title: Preoperative exercise heart rate recovery predicts intraoperative hypotension in patients undergoing noncardiac surgery.
abstract: OBJECTIVE
  To assess the predictive role of heart rate (HR) recovery in the detection of intraoperative hypotension in patients undergoing noncardiac surgery.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  Department of cardiology and operating rooms of university hospitals.
  
  
  METHODS
  160 ASA physical status 1 and 2 patients scheduled for elective noncardiac surgery.
  
  
  METHODS
  All patients underwent exercise stress testing. Maximum HRs and metabolic equivalent levels were recorded. Heart rate recovery at the first, second, and third minutes were calculated by subtracting HRs one, two, and three minutes into the recovery period from the maximal HR at peak exercise. A decrease in mean arterial pressure (MAP) of greater than 30% was defined as intraoperative hypotension and recorded. Patients were classified to two groups according to whether they had intraoperative hypotension.
  
  
  RESULTS
  Hypotensive episode was observed in 31 patients (19.7%) during the operation. The presence of diabetes mellitus was higher in patients with intraoperative hypotension (22.6% vs 7.1%, P = 0.019). Mean HR recovery at the first, second, and third minutes was significantly lower in the intraoperative hypotension group (P = 0.001, P = 0.004, and P = 0.031, respectively). Heart rate recovery at the first, second, and third minutes was a good predictor of intraoperative hypotension, but only HR recovery at the first minute (OR 0.82, 95% CI 0.73 to 0.92, P = 0.001) and HR recovery at the second minute (OR, 0.90; 95% CI, 0.82 to 0.98; P = 0.019) were independent predictors of intraoperative hypotension. A higher negative correlation was noted between the degree of MAP reduction and HR recovery at the first minute (r = -0.797, P = 0.001).
  
  
  CONCLUSIONS
  Abnormal preoperative exercise HR recovery predicts intraoperative hypotension in patients undergoing noncardiac surgery. Given the importance of intraoperative hypotension, preoperative use of exercise testing might be considered.
authors.affiliation: Department of Anesthesiology and Reanimation, Kirikkale University, School of Medicine, 71100 Kirikkale, Turkey. arzuhct@hotmail.com
authors.forename: Emine Arzu
authors.initials: EA
authors.lastname: Kose
authors.forename: Hasan Kutsi
authors.initials: HK
authors.lastname: Kabul
authors.forename: Vedat
authors.initials: V
authors.lastname: Yildirim
authors.forename: Murat
authors.initials: M
authors.lastname: Tulmac
mesh_terms: D000328:Adult; D062186:Arterial Pressure; D003920:Diabetes Mellitus / Q000453:epidemiology; D017558:Elective Surgical Procedures / Q000379:methods; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006785:Hospitals, University; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology*; D007431:Intraoperative Complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D013997:Time Factors