Is chronotropic incompetence a limitation in the evaluation of myocardial ischemia and prognosis?

Abstract:

OBJECTIVE:The aim of this study was to evaluate whether chronotropic incompetence (CI), the inability to reach 85% of the maximal predicted heart rate during exercise, affects the assessment of myocardial ischemia and prognosis in patients undergoing myocardial perfusion single-photon emission computed tomography (MPS). METHODS:Patients undergoing exercise/rest MPS were studied. Those taking drugs with negative chronotropic properties were excluded. Summed stress, rest, and difference scores (SSS, SRS, and SDS, representing, respectively, the extent and severity of the total perfusion defect, fibrosis, or ischemia) were calculated. Patients were followed up for the occurrence of hard events (death or myocardial infarction) or myocardial revascularization for 36±20 months. RESULTS:A total of 391 patients were studied; among them, 11.5% had CI. All perfusion scores were higher in patients with CI. On logistic regression, history of myocardial infarction and SDS were found to be independent predictors of CI. On comparing patients with and without CI, the former more often had hard events (12.5 vs. 0.9%, P=0.007) and revascularization (20.0 vs. 8.1%, P=0.003). CONCLUSION:CI was associated with myocardial ischemia. Higher rates of hard events and revascularization were observed in patients with CI, in accordance with the larger extent of myocardial ischemia found in these patients. Performing MPS in the setting of CI may maintain the diagnostic and prognostic abilities of the test.

journal_name

Coron Artery Dis

journal_title

Coronary artery disease

authors

De Lorenzo A,Oliveira G,Ramos AC,Pinto F,Rothstein T,Lima RS

doi

10.1097/MCA.0000000000000064

subject

Has Abstract

pub_date

2014-03-01 00:00:00

pages

167-71

issue

2

eissn

0954-6928

issn

1473-5830

journal_volume

25

pub_type

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