Impaired Chronotropic Response to Exercise Stress Testing as a Predictor of Mortality

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Abstract
An attenuated heart rate response to exercise, known as chronotropic incompetence, has been shown to be predictive of mortality and coronary heart disease risk, even after adjusting for age, physical fitness, standard cardiovascular risk factors, and ST-segment changes with exercise.1,2 Chronotropic incompetence is also thought to decrease the accuracy of noninvasive imaging tests, such as stress testing with thallium imaging, regarding diagnosis of significant obstructive epicardial coronary disease.3 Nonetheless, among patients undergoing thallium scintigraphy, chronotropic incompetence has been shown to be related to risk of coronary events.4 It is not known whether chronotropic incompetence is independently predictive of all-cause mortality among patients referred for stress testing after accounting for myocardial perfusion defects.

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