Kim YH, Lee KH, Chang HJ, Lee EJ, Chung HW, Choi JY, Choi Y, Choe YS, Lee SH, Kim BT. Depressed heart rate response to vasodilator stress for myocardial SPECT predicts mortality in patients after myocardial infarction.
Int J Cardiovasc Imaging 2006;
22:663-70. [PMID:
16628384 DOI:
10.1007/s10554-005-9066-3]
[Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Accepted: 12/02/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND
As heart rate (HR) response during vasodilator stress myocardial perfusion studies can be a marker of HR variability, we investigated its prognostic value in patients after myocardial infarction (MI).
METHODS
Subjects were 147 survivors of MI who underwent vasodilator stress thallium-201 scintigraphy. HR response was measured as peak to basal (P/B) ratios during vasodilator infusion. End points for survival analysis were all-cause deaths, non-fatal recurrent MI, and soft events.
RESULTS
HR response was significantly depressed in the post-MI patients compared to controls (p<0.0005). HR response correlated to LVEF (r=0.37, p<0.0001) and summed stress scores (r=-0.18, p<0.05), but not with antianginal medication. During 58+/-30 mo of follow-up, there were 15 deaths, 7 recurrent MI, and 11 soft events. Low HR response, old age, low LVEF, and high difference score were significant univariate risk factors for death. Multivariate analysis identified low HR response (p=0.03), high stress score (p=0.02), and low LVEF (p=0.05) as independent predictors of mortality. The predictive value of HR response was incremental to that offered by other variables (p=0.02).
CONCLUSIONS
HR response, readily attained during vasodilator stress myocardial perfusion studies, may provide useful additional prognostic information in post-MI patients.
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