title: Exercise stress echocardiography in the identification of coronary artery disease in the elderly with chronotropic incompetence.
abstract: BACKGROUND
  Chronotropic incompetence (CTI) is frequent in elderly patients and may limit the role of the exercise test in the identification of coronary artery disease (CAD) in this population.
  
  
  OBJECTIVE
  To assess the value of CTI in an elderly population in the diagnosis of CAD.
  
  
  METHODS
  A total of 3,308 patients were studied, 804 were elderly individuals (age > 65 years) who underwent exercise stress echocardiography (ESE). Based on the heart rate (HR) reached during the exercise test, were divided into two groups: G1 150 patients who did not reach 85% of the age-predicted HR, and G2 654 patients who did. The groups were compared to clinical characteristics, segmental left ventricular contractility rate (WMSI) and coronary angiography (CAG).
  
  
  RESULTS
  Clinical characteristics were similar between the groups. WMSI was higher in G1 than in G2, both at rest (1.09 +/- 0.21 versus 1.04 +/- 0.15) and after exercise (1.15 +/- 0.29 versus 1.08 +/- 0.2) (p < 0.001). Abnormalities in wall contractility were more frequent in G1 than in G2 (55% versus 37%; p < 0.05), thus suggesting that elderly with CTI have a higher frequency of CAD. CAG was performed in 69% ESE positive for myocardial ischemia. In the G1 group, 91% of the ESE were true positive versus 84.5% in G2, that is, presence of obstructive coronary artery disease (> 50%).
  
  
  CONCLUSIONS
  CTI is associated with a higher frequency of contractile alterations in the elderly population and adds a positive predictive value to ESE in the identification of patients with obstructive CAD.
authors.affiliation: Universidade Federal de Sergipe, Salvador, BA, Brazil. jlobelem@cardiol.br
authors.forename: Joselina Luzia Menezes
authors.initials: JL
authors.lastname: Oliveira
authors.forename: Thiago Jônatas Santos
authors.initials: TJ
authors.lastname: Góes
authors.forename: Thaiana Aragão
authors.initials: TA
authors.lastname: Santana
authors.forename: Isabela Souza
authors.initials: IS
authors.lastname: Silva
authors.forename: Thiago Figueiredo
authors.initials: TF
authors.lastname: Travassos
authors.forename: Lívia Dantas
authors.initials: LD
authors.lastname: Teles
authors.forename: Martha Azevedo
authors.initials: MA
authors.lastname: Barreto
authors.forename: José Augusto
authors.initials: JA
authors.lastname: Barreto-Filho
authors.forename: Argemiro
authors.initials: A
authors.lastname: D'Oliveira
authors.forename: Antonio Carlos Sobral
authors.initials: AC
authors.lastname: Sousa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012016:Reference Values; D012146:Rest; D016277:Ventricular Function, Left / Q000502:physiology