Heart rate recovery after exercise is a predictor of mortality, independent of the angiographic severity of XXXX .

@entity1 @entity453 @entity204 @entity301
OBJECTIVES: We sought to determine whether abnormal heart rate recovery predicts mortality independent of the angiographic severity of @entity301 . BACKGROUND: An attenuated decrease in heart rate after exercise, or heart rate recovery (HRR), has been shown to predict mortality. There are few data on its prognostic significance once the angiographic severity of @entity453 ( @entity453 ) is ascertained. METHODS: For six years we followed 2,935 consecutive @entity1 who underwent symptom-limited exercise testing for suspected @entity453 and then had a coronary angiogram within 90 days. The HRR was abnormal if < or =12 beats/min during the first minute after exercise, except among @entity1 undergoing stress echocardiography, in whom the cutoff was < or =18 beats/min. Angiographic @entity453 was considered severe if the Duke @entity453 Prognostic Severity Index was > or =42 (on a scale of 0 to 100), which corresponds to a level of @entity453 where revascularization is associated with better long-term survival. RESULTS: Severe @entity453 was present in 421 @entity1 (14%), whereas abnormal HRR was noted in 838 @entity1 (29%). There were 336 deaths (11%). Mortality was predicted by abnormal HRR (hazard ratio [HR] 2.5, 95% confidence interval [CI] 2.0 to 3.1; p < 0.0001) and by severe @entity453 (HR 2.0, 95% CI 1.6 to 2.6; p < 0.0001); both variables provided additive prognostic information. After adjusting for age, gender, standard risk factors, medications, exercise capacity, and left ventricular function, abnormal HRR remained predictive of @entity204 (adjusted HR 1.6, 95% CI 1.2 to 2.0; p < 0.0001); severe @entity453 was also predictive (adjusted HR 1.4, 95% CI 1.1 to 1.9; p = 0.008). CONCLUSIONS: Even after taking into account the angiographic severity of @entity453 , left ventricular function, and exercise capacity, HRR is independently predictive of mortality.
