title: Association of exercise capacity and the heart rate profile during exercise stress testing with subclinical coronary atherosclerosis: data from the Heinz Nixdorf Recall study.
abstract: BACKGROUND
  Exercise capacity and heart rate profile parameters obtained from exercise stress testing as well as the subclinical coronary atherosclerosis burden from cardiac CT have been suggested to improve cardiovascular (CV) risk stratification beyond traditional risk factors (RF) in persons at risk of CV events.
  
  
  OBJECTIVE
  To study the association of exercise stress-test variables with the coronary artery calcium (CAC) burden in relation to age, sex and traditional RF in subjects without known coronary artery disease from the general population.
  
  
  METHODS
  In 3,163 subjects, CV and RF were measured, a bicycle stress test was performed and the electron beam CT-based CAC-Agatston score was quantified.
  
  
  RESULTS
  Exercise capacity, chronotropic response and an abnormal HR recovery were significantly and inversely related to CAC scores in men and women in univariate unadjusted analysis. This association was diminished after adjustment for age and sex and further after adjustment for traditional risk factors. In multivariate analysis, chronotropic response in men [estimate (95% CI): 0.94 (0.91-0.97), P = 0.0005] and an abnormal HR recovery (<15 bpm after 1 min) in women [estimate: 1.34 (1.07-1.70), P = 0.013] but not exercise capacity remained associated with CAC independent of traditional RF. In subjects not taking lipid-lowering, antiarrhythmic or antihypertensive drugs, estimates for the observed associations were essentially unchanged. The clinical ability of these variables to predict a high CAC score was limited.
  
  
  CONCLUSIONS
  The strong inverse association of exercise capacity, chronotropic response and abnormal HR recovery during exercise stress testing with the CAC burden in unadjusted univariate analysis is largely influenced by age, sex and cardiovascular RFs. The degree, to which exercise stress-test variables and the CAC burden independently contribute to the prediction of cardiovascular events, remains to be shown.
authors.affiliation: Department of Cardiology, West-German Heart Center Essen, University Clinic Duisburg-Essen, Hufelandstrasse 55, Essen, Germany. stefan.moehlenkamp@uk-essen.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Möhlenkamp
authors.forename: Nils
authors.initials: N
authors.lastname: Lehmann
authors.forename: Axel
authors.initials: A
authors.lastname: Schmermund
authors.forename: Ulla
authors.initials: U
authors.lastname: Roggenbuck
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.forename: Nico
authors.initials: N
authors.lastname: Dragano
authors.forename: Marcus
authors.initials: M
authors.lastname: Bauer
authors.forename: Hagen
authors.initials: H
authors.lastname: Kälsch
authors.forename: Barbara
authors.initials: B
authors.lastname: Hoffmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Stang
authors.forename: Martina
authors.initials: M
authors.lastname: Bröcker-Preuss
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Klaus
authors.initials: K
authors.lastname: Mann
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Jöckel
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006339:Heart Rate; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
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