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Chronotropic incompetence- still a suitable indicator?
Session:
Posters (Sessão 5 - Écran 6) - DAC e Cuidados Intensivos 7 - Marcadores de Risco e Prognóstico
Speaker:
Isabel Cruz
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.6 Coronary Artery Disease - Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Isabel Martins da Cruz; Inês Oliveira; Bruno Bragança; Rafaela Lopes; Rui Pontes Dos Santos; Conceição Queirós; Aurora Andrade
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction </strong></span></span><br /> <span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">Chronotropic incompetence (CI) is defined as the incapacity to increase heart rate in response to increased activity. It is common in patients (pts) with cardiovascular disease; however, its importance is often undervalued in clinical practice.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong></span></span><br /> <span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Evaluate the prognostic value of CI in pts with <span style="color:black">known coronary artery disease (CAD)</span> who performed <span style="color:black">Bruce protocol treadmill</span> testing. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span><br /> <span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Unicentric, retrospective analysis of consecutive pts with <span style="color:black">known CAD</span> <span style="color:black">who underwent Bruce protocol treadmill</span> testing between 2009 and 2014. Chronotropic index (ChI) was calculated according to the following formula: <span style="background-color:white"><span style="color:#202124">(peak heart rate–resting heart rate)/(220–age–resting heart rate)</span></span>. CI was generally defined as ChI<80% (or <62% to pts prescribed with beta-blockers). Pts were divided in two groups- G1: CI and G2: normal chronotropic response. Events were defined as: all-cause mortality, cardiovascular mortality, <em>de novo</em> heart failure, CAD progression, myocardial infarction and stroke.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span><br /> <span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 471 pts were included (87.3% male, mean age 69±9.8 years). Mean follow-up was 9.7 years. The groups were similar regarding sex (p=0.157), age (p=0.057), body mass index (p=0.172), diabetes (p=0.110), arterial hypertension (p=0.782), dyslipidemia (p=0.549), myocardial infarction (p=0.487) and left ventricle ejection fraction (p=0.656). CI was identified in 129 pts (27,4%). Comparing G1 vs G2, no differences were found related to all-cause mortality (18.6% vs 11.7%, p=0.051), <em>de novo</em> heart failure (10.9% vs 9.6%, p=0.698), CAD progression (31.8% vs 26.3%, p= 0.238), myocardial infarction (34.1% vs 32.2%, p=0.688) and stroke (9.3% vs 8.8%, p= 0.857). However, statistically significant differences were found regarding cardiovascular deaths (7.0% vs 2.6%, p=0.028). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span><br /> <span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">CI is a simple and easily available parameter that shows a clear association with cardiovascular death in a long term follow-up of consecutive pts with known CAD. Even though cardiovascular death was the only endpoint with a statistically significant difference between the groups, G1 presented a higher absolute rate of pts in all endpoints. </span></span></p>
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