Prognostic Value of Heart Rate Reserve in Patients with Suspected Coronary Artery Disease Undergoing Stress Myocardial Perfusion Imaging

Overview

Journal J Nucl Cardiol

Specialty Cardiology & Vascular Diseases

Date 2021 Aug 4

PMID 34346030

Citations 2

Authors

Carmela Nappi

Mario Petretta

Roberta Assante

Emilia Zampella

Valeria Gaudieri

Valeria Cantoni

Roberta Green

Fabio Volpe

Leandra Piscopo

Ciro Gabriele Mainolfi

Emanuele Nicolai

Wanda Acampa

Alberto Cuocolo

Affiliations

Soon will be listed here.

Abstract

Background: Chronotropic incompetence is common in patients with cardiovascular disease and is associated with increased risk of adverse events. We assessed the incremental prognostic value of heart rate reserve (HRR) over stress myocardial perfusion single-photon emission computed tomography (MPS) findings in patients with suspected coronary artery disease (CAD).

Methods: We studied 866 patients with suspected CAD undergoing exercise stress-MPS as part of their diagnostic program. The primary study endpoint was all-cause mortality. All patients were followed for at least 5 years. HRR was calculated as the difference between peak exercise and resting HR, divided by the difference of age-predicted maximal and resting HR and expressed as percentage.

Results: During 7 years follow-up, 61 deaths occurred, with a 7% cumulative event rate. Patients experiencing death were older (P < .001), and had a higher prevalence of male gender (P < .001) and diabetes (P < .05). Patients with event also had lower values of HRR (65% ± 27% vs 73% ± 18%, P < .0001) and higher prevalence of stress-induced myocardial ischemia (25% vs 8%, P < .0001). Male gender, HRR and stress-induced ischemia were independent predictors of all-cause mortality (all P < .01). HRR improved the prognostic power of a model including clinical data and MPS findings, increasing the global χ from 66 to 82 (P < .005).

Conclusions: Chronotropic incompetence has independent and incremental prognostic value in predicting all-cause mortality in patients with suspected CAD undergoing exercise stress-MPS. Hence, the evaluation of HRR may further improve patients' risk stratification.

Citing Articles

The incremental significance of heart rate recovery as a predictor during exercise-stress myocardial perfusion SPECT imaging in individuals with suspected coronary artery disease.

Yang S, Xi R, Li B, Wang X, Song L, Ji T Front Cardiovasc Med. 2023; 10:1082019.

PMID: 37034341 PMC: 10074983. DOI: 10.3389/fcvm.2023.1082019.

Interaction of impaired myocardial flow reserve and extent of myocardial ischemia assessed using N-ammonia positron emission tomography imaging on adverse cardiovascular outcomes.

Miura S, Okizaki A, Kumamaru H, Manabe O, Naya M, Miyazaki C J Nucl Cardiol. 2023; 30(5):2043-2053.

PMID: 37012523 DOI: 10.1007/s12350-023-03255-x.

References

Nappi C, Assante R, Zampella E, Gaudieri V, De Simini G, Giordano A . Relationship between heart rate response and cardiac innervation in patients with suspected or known coronary artery disease. J Nucl Cardiol. 2020; 28(6):2676-2683. DOI: 10.1007/s12350-020-02091-7. View

Gebhard C, Maredziak M, Portmann A, Bengs S, Haider A, Fiechter M . Heart rate reserve is a long-term risk predictor in women undergoing myocardial perfusion imaging. Eur J Nucl Med Mol Imaging. 2019; 46(10):2032-2041. DOI: 10.1007/s00259-019-04344-1. View

Benes J, Kotrc M, Borlaug B, Lefflerova K, Jarolim P, Bendlova B . Resting heart rate and heart rate reserve in advanced heart failure have distinct pathophysiologic correlates and prognostic impact: a prospective pilot study. JACC Heart Fail. 2014; 1(3):259-66. DOI: 10.1016/j.jchf.2013.03.008. View

Megna R, Nappi C, Gaudieri V, Mannarino T, Assante R, Zampella E . Diagnostic value of clinical risk scores for predicting normal stress myocardial perfusion imaging in subjects without coronary artery calcium. J Nucl Cardiol. 2020; 29(1):323-333. DOI: 10.1007/s12350-020-02247-5. View

Cortigiani L, Carpeggiani C, Landi P, Raciti M, Bovenzi F, Picano E . Prognostic Value of Heart Rate Reserve in Patients with Permanent Atrial Fibrillation during Dipyridamole Stress Echocardiography. Am J Cardiol. 2020; 125(11):1661-1665. DOI: 10.1016/j.amjcard.2020.02.046. View

Acampa W, Petretta M, Daniele S, Del Prete G, Assante R, Zampella E . Incremental prognostic value of stress myocardial perfusion imaging in asymptomatic diabetic patients. Atherosclerosis. 2013; 227(2):307-12. DOI: 10.1016/j.atherosclerosis.2013.01.011. View

Betancur J, Otaki Y, Motwani M, Fish M, Lemley M, Dey D . Prognostic Value of Combined Clinical and Myocardial Perfusion Imaging Data Using Machine Learning. JACC Cardiovasc Imaging. 2017; 11(7):1000-1009. PMC: 5902657. DOI: 10.1016/j.jcmg.2017.07.024. View

Abidov A, Rozanski A, Hachamovitch R, Hayes S, Aboul-Enein F, Cohen I . Prognostic significance of dyspnea in patients referred for cardiac stress testing. N Engl J Med. 2005; 353(18):1889-98. DOI: 10.1056/NEJMoa042741. View

Frome E . The analysis of rates using Poisson regression models. Biometrics. 1983; 39(3):665-74. View

10.

Diamond G, Forrester J . Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med. 1979; 300(24):1350-8. DOI: 10.1056/NEJM197906143002402. View

11.

Nappi C, Gaudieri V, Cuocolo A . Behind Traditional Semi-quantitative Scores of Myocardial Perfusion Imaging: An Eye on Niche Parameters. Eur Cardiol. 2019; 14(1):13-17. PMC: 6523048. DOI: 10.15420/ecr.2019.5.1. View

12.

Phillips L, Vitola J, Shaw L, Giubbini R, Karthikeyan G, Alexanderson E . Value of gated-SPECT MPI for ischemia-guided PCI of non-culprit vessels in STEMI patients with multivessel disease after primary PCI. J Nucl Cardiol. 2018; 25(5):1616-1620. DOI: 10.1007/s12350-018-1368-7. View

13.

Verberne H, Acampa W, Anagnostopoulos C, Ballinger J, Bengel F, De Bondt P . EANM procedural guidelines for radionuclide myocardial perfusion imaging with SPECT and SPECT/CT: 2015 revision. Eur J Nucl Med Mol Imaging. 2015; 42(12):1929-40. PMC: 4589547. DOI: 10.1007/s00259-015-3139-x. View

14.

Nappi C, Acampa W, Nicolai E, Daniele S, Zampella E, Assante R . Long-term prognostic value of low-dose normal stress-only myocardial perfusion imaging by wide beam reconstruction: A competing risk analysis. J Nucl Cardiol. 2018; 27(2):547-557. DOI: 10.1007/s12350-018-1373-x. View

15.

Gayda M, Bourassa M, Tardif J, Fortier A, Juneau M, Nigam A . Heart rate recovery after exercise and long-term prognosis in patients with coronary artery disease. Can J Cardiol. 2012; 28(2):201-7. DOI: 10.1016/j.cjca.2011.12.004. View

16.

Cortigiani L, Carpeggiani C, Landi P, Raciti M, Bovenzi F, Picano E . Usefulness of Blunted Heart Rate Reserve as an Imaging-Independent Prognostic Predictor During Dipyridamole Stress Echocardiography. Am J Cardiol. 2019; 124(6):972-977. DOI: 10.1016/j.amjcard.2019.06.017. View

17.

Youden W . Index for rating diagnostic tests. Cancer. 1950; 3(1):32-5. DOI: 10.1002/1097-0142(1950)3:1<32::aid-cncr2820030106>3.0.co;2-3. View

18.

Kattoor A, Kolkailah A, Iskander F, Iskander M, Diep L, Khan R . The prognostic value of regadenoson SPECT myocardial perfusion imaging: The largest cohort to date. J Nucl Cardiol. 2020; 28(6):2799-2807. DOI: 10.1007/s12350-020-02135-y. View

19.

Azarbal B, Hayes S, Lewin H, Hachamovitch R, Cohen I, Berman D . 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.... J Am Coll Cardiol. 2004; 44(2):423-30. DOI: 10.1016/j.jacc.2004.02.060. View

20.

Brubaker P, Kitzman D . Chronotropic incompetence: causes, consequences, and management. Circulation. 2011; 123(9):1010-20. PMC: 3065291. DOI: 10.1161/CIRCULATIONAHA.110.940577. View