Abstract 14308: Parameters of Exercise Stress Testing Are Associated With Incident Major Cardiovascular Event independent of Risk Factors and Coronary Artery Calcification - The Heinz Nixdorf Recall Study
Objective: To assess the prognostic value of parameters of autonomic cardiac function and cardiovascular fitness, as derived from exercise stress ECG testing, in addition to traditional risk factors and the anatomic information of coronary artery calcification (CAC)-score.
Methods: Participants from the population based Heinz Nixdorf Recall Study without known cardiovascular disease and without heart rate lowering therapy were included. CAC-score was quantified from non-contrast electron beam CT. From bicycle stress ECG testing peak heart rate (HR), HR recovery (decline of HR 1 minute after peak exercise), exercise capacity, exercise duration, and chronotropic incompetence (chronotropic response of ≤80%) were assessed. We determined gender differences of exercise parameters. Associations with cardiovascular events (myocardial infarction, stroke, cardiovascular death) were evaluated using multivariable Cox regression.
Results: We included 2349 subjects (age 58.1 ± 7.4 years, 48% male). Exercise duration and exercise capacity were higher in men (11.6 ± 3.0 vs. 7.6 ± 1.9 min, p<0.0001 and 8.9 ± 1.9 vs. 6.5 ± 1.3 METs, p<0.0001), while peak HR, HR recovery, and frequency of chronotropic response were not significantly different between gender (p>0.05). During a median (Q1; Q3) follow-up of 10.6 (10.2; 11.4) years, 118 cardiovascular events occurred. Adjusting for Framingham risk score, peak HR (0.70 (0.52-0.95), p=0.02), HR recovery (0.70 (0.50-0.98), p=0.04), exercise capacity (0.64 (0.45-0.92), p=0.01), and chronotopic incompetence (2.62 (1.35-5.06), p=0.004) were associated with events in women, while only exercise duration was significantly associated in men (0.77 (0.60-0.99), p=0.04). When ancillary adjusting for CAC-score, exercise duration was associated with events in both genders (women: 0.67 (0.47-0.96), p=0.03, men: 0.61 (0.43-0.87), p=0.007), while chronotropic incompetence (2.43 (1.25-4.70), p=0.01) and exercise capacity (0.69 (0.48-0.99), p=0.04) were significantly associated in women only.
Conclusion: Parameters of exercise stress ECG testing are associated with incident major cardiovascular events, independent of traditional risk factors and coronary artery calcification, especially in female subjects.
- Exercise Stress Test
- Coronary artery calcification
- Chronotropic incompetence
- Heinz Nixdorf Recall Study
Author Disclosures: A.A. Mahabadi: None. N. Lehmann: None. H. Kälsch: None. N. Pundt: None. I. Dykun: None. S. Moebus: None. K. Jöckel: None. R. Erbel: None. S. Möhlenkamp: None.
- © 2015 by American Heart Association, Inc.