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Submitted: 13 February 2017 Modified: 30 May 2017
HERDIN Record #: NCR-PHC-17021313361821

Heart rate recovery after Treadmill Exercise Testing as a predictor of long term outcomes of cardiovascular morbidity and mortality: a retrospective cohort study at the Philippine Heart Center from year 2001-2003.

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Background. The increase in heart rate that accompanies exercise is due to a reduction in vagal tone. Recovery of the heart rate immediately after exercise is a function of vagal reactivation. Because a generalized decrease in vagal activity is known to be a risk factor for death, we hypothesized that a delay in the heart rate recovery after treadmill exercise test is an important prognostic marker for cardiovascular mortality as well as acute coronary syndrome (ACS).


Methods. This is a cohort study wherein we reviewed the stress test of patients who underwent stress test at the Cardiographics and Nuclear Medicine section of Philippine Heart Center for diagnostic purposes. Excluded were those with known CAD, heart failure, congenital and valvular heart disease, with preexcitation, use of digoxin and left bundle branch block. Heart rate recovery was determined and patients were followed up for an average of five years for occurrence of cardiovascular mortality and ACS.


Results. Two hundred twelve patients were included. Forty-four patients had abnormal heart rate recovery. Two mortalities and nine ACS were observed. There was a trend towards mortality among those who are older. Abnormal heart rate recovery was associated with occurrence of acute coronary syndrome. However, this was not associated with mortality due to a small sample size.


Conclusion. A low value for the heart rate recovery after exercise testing, which has been previously shown to be a marker of decreased vagal activity, is a powerful and independent predictor of cardiovascular morbidity and combined outcome. Therefore, we believe that this marker, which is simple to calculate from data that are already contained in the results of standard treadmill stress test, may be valuable for the assessment of cardiovascular risk in routine clinical practice. In conjunction with other parameters in the treadmill results, heart rate recovery will give us a good picture of who should be treated aggressively and who should be reassured that they are at little risk within five years.

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Heart Center Journal
Frequency
Semi-Annual
Publication Date
July-December 2008
Volume
14
Page(s)
89-92
LocationLocation CodeAvailable FormatAvailability
Philippine Heart Center Medical Library Fulltext Print Format