Factors Affect Heart Rate Recovery After Symptom-limited Exercise Stress Testing
Abstract
Background. Heart rate recovery (HRR) has been recognized as an inde-pendent predictor of mortality.Objective.To identify factors that may affect HRR in patient with un-known coronary artery disease (CAD).
Methods. This cross sectional study was performed in National Cardiac Center Harapan Kita. We reviewed the chart of patients with unknown CAD who underwent symptom-limited exercise stress testing for medical check up between January – December 2006. Factors that may influence HRR were recorded including current medications, peak exercise heart rate (HR), HR after 3-minute recovery, and the ischemic response to exer-cise. HRR was defined as the change in HR from peak exercise to 3-minute recovery. We further categorized patients to normal or abnormal HRR by using mean HRR as cut off value. All factors related to HRR and normal/abnormal categories were analyzed.
Results. There were 188 patients aged 48 + 11 years. HRR significantly influenced by male sex (p=0.003), hypertension (p=0.028), â-blocker (p=0.03), calcium channel blocker (p=0.008), aspirin (p<0.001), and pro-voked ischemia (p=0.005). Using mean HRR (57x) as cut off, patients were classified as having normal (HRR <57x) or abnormal (HRR ? 57x). On fur-ther analysis, there was significant association between age (p=0.003), male sex (p=0.02), hypertension (p=0.02), use of â-blocker (p=0.026) and aspirin (p<0.005).
Conclusion. In patients with unknown CAD who underwent symptom-limited exercise stress testing, HRR was influenced by age, male sex, hy-pertension, the presence of provoked ischemia, use of â-blocker, calcium channel blocker, and aspirin.
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References
Vivekananthan DP, Blackstone EH, Pothier CE, Lauer MS. Heart rate recovery after exercise is a predictor of mortality, independent of the angiographic severity of coronary disease. J Am Coll Cardiol 2003;42:831– 8.
Panzer C, Lauer MS, Brieke A, Blackstone E, Hoogwerf B. Association of fasting plasma glucose with heart rate recovery in healthy adults. A population-based study. Diabetes 2002;51:803–7.
Shetler K, Marcus R, Froelicher VF, Vora S, Kalisetti D, Prakash M, et al. Heart rate recovery: validation and methodologic issues. J Am Coll Cardiol 2001;38:1980 –7.
Shishehbor MH, Hoogwerf BJ, Lauer MS. Association of triglyceride–to–HDL cholesterol ratio with heart rate recovery. Diabetes Care 2007;27:936–41.
Watanabe J, Thamilarasan M, Blackstone EH, Thomas JD, Lauer MS. Heart rate recovery immediately after treadmill exercise and left ventricular systolic dysfunction as predictors of mortality. The case of stress echocardiography
Cole CR, Blackstone EH, Pashkow SJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Eng J Med 1999;341:1351-7.
Diaz LA, Brunken RC, Blackstone EH, Snader CE, Lauer MS. 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. J Am Coll Cardiol 2001;37:1558–64.
Cole CR, Foody JM, Blackstone EH, Lauer MS. Heart rate recovery after submaximal exercise testing as a predictor of mortality in a cardiovascularly hearlthy cohort. Ann Intern Med 2000;132:552-5.
Panzer C, Lauer MS, Brieke A, Blackstone E, Hoogwerf B. Association of fasting plasma glucose with heart rate recovery in healthy adults. A population-based study. Diabetes 2002;51:803–7.
Shetler K, Marcus R, Froelicher VF, Vora S, Kalisetti D, Prakash M, et al. Heart rate recovery: validation and methodologic issues. J Am Coll Cardiol 2001;38:1980 –7.
Shishehbor MH, Hoogwerf BJ, Lauer MS. Association of triglyceride–to–HDL cholesterol ratio with heart rate recovery. Diabetes Care 2007;27:936–41.
Watanabe J, Thamilarasan M, Blackstone EH, Thomas JD, Lauer MS. Heart rate recovery immediately after treadmill exercise and left ventricular systolic dysfunction as predictors of mortality. The case of stress echocardiography
Cole CR, Blackstone EH, Pashkow SJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Eng J Med 1999;341:1351-7.
Diaz LA, Brunken RC, Blackstone EH, Snader CE, Lauer MS. 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. J Am Coll Cardiol 2001;37:1558–64.
Cole CR, Foody JM, Blackstone EH, Lauer MS. Heart rate recovery after submaximal exercise testing as a predictor of mortality in a cardiovascularly hearlthy cohort. Ann Intern Med 2000;132:552-5.
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How to Cite
Pakpahan, H., Priyana, A., Basha, A., & Radi, B. (1). Factors Affect Heart Rate Recovery After Symptom-limited Exercise Stress Testing. Indonesian Journal of Cardiology, 28(5), 338-342. https://doi.org/10.30701/ijc.v28i5.219
Section
Clinical Research
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