(Circulation. 1996;93:1485-1487.)
© 1996 American Heart Association, Inc.
Articles |
Chronotropic Incompetence
The Implications of Heart Rate Response to Exercise (Compensatory Parasympathetic Hyperactivity?)
From Memorial Heart Institute, Long Beach Memorial Medical Center, Long Beach, Calif, and University of California, Irvine, School of Medicine.
Correspondence to Myrvin H. Ellestad, MD, Memorial Heart Institute, Long Beach Memorial Medical Center, 2801 Atlantic Ave, Long Beach, CA 90801.
Key Words: Editorials • heart rate • exercise
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Introduction |
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The report in this issue by Lauer et al1 provides more fascinating data on the possible predictive value of a reduced response of the sinus node to exercise. They exploited the opportunity to study this important response in 1575 healthy participants in the Framingham Offspring Study who had exercise tests on entry in the 1970s. The mortality and morbidity of the men in this study were extracted from the Framingham follow-up data as well as during follow-up examinations 8, 12, and 16 years after their entry.
These investigators correlated the mortality and incident coronary disease with the subject's ability or failure to reach 85% of maximum predicted heart rate, actual increase in heart rate from rest to maximum, and a ratio of heart rate to metabolic reserve achieved by stage 2 of the Bruce exercise protocol. This ratio compensates for the differences in age and physical fitness and provides a chronotropic index.
During a mean follow-up of 7.7 years, the inability to achieve the
target heart rate in 21% of the subjects was correlated with total
mortality and with the incidence of coronary disease including
myocardial infarction. Similar correlations occurred with a reduced
heart rate increase with exercise and with the chronotropic response
index calculated as previously mentioned. The data suffer from the fact
that exercise was arbitrarily terminated at 85% of age-predicted
heart rate, a highly artificial value that had considerable adherence
in the 1970s. However, previous work suggests that if their patients
had been exercised to a symptom-limited
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