Independent contribution of myocardial perfusion defects to exercise capacity and heart rate recovery for prediction of all-cause mortality in patients with known or suspected coronary heart disease

Value of Exercise Capacity and Heart Rate Recovery in Older People

“…Characteristics of patients in this exercise stress database, whether younger than 65 or aged 65 and older, have been published previously. [8][9][10][11] The Cleveland Clinic Foundation Institutional Review Board approved the research analysis, and informed consent for testing was obtained from all patients.…”

“…11 Functional capacity was defined as estimated peak exercise workload expressed in metabolic equivalents. 6,7,10,11 Impaired functional capacity was defined as peak exercise workload in the lowest quintile per prespecified strata of age and sex. Thus, functional capacity for men younger than 70, 70 to 74, 75 to 79, and 80 and older was considered impaired if it was 6.2, 5.6, 4.9, or 4.0 metabolic equivalents or less, respectively.…”

“…Although all exercise variables were considered, functional capacity and heart rate recovery were considered the primary predictive variables of interest because they can be interpreted irrespective of baseline electrocardiographic findings and use or nonuse of beta-blockers. 10 The association of these variables, along with potential confounders and effect modifiers, with all-cause mortality were tested using Kaplan-Meier plots, 16 log-rank chi-square statistics, and Cox proportional hazards analyses. 17 The Cox proportional hazards assumption was verified by examination of weighted Schoenfeld residuals and by testing of timedependent interaction covariates.…”

“…5 Recent studies demonstrate that exercise-testing data have powerful prognostic properties, particularly when attention is paid to functional capacity 7 and exercise heart rate dynamics. [8][9][10] This study focused on the prognostic properties of exercise capacity and heart rate recovery in a large, single-center cohort of older men and women referred for exercise testing.…”

Abnormal Heart Rate Recovery in Stable Heart Failure Patients

“…[1][2][3][4] Moreover, delayed HRR measured up to 2 minutes after maximal exercise has been suggested to predict all-cause mortality. 5,6 In normal individuals, cardiac output goes up by an increase in heart rate and stroke volume during exercise test. The increase in heart rate is caused by the disappearance of vagal tonus and dominance of sympathetic tonus.…”