ISSN: 2451-0629
Archives of Medical Science - Atherosclerotic Diseases
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Official journal of the International Lipid Expert Panel (ILEP)
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1/2019
vol. 4
 
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abstract:
Clinical research

Severely blunted early heart rate response during treadmill exercise is associated with above average exercise capacity

Afshan Alvi
,
Ayesha Salahuddin
,
Cindy Y. Wang
,
Wilbert S. Aronow
,
Daniel M. Spevack

Arch Med Sci Atheroscler Dis 2019; 4: e167–e173
Online publish date: 2019/07/18
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Introduction
Chronotropic response with exercise is evaluated by peak heart rate (HR) achieved. Since most of the exercise-related chronotropic response occurs early after exercise is initiated, we investigated whether the HR achieved with a standard dose of exercise (Bruce stage 2) is associated with exercise capacity. We hypothesized that those with a blunted or disproportionate HR response at this exercise dose would have reduced exercise capacity compared to those with a typical HR response.

Material and methods
We reviewed 3,084 consecutive normal maximal treadmill stress echocardiographic reports acquired from individual adults over a 1.5-year period. We examined for association between stage 2 Bruce HR with age and sex-adjusted exercise capacity.

Results
After adjustment for age and sex, Bruce stage 2 HR was inversely associated ( = –0.08, p < 0.01) with exercise duration. Thus for every additional 10 beats per minute achieved in stage 2, exercise duration was generally shortened by about 45 s. Most of the subjects (92%) who had a stage 2 Bruce HR response below the 10th percentile had above average or average exercise capacity for their age and sex.

Conclusions
Lower Bruce stage 2 HR was associated with increased exercise capacity. Severely blunted HR response was associated with above average exercise capacity. Caution should therefore be exercised in attributing exercise intolerance to a blunted HR response when making a diagnosis of chronotropic incompetence.

keywords:

chronotropic incompetence, peak heart rate, exercise capacity

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