Prognostic value of combined exercise and recovery electrocardiographic analysis

Riccardo Bigi, Lauro Cortigiani, Dario Gregori, Jeroen J. Bax, Cesare Fiorentini

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Heart rate-adjusted ST-segment depression (ST/HR) analysis improves the diagnostic accuracy of exercise testing, but its prognostic value has not been evaluated in unselected populations. We prospectively used comparative exercise-recovery ST/HR analysis to predict outcome in a consecutive cohort of outpatients referred for exercise testing. Methods: The stress-recovery index, defined as the difference between ST/HR areas during exercise and recovery, was derived in 1163 patients (median age, 60 years; interquartile range, 54-65 years). All-cause mortality and the combination of death or nonfatal myocardial infarction were target end points. The individual effect of clinical and exercise-testing data on outcome was evaluated by Cox regression analysis using separate models for each group of variables. Model validation was performed using bootstrap methods adjusted by the degree of optimism in estimates. Survival analysis was performed with the product-limit Kaplan-Meier method. Results: During a 33-month follow-up, 48 deaths and 72 nonfatal myocardial infarctions occurred. After adjusting for confounding variables, hypertension (hazard ratio, 1.80; 95% confidence interval, 1.26-2.59), ST/HR index (hazard ratio, 1.32; 95% confidence interval, 1.04-1.66; for interquartile difference), and stress-recovery index (hazard ratio, 0.75; 95% confidence interval, 0.65-0.86; for interquartile difference) were predictive of death or nonfatal myocardial infarction, whereas hypertension (hazard ratio, 3.67; 95% confidence interval, 2.00-6.73) and stress-recovery index (hazard ratio, 0.55; 95% confidence interval, 0.48-0.63; for interquartile difference) were predictive of all-cause mortality. In addition, stress-recovery index increased the prognostic power of the model on top of clinical and exercise-testing variables and provided significant discrimination for survival. Conclusion: Combined evaluation of ST/HR analysis during exercise and recovery improves the prognostic capacity of standard exercise electrocardiography.

Original languageEnglish
Pages (from-to)1253-1258
Number of pages6
JournalArchives of Internal Medicine
Volume165
Issue number11
DOIs
Publication statusPublished - Jun 13 2005

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Exercise
Confidence Intervals
Myocardial Infarction
Hypertension
Confounding Factors (Epidemiology)
Mortality
Survival Analysis
Electrocardiography
Outpatients
Heart Rate
Regression Analysis
Survival
Population

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Prognostic value of combined exercise and recovery electrocardiographic analysis. / Bigi, Riccardo; Cortigiani, Lauro; Gregori, Dario; Bax, Jeroen J.; Fiorentini, Cesare.

In: Archives of Internal Medicine, Vol. 165, No. 11, 13.06.2005, p. 1253-1258.

Research output: Contribution to journalArticle

Bigi, Riccardo ; Cortigiani, Lauro ; Gregori, Dario ; Bax, Jeroen J. ; Fiorentini, Cesare. / Prognostic value of combined exercise and recovery electrocardiographic analysis. In: Archives of Internal Medicine. 2005 ; Vol. 165, No. 11. pp. 1253-1258.
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abstract = "Background: Heart rate-adjusted ST-segment depression (ST/HR) analysis improves the diagnostic accuracy of exercise testing, but its prognostic value has not been evaluated in unselected populations. We prospectively used comparative exercise-recovery ST/HR analysis to predict outcome in a consecutive cohort of outpatients referred for exercise testing. Methods: The stress-recovery index, defined as the difference between ST/HR areas during exercise and recovery, was derived in 1163 patients (median age, 60 years; interquartile range, 54-65 years). All-cause mortality and the combination of death or nonfatal myocardial infarction were target end points. The individual effect of clinical and exercise-testing data on outcome was evaluated by Cox regression analysis using separate models for each group of variables. Model validation was performed using bootstrap methods adjusted by the degree of optimism in estimates. Survival analysis was performed with the product-limit Kaplan-Meier method. Results: During a 33-month follow-up, 48 deaths and 72 nonfatal myocardial infarctions occurred. After adjusting for confounding variables, hypertension (hazard ratio, 1.80; 95{\%} confidence interval, 1.26-2.59), ST/HR index (hazard ratio, 1.32; 95{\%} confidence interval, 1.04-1.66; for interquartile difference), and stress-recovery index (hazard ratio, 0.75; 95{\%} confidence interval, 0.65-0.86; for interquartile difference) were predictive of death or nonfatal myocardial infarction, whereas hypertension (hazard ratio, 3.67; 95{\%} confidence interval, 2.00-6.73) and stress-recovery index (hazard ratio, 0.55; 95{\%} confidence interval, 0.48-0.63; for interquartile difference) were predictive of all-cause mortality. In addition, stress-recovery index increased the prognostic power of the model on top of clinical and exercise-testing variables and provided significant discrimination for survival. Conclusion: Combined evaluation of ST/HR analysis during exercise and recovery improves the prognostic capacity of standard exercise electrocardiography.",
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