Coronary Artery DiseasePrognostic Contribution of Exercise Capacity, Heart Rate Recovery, Chronotropic Incompetence, and Myocardial Perfusion Single-Photon Emission Computerized Tomography in the Prediction of Cardiac Death and All-Cause Mortality
Section snippets
Methods
We identified 11,218 consecutive patients who underwent exercise MPS from 1991 to 1999 at Cedars-Sinai Medical Center, had no history of valvular heart disease, were not under the influence of β blockers at the time of the exercise study, and did not undergo early revascularization, defined as revascularization <90 days after exercise testing. Institutional review board approval was obtained for the performance of this research. Data regarding the presence of hypertension, diabetes mellitus,
Results
The baseline and stress test characteristics of the 11,218 patients enrolled in this study are summarized on the basis of EC in Tables 1 and 2. The most common reason for testing was abnormal treadmill exercise test (35%), followed by reported presence of CAD by primary physician (22.5%), unstable angina (16.6%), abnormal ECG at rest (15%), preoperative evaluation (5.9%), and history of arrhythmia (5.4%). Patients with poor exercise tolerance had greater SSS, SRS, and SDS (all p <0.001). Women
Discussion
In this study, we have demonstrated for the first time that EC, CI as assessed by %HR reserve, and abnormal HR recovery are independent predictors of and add incremental value in the prediction of ACM and CD over traditional cardiovascular risk factors and comprehensive assessment MPS abnormalities. Previously, EC, %HR reserve, and HR recovery have shown incremental value over dichotomized MPS (normal/abnormal) in ACM prediction10; however, added value has not been examined regarding extent and
Disclosures
The authors have no conflicts of interest to disclose.
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