title: Excessive heart rate increase during mild mental stress in preparation for exercise predicts sudden death in the general population.
abstract: OBJECTIVE
  The aim of this study involves the early identification, among apparently healthy individuals, of those at high risk for sudden cardiac death. We tested the hypothesis that individuals who respond to mild mental stress in preparation for exercise test with the largest heart rate increases might be at highest risk.
  
  
  RESULTS
  Data from 7746 civil servants participating in the Paris Prospective Study I, followed-up for 23 years, allowed to compare heart rate changes between rest and mild mental stress (preparation prior to an exercise test) between subjects who suffered sudden cardiac death (n = 81), non-sudden (n = 129) coronary death, or death from any cause (n = 1306). The mean heart rate increase during mild mental stress was 8.9 +/- 10.8 b.p.m. Risk of sudden cardiac death increased progressively with heart rate increase during mental stress and the relative risk of the third vs. the first tertile was 2.09 (95% confidence interval, 1.13-3.86) after adjustment for confounders. This relationship was not observed for non-sudden coronary death.
  
  
  CONCLUSIONS
  An important heart rate increase produced by a mild mental stress predicts long-term risk for sudden cardiac death. Heart rate changes before an exercise test may provide a simple tool for risk stratification.
authors.affiliation: INSERM, Unit 909, Cardiovascular Epidemiology and Sudden Death, Hopital Européen Georges Pompidou, 75015 Paris, France. xavier.jouven@egp.aphp.fr
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Schwartz
authors.forename: Sylvie
authors.initials: S
authors.lastname: Escolano
authors.forename: Céline
authors.initials: C
authors.lastname: Straczek
authors.forename: Muriel
authors.initials: M
authors.lastname: Tafflet
authors.forename: Michel
authors.initials: M
authors.lastname: Desnos
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Empana
authors.forename: Pierre
authors.initials: P
authors.lastname: Ducimetière
mesh_terms: D000328:Adult; D016757:Death, Sudden, Cardiac; D042241:Early Diagnosis; D005080:Exercise Test / Q000523:psychology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000503:physiopathology* / Q000523:psychology