TY - JOUR
T1 - Heart Rate Response During Exercise Predicts Survival in Adults With Congenital Heart Disease
AU - Diller, Gerhard Paul
AU - Dimopoulos, Konstantinos
AU - Okonko, Darlington
AU - Uebing, Anselm
AU - Broberg, Craig S.
AU - Babu-Narayan, Sonya
AU - Bayne, Stephanie
AU - Poole-Wilson, Philip A.
AU - Sutton, Richard
AU - Francis, Darrel P.
AU - Gatzoulis, Michael A.
N1 - Funding Information:
The Royal Brompton Adult Congenital Heart Programme and the Department of Clinical Cardiology have received support from the British Heart Foundation and the Clinical Research Committee, Royal Brompton Hospital, London.
PY - 2006/9/19
Y1 - 2006/9/19
N2 - Objectives: To assess the prognostic value of heart rate response to exercise in adult congenital heart disease (ACHD) patients. Background: An abnormal heart rate response to exercise is related to autonomic dysfunction and may have prognostic implications in ACHD. Methods: We identified 727 consecutive ACHD patients (mean age [± SD] 33 ± 13 years) with varying diagnoses and without pacemakers. Peak oxygen consumption (peak Vo2), resting heart rate, and the increase in heart rate from resting level to peak exercise ("heart rate reserve") were measured. We also quantified the decrease in heart rate ("heart rate recovery") after cessation of exercise. Results: During a median follow-up of 28 months, 38 patients died. Lower values of heart rate reserve, peak heart rate, heart rate recovery, and peak Vo2 (p < 0.01 for each) were associated with increased mortality in univariate analysis. Furthermore, heart rate reserve predicted mortality independently of antiarrhythmic therapy, functional class, and peak Vo2. Stratifying patients by diagnostic groups revealed that a lower heart rate reserve was also associated with a greater risk of death in patients with complex anatomy, Fontan circulation, and tetralogy of Fallot (p < 0.05 for each). Conclusions: An abnormal heart rate response to exercise identifies ACHD patients with a higher risk of mortality in the midterm, even after accounting for antiarrhythmic medication and exercise capacity. Heart rate reserve is a simple and inexpensive way to identify ACHD patients at higher mortality risk.
AB - Objectives: To assess the prognostic value of heart rate response to exercise in adult congenital heart disease (ACHD) patients. Background: An abnormal heart rate response to exercise is related to autonomic dysfunction and may have prognostic implications in ACHD. Methods: We identified 727 consecutive ACHD patients (mean age [± SD] 33 ± 13 years) with varying diagnoses and without pacemakers. Peak oxygen consumption (peak Vo2), resting heart rate, and the increase in heart rate from resting level to peak exercise ("heart rate reserve") were measured. We also quantified the decrease in heart rate ("heart rate recovery") after cessation of exercise. Results: During a median follow-up of 28 months, 38 patients died. Lower values of heart rate reserve, peak heart rate, heart rate recovery, and peak Vo2 (p < 0.01 for each) were associated with increased mortality in univariate analysis. Furthermore, heart rate reserve predicted mortality independently of antiarrhythmic therapy, functional class, and peak Vo2. Stratifying patients by diagnostic groups revealed that a lower heart rate reserve was also associated with a greater risk of death in patients with complex anatomy, Fontan circulation, and tetralogy of Fallot (p < 0.05 for each). Conclusions: An abnormal heart rate response to exercise identifies ACHD patients with a higher risk of mortality in the midterm, even after accounting for antiarrhythmic medication and exercise capacity. Heart rate reserve is a simple and inexpensive way to identify ACHD patients at higher mortality risk.
UR - http://www.scopus.com/inward/record.url?scp=33748421554&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33748421554&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2006.05.051
DO - 10.1016/j.jacc.2006.05.051
M3 - Article
C2 - 16979014
AN - SCOPUS:33748421554
SN - 0735-1097
VL - 48
SP - 1250
EP - 1256
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 6
ER -