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Sipilä K, Tikkakoski A, Alanko S, Haarala A, Hernesniemi J, Lyytikäinen LP, Viik J, Lehtimäki T, Nieminen T, Nikus K, Kähönen M. Combination of low blood pressure response, low exercise capacity and slow heart rate recovery during an exercise test significantly increases mortality risk. Ann Med 2019; 51:390-396. [PMID: 31638839 PMCID: PMC7877875 DOI: 10.1080/07853890.2019.1684550] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Aims: We investigated the combination of low systolic blood pressure (SBP) response, low exercise capacity (EC) and slow heart rate recovery (HRR) during an exercise test in mortality prediction.Patients and methods: Our population consisted of 3456 patients from the Finnish Cardiovascular Study. A failure of SBP to increase >42 mmHg was defined as a low response. Low EC was defined as < 8 metabolic equivalents. 1-minute HRR ≤18 bpm from maximum was defined as slow HRR.Results: During a median follow up of 10.0 years, 537 participants died. Reduced SBP response, low EC and slow HRR were independent predictors of all-cause and CV mortality (p < .001 for all). Patients with reduced SBP response, low EC and slow HRR had a very high mortality rate of 42.1% during follow up compared to only 4.5% of the patients without any of these risk factors. The hazard ratios for all-cause mortality in patients with one, two or three of the studied risk factors were 3.2, 6.0, and 10.6, respectively (p < .001 for all).Conclusion: The combination of reduced SBP response, low exercise capacity, and reduced HRR in an exercise test is associated with very high mortality and can be used in risk stratification.Key messagesThe combination of low blood pressure response, low exercise capacity and slow heart rate recovery in an exercise test is able to identify a group of patients in a very high mortality risk.These parameters are easily derived from an exercise test.All parameters are commonly available in clinical practice.
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Affiliation(s)
- Kalle Sipilä
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Sanni Alanko
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Atte Haarala
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Heart Center, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Jari Viik
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
| | - Tuomo Nieminen
- Department of Internal Medicine, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland.,South Karelia Central Hospital, Lappeenranta, Finland
| | - Kjell Nikus
- Heart Center, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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