دورية أكاديمية
The incremental prognostic value of percentage of heart rate reserve achieved over myocardial perfusion single-photon emission computed tomography in the prediction of cardiac death and all-cause mortality: superiority over 85% of maximal age-predicted heart rate.
| العنوان: | The incremental prognostic value of percentage of heart rate reserve achieved over myocardial perfusion single-photon emission computed tomography in the prediction of cardiac death and all-cause mortality: superiority over 85% of maximal age-predicted heart rate. |
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| المؤلفون: | Azarbal B; Department of Medicine (Division of Cardiology), University of California, Los Angeles, School of Medicine, Los Angeles, California, USA., Hayes SW, Lewin HC, Hachamovitch R, Cohen I, Berman DS |
| المصدر: | Journal of the American College of Cardiology [J Am Coll Cardiol] 2004 Jul 21; Vol. 44 (2), pp. 423-30. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Biomedical Country of Publication: United States NLM ID: 8301365 Publication Model: Print Cited Medium: Print ISSN: 0735-1097 (Print) Linking ISSN: 07351097 NLM ISO Abbreviation: J Am Coll Cardiol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [New York, N.Y.] : Elsevier Biomedical, [c1983- |
| مواضيع طبية MeSH: | Coronary Circulation* , Death, Sudden, Cardiac* , Exercise Test* , Heart Rate* , Tomography, Emission-Computed, Single-Photon*, Age Factors ; Cardiovascular Diseases/mortality ; Disease-Free Survival ; Humans ; Mortality ; Prognosis ; Proportional Hazards Models ; Risk Factors ; Survival Rate |
| مستخلص: | Objectives: We sought to determine whether chronotropic incompetence (CI) adds incremental value in predicting cardiac death (CD) and all-cause mortality and to determine which marker of CI is superior. Background: Chronotropic incompetence, defined by either a low percent heart rate (HR) reserve achieved or failure to achieve 85% maximal age-predicted heart rate (MA-PHR), is a predictor of mortality. These variables have not been examined together in a comprehensive myocardial perfusion single-photon emission computed tomographic (SPECT), or MPS, model. Methods: A total of 10,021 patients who underwent exercise MPS, evaluated by a summed stress score (SSS), were followed up for 719 +/- 252 days. Percent HR reserve = (peak HR - rest HR)/(220 - age - rest HR) x 100, with <80% considered abnormal. Results: A total of 2,956 patients (29.5%) had low %HR reserve; 1,331 (13.3%) achieved <85% MA-PHR; and 1,296 (13.0%) had both. There were 234 deaths (93 CDs). On multivariate analysis, the SSS, %HR reserve, and inability to achieve 85% MA-PHR were predictors of all-cause mortality and CD (all p < 0.01). Myocardial perfusion SPECT was the most powerful predictor of CD (chi-square = 50). When the %HR reserve and ability to achieve 85% MA-PHR were considered, only the former remained a predictor of CD (p = 0.006 vs. p = 0.59). Conclusions: In a comprehensive MPS model, CI was an important predictor of CD and all-cause mortality. Percent HR reserve was superior to the ability to achieve 85% MA-PHR in predicting CD; MPS was superior to both. Combined with previous studies, the findings suggest that %HR reserve should become the standard for assessing the adequacy of HR response during exercise testing, and that it should be routinely incorporated in risk stratification algorithms. |
| التعليقات: | Comment in: J Am Coll Cardiol. 2004 Jul 21;44(2):431-2. (PMID: 15261943) |
| تواريخ الأحداث: | Date Created: 20040721 Date Completed: 20040810 Latest Revision: 20061115 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1016/j.jacc.2004.02.060 |
| PMID: | 15261942 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 0735-1097 |
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| DOI: | 10.1016/j.jacc.2004.02.060 |