European Heart Journal Advance Access originally published online on June 13, 2008
European Heart Journal 2008 29(15):1896-1902; doi:10.1093/eurheartj/ehn269
Chronotropic incompetence and mortality in middle-aged men with known or suspected coronary heart disease
1 Kuopio Research Institute of Exercise Medicine, Haapaniementie 16, 70100 Kuopio, Finland
2 Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
3 Information Technology Center, University of Kuopio, Kuopio, Finland
4 School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland
5 Lapland Central Hospital, Rovaniemi, Finland
6 Department of Physiology, Institute of Biomedicine, University of Kuopio, Kuopio, Finland
7 Oy Jurilab Ltd, Kuopio, Finland
Received 31 January 2008; revised 25 April 2008; accepted 29 May 2008; online publish-ahead-of-print 13 June 2008.
* Corresponding author. Tel: +358 17 2884422, Fax: +358 17 2884488, Email: savonen{at}hytti.uku.fi
Aims: The objective is to study whether a heart rate (HR) increase from 40 to 100% of maximal work capacity in the exercise test (HR40-100) independently predicts mortality in men with known or suspected coronary heart disease (CHD).
Methods and results: The subjects were 294 men, 42–61 years of age, from eastern Finland with known or suspected CHD but without use of HR-lowering medication at baseline. HR was measured at rest and during a maximal, symptom-limited exercise test. During an average follow-up of 11.0 years, there were 61 all-cause deaths. In Cox-multivariable model, mortality increased by 41% (95% confidence interval, 12–79%) with a 1-SD (15 b.p.m.) decrement in HR40-100. HR increase from rest to 40% of maximal work capacity was not associated with an increased risk of death. Synergism was observed between HR40-100 and workload achieved at HR of 100 b.p.m. so that men having low values for both these HR variables had a particularly adverse prognosis compared with men with high values for these variables.
Conclusion: An attenuated HR increase particularly during the latter half of a maximal exercise test is an independent predictor of death in men with known or suspected CHD.
Key Words: Exercise testing • Heart rate • Mortality