Article Text

PDF

Original research article
Rapid early rise in heart rate on treadmill exercise in patients with asymptomatic moderate or severe aortic stenosis: a new prognostic marker?
  1. John B Chambers1,
  2. Ronak Rajani1,
  3. Denise Parkin1 and
  4. Sahrai Saeed1,2
  1. 1 Cardiothoracic Centre, Guy’s and St Thomas’ Hospital, London, UK
  2. 2 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
  1. Correspondence to Dr John B Chambers; jboydchambers{at}aol.com

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.

  • exercise treadmill test
  • aortic stenosis
  • early rise in heart rate
  • outcomes

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Statistics from Altmetric.com

Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the local institutional review board (Study Protocol n. 7461/2017).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.