Long-term prognostic value of heart-rate recovery after treadmill testing in patients with diabetes mellitus

Georgoulias, Panagiotis; Demakopoulos, Nikolaos; Valotassiou, Varvara; Orfanakis, Alexandros; Zaganides, Alexia; Tsougos, Ioannis; Fezoulidis, Ioannis

doi:10.1016/j.ijcard.2008.01.036

« Previous Next »International Journal of Cardiology
Volume 134, Issue 1 , Pages 67-74, 1 May 2009

Long-term prognostic value of heart-rate recovery after treadmill testing in patients with diabetes mellitus

Panagiotis Georgoulias
- Department of Nuclear Medicine, Medical School, University of Thessaly and University Hospital of Larissa, Larissa, Greece
- Corresponding author. 15 Kritis St. 19009 Rafina, Greece. Tel.: +30 22940 26201, +30 2410 682052; fax: +30 22940 78400, +30 2410 670117.
Nikolaos Demakopoulos
- Department of Nuclear Medicine, NIMTS Hospital, Athens, Greece
Varvara Valotassiou
- Department of Nuclear Medicine, Medical School, University of Thessaly and University Hospital of Larissa, Larissa, Greece
Alexandros Orfanakis
- Department of Cardiology, University Hospital of Heraklion, Heraklion, Greece
Alexia Zaganides
- Department of Nuclear Medicine, Medical School, University of Thessaly and University Hospital of Larissa, Larissa, Greece
Ioannis Tsougos
- Department of Medical Physics, Medical School, University of Thessaly, Larissa, Greece
Ioannis Fezoulidis
- Department of Nuclear Medicine, Medical School, University of Thessaly and University Hospital of Larissa, Larissa, Greece

Received 24 June 2007; received in revised form 17 October 2007; accepted 14 January 2008. published online 22 May 2008.

Abstract

Background

Heart-rate recovery (HRR) is considered to be an independent predictor of cardiac and all-cause mortality. We examined the long-term prognostic value of HRR in patients suffering from diabetes mellitus.

Methods

In this study, we included 258 consecutive patients. Patients whose HRR value or myocardial perfusion imaging could have been influenced by factors other than myocardial ischaemia, were excluded. The value of HRR was defined as the decrease in the heart-rate from peak exercise to 1 min after the termination of the exercise. All patients underwent SPECT myocardial perfusion imaging combined with exercise testing. Cardiovascular death and non-fatal myocardial infarction were considered as hard cardiac events, while late revascularization procedures as soft events. Cox proportional-hazard models were applied to evaluate the association between HRR and the investigated outcome.

Results

During the follow-up period (30.8±6.9 months), hard cardiac events occurred in 21 (8%) patients (15 with abnormal HRR value, p<0.001), while 35 (14%) patients underwent revascularization (31 with abnormal HRR value, p<0.001). Considering it as a continuous variable, HRR was a strong predictor for both hard cardiac (coefficient=−0.41, SE=0.052, p<0.001) and soft cardiac events (coefficient=−0.63, SE=0.058, p<0.001). After adjustments were made for potential confounders, including scintigraphic variables, abnormal HRR remained an independent predictor for hard and soft cardiac events (p<0.001).