response to Exercise and Recovery

Heart Rate Response to Exercise and Recovery

Mortality during the COVID-19 pandemic: findings from the CLINIMEX exercise cohort in the year of 2020

A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study

Contact Info

Product

Resources

About