Rapid Early Rise in Heart Rate on Treadmill Exercise in Patients with Asymptomatic Moderate or Severe Aortic Stenosis: a New Prognostic Marker?

Overview

Journal Open Heart

Publisher BMJ Publishing Group

Specialty Cardiology & Vascular Diseases

Date 2019 Mar 1

PMID 30815268

Citations 6

Authors

John B Chambers

Ronak Rajani

Denise Parkin

Sahrai Saeed

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the clinical significance and prognostic value of an early rapid rise in heart rate (RR-HR) in asymptomatic patients with moderate or severe aortic stenosis (AS).

Methods: We retrospectively assessed the prospectively collected data from 306 patients (age 65±12 years, 33% women) with moderate (n=204) or severe AS (n=102) with a median follow-up of 25 months (mean 34.9±34.6 months). All had echocardiography and modified Bruce exercise treadmill tests (ETT). RR-HR was defined as achieving 85% target HR or ≥50% increase from baseline in the first 6 min. The outcome measures were revealed symptoms during ETT, aortic valve replacement (AVR) and all-cause mortality.

Results: RR-HR occurred in 77 (25%) and 64% developed revealed symptoms (postive predictive value 64% and negative predictive value 84%). On univariate Cox regression analyses in patients with severe AS, RR-HR was associated with AVR (HR 3.32, 95% CI 2.03 to 5.45, p<0.001) but not with all-cause mortality (HR 0.04, 95% CI 0.13 to 9.21, p=0.798). In patients with moderate AS, RR-HR was associated with all-cause mortality (HR 2.67, 95% CI 1.09 to 6.56, p=0.032), but not with AVR (HR 1.35, 95% CI 0.92 to 1.98, p=0.127). These associations remained significant in multivariate Cox regression analyses after adjustment for age, sex, hypertension, coronary artery disease, abnormal blood pressure response, Doppler stroke volume and mean pressure gradient (both p<0.001).

Conclusions: RR-HR was associated with the development of revealed symptoms. It predicted revealed symptoms on serial ETT, AVR in severe AS and all-cause mortality in moderate AS. RR-HR may be a useful new measure to define risk in AS.

Citing Articles

Brazilian Guideline for Exercise Test in the Adult Population - 2024.

Carvalho T, Freitas O, Chalela W, Hossri C, Milani M, Buglia S Arq Bras Cardiol. 2024; 121(3):e20240110.

PMID: 38896581 PMC: 11656589. DOI: 10.36660/abc.20240110.

Exercise Testing in Aortic Stenosis: Safety, Tolerability, Clinical Benefits and Prognostic Value.

Saeed S, Chambers J J Clin Med. 2022; 11(17).

PMID: 36078911 PMC: 9457179. DOI: 10.3390/jcm11174983.

The safety of exercise for older patients with severe aortic stenosis undergoing conservative management: A narrative review.

Nashimoto S, Inoue T, Hotta K, Sugito Y, Iida S, Tsubaki A Physiol Rep. 2022; 10(8):e15272.

PMID: 35439351 PMC: 9017979. DOI: 10.14814/phy2.15272.

Arterial Hypertension in Aortic Valve Stenosis: A Critical Update.

Basile C, Fucile I, Lembo M, Manzi M, Ilardi F, Franzone A J Clin Med. 2021; 10(23).

PMID: 34884254 PMC: 8658702. DOI: 10.3390/jcm10235553.

The clinical significance of the incorporation of tissue Doppler imaging into low-dose Dobutamine stress echocardiography in patients with aortic stenosis prior to Transcatheter aortic valve implantation.

Saeed S, Kellermair J, Herstad J, Bleie O BMC Cardiovasc Disord. 2020; 20(1):416.

PMID: 32928125 PMC: 7490967. DOI: 10.1186/s12872-020-01700-0.

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