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. 2007 Nov 2:5:38.
doi: 10.1186/1476-7120-5-38.

Chronotropic incompetence and a higher frequency of myocardial ischemia in exercise echocardiography

Joselina L M Oliveira  1 , Thiago J S Góes, Thaiana A Santana, Thiago F Travassos, Lívia D Teles, Fernando D Anjos-Andrade, Adão C Nascimento-Júnior, Erica O Alves, Martha A Barreto, José A Barreto-Filho, Argemiro D'Oliveira Jr, Antônio C S Sousa
Affiliations

Chronotropic incompetence and a higher frequency of myocardial ischemia in exercise echocardiography

Joselina L M Oliveira et al. Cardiovasc Ultrasound. .

Abstract

Background: Exercise echocardiography (EE) is an established method to diagnose coronary artery disease (CAD). Chronotropic incompetence (CI) during the EE may be a marker of myocardial ischemia. The purpose of this investigation was to evaluate the additive value of CI during EE in CAD diagnosis.

Methods: Between 2000 and 2006, 4042 patients (1900 men with a mean age of 56 +/- 11 years) were evaluated by EE. Based on the heart rate (HR) reached during the exercise test, the subjects were divided into two groups: G1 group - 490 patients who failed to achieve 85% of the maximal age-predicted HR, and G2 group - 3552 patients who were able to achieve 85% of the maximal age-predicted HR. Clinical characteristics, left ventricular wall motion abnormalities - wall motion score index (WMSI) - and coronary angiography (CA) were the parameters compared between the two groups.

Results: The left ventricular wall motion abnormalities were more frequent in G1 group than in G2 group (54% versus 26%; P < 0.00001). WMSI was higher in G1 group than in G2 group, both at rest (1.06 +/- 0.17 versus 1.02 +/- 0.09; P < 0.0001) and after exercise (1.12 +/- 0.23 versus 1.04 +/- 0.21; P < 0.0001). In G1 group, 82% of the patients with positive EE for myocardial ischemia presented obstructive coronary, compared to 71% (P = 0.03) in G2 group.

Conclusion: CI is associated with a higher frequency of myocardial ischemia during EE, reinforcing the concept that CI is a marker of the severity of myocardial ischemia.

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Figures

Figure 1
Figure 1
WM Abnormality in patients with and without chronotropic incompetence. G1 group (black): patients who failed to achieve 85% of the maximal age-predicted HR; G2 group (white): patients who were able to achieve 85% of the maximal age-predicted HR.
Figure 2
Figure 2
Exercise Echocardiography Results. G1 group (black): patients who failed to achieve 85% of the maximal age-predicted HR; G2 group (white): patients who were able to achieve 85% of the maximal age-predicted HR.
Figure 3
Figure 3
Patient, male, 57 years old with CI (85% of the maximal age-predicted HR = 139 beats per minute). He achieved HR = 110 beats per minute. In the EE, akinetic apical septum and hypokinetic antero-apical segment were observed and the CA demonstrated coronary stenosis greater than 50%.
See this image and copyright information in PMC

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