Prognostic Value of Heart Rate Reserve during Dipyridamole Stress Echocardiography in Patients With Abnormal Chronotropic Response to Exercise
Section snippets
Methods
The study population was made by 379 patients showing chronotropic incompetence during upright bicycle exercise-electrocardiography defined as HRR used [(peak HR - rest HR) / (220 - age) - rest HR] ≤80% if tested off and ≤62% if tested on beta-blockers.1,7 The cut-off of <62% was chosen on the basis of previous data showing that this value predicted death in patients taking beta-blockers, irrespective of the drug taken (atenolol or metoprolol) and number of half-lives elapsed since the last
Results
The main clinical, exercise, and echocardiographic characteristics of the study patients are described in Table 1.
After dipyridamole, inducible RWMA were present in 25 (7%) cases. Heart rate significantly increased (from 68 ± 11 at rest to 91 ± 18 at peak of stress; p < 0.0001). HRR during DSE was normal (>1.22) in 275 (73%) and abnormal (≤1.22) in 104 patients (27%). Patients with impaired HRR showed higher heart rate at rest (p = 0.02) and lower heart rate at peak pf stress (p < 0.0001) than
Discussion
In patients with chronic CCS and exercise testing with inadequate chronotropic response referred to DSE, a blunted HRR predicts survival better than, and independently of, inducible ischemia. The value of HRR during DSE was previously shown,6 but the present study expands the previous observations in the subgroup with inadequate chronotropic response during exercise. The mechanism of reduced HRR reserve during dipyridamole is likely due to an increased resting adrenergic tone mirrored by
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The Authors have no conflict of interest to disclose