title: Long-term prognostic value of heart-rate recovery after treadmill testing in patients with diabetes mellitus.
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).
  
  
  CONCLUSIONS
  Our results suggest that among patients with diabetes, a decreased HRR is a significant independent predictor of hard and soft cardiac events.
authors.affiliation: Department of Nuclear Medicine, Medical School, University of Thessaly and University Hospital of Larissa, Larissa, Greece. pgeorgoul@med.uth.gr
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Georgoulias
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Demakopoulos
authors.forename: Varvara
authors.initials: V
authors.lastname: Valotassiou
authors.forename: Alexandros
authors.initials: A
authors.lastname: Orfanakis
authors.forename: Alexia
authors.initials: A
authors.lastname: Zaganides
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsougos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Fezoulidis
mesh_terms: D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000401:mortality*; D018572:Disease-Free Survival; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin