title: Delayed heart rate recovery after adenosine stress testing with supplemental arm exercise predicts mortality.
abstract: BACKGROUND
  Delayed heart rate (HR) recovery after treadmill exercise testing predicts mortality. Patients with suspected ischemic heart disease who cannot perform adequate treadmill exercise are typically evaluated with pharmacological stress myocardial perfusion imaging (MPI) studies, but little prognostic significance has been attributed to the hemodynamic response to vasodilator stress testing with low-level exercise. We hypothesized that a delay in HR recovery after adenosine stress testing with arm exercise is associated with increased mortality.
  
  
  RESULTS
  Technetium 99m-Sestamibi MPI was performed in 1,455 consecutive patients (70 +/- 12 years, 50.2% men) with adenosine stress and supplemental arm exercise. HRs were recorded at rest, continuously during infusion, and then 5 minutes post-infusion. Delayed HR recovery was defined as a decline of < or = 12 bpm from peak HR at 5 minutes after discontinuation of the infusion. Of 1,356 patients during 5 years of follow up, there were 135 deaths (10%). Delayed HR recovery was strongly predictive of all-cause mortality (16.5% vs 5.3% in those with normal HR recovery, P < .001) with an adjusted hazard ratio of 2.5 (95% CI, 1.7-3.6; P < .001).
  
  
  CONCLUSIONS
  Delayed HR recovery after adenosine stress testing with arm exercise is a readily available and powerful predictor of all-cause mortality.
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Yawkey 5E 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Akutsu
authors.forename: Shawn A
authors.initials: SA
authors.lastname: Gregory
authors.forename: Arash
authors.initials: A
authors.lastname: Kardan
authors.forename: Gerasimos D
authors.initials: GD
authors.lastname: Zervos
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Thomas
authors.forename: Henry
authors.initials: H
authors.lastname: Gewirtz
authors.forename: Tsunehiro
authors.initials: T
authors.lastname: Yasuda
mesh_terms: D000241:Adenosine; D000368:Aged; D001132:Arm; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D017256:Technetium Tc 99m Sestamibi; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents
chemical_list: D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D017256:Technetium Tc 99m Sestamibi; D000241:Adenosine