The prognostic value of haemodynamic parameters in the recovery phase of an exercise test. The Finnish Cardiovascular Study

Abstract

We tested the hypothesis that the change from the peak to recovery values of systolic arterial pressure (SAPrecovery) and rate-pressure product (RPPrecovery) can be used to predict all-cause and cardiovascular mortality, as well as sudden cardiac death (SCD) in patients referred to a clinical exercise stress test. As a part of the Finnish Cardiovascular Study (FINCAVAS), consecutive patients (n=2029; mean age±SD=57±13 years; 1290 men and 739 women) with a clinically indicated exercise test using a bicycle ergometer were included in the present study. Capacities of attenuated SAPrecovery, RPPrecovery and heart rate recovery (HRR) to stratify the risk of death were estimated. During a follow-up (mean±s.d.) of 47±13 months, 122 patients died; 58 of the deaths were cardiovascular and 33 were SCD. In Cox regression analysis after adjustment for the peak level of the variable under assessment, age, sex, use of β-blockers, previous myocardial infarction and other common coronary risk factors, the hazard ratio of the continuous variable RPPrecovery (in units 1000mmHg × b.p.m.) was 0.85 (95% CI: 0.73-0.98) for SCD, 0.87 (0.78-0.97) for cardiovascular mortality, and 0.87 (0.81 to 0.94) for all-cause mortality. SAPrecovery was not a predictor of mortality. The relative risks of having HRR below 18b.p.m., a widely used cutoff point, were as follows: for SCD 1.28 (0.59-2.81, ns), for cardiovascular mortality 2.39 (1.34-4.26) and for all-cause mortality 2.40 (1.61-3.58). In conclusion, as a readily available parameter, RPPrecovery is a promising candidate for a prognostic marker.