RT Journal Article
SR Electronic
T1 Cardiorespiratory fitness and heart rate recovery predict sudden cardiac death independent of ejection fraction
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 434
OP 440
DO 10.1136/heartjnl-2019-315198
VO 106
IS 6
A1 Jussi A Hernesniemi
A1 Kalle Sipilä
A1 Antti Tikkakoski
A1 Juho T Tynkkynen
A1 Pashupati P Mishra
A1 Leo-Pekka Lyytikäinen
A1 Kjell Nikus
A1 Tuomo Nieminen
A1 Terho Lehtimaki
A1 Mika Kähönen
YR 2020
UL http://heart.bmj.com/content/106/6/434.abstract
AB Objective To evaluate whether cardiorespiratory fitness (CRF) and heart rate recovery (HRR) associate with the risk of sudden cardiac death (SCD) independently of left ventricular ejection fraction (LVEF).Methods The Finnish Cardiovascular Study is a prospective clinical study of patients referred to clinical exercise testing in 2001–2008 and follow-up until December 2013. Patients without pacemakers undergoing first maximal or submaximal exercise testing with cycle ergometer were included (n=3776). CRF in metabolic equivalents (METs) was estimated by achieving maximal work level. HRR was defined as the reduction in heart rate 1 min after maximal exertion. Adjudication of SCD was based on death certificates. LVEF was measured for clinical indications in 71.4% of the patients (n=2697).Results Population mean age was 55.7 years (SD 13.1; 61% men). 98 SCDs were recorded during a median follow-up of 9.1 years (6.9–10.7). Mean CRF and HRR were 7.7 (SD 2.9) METs and 25 (SD 12) beats/min/min. Both CRF and HRR were associated with the risk of SCD in the entire study population (HRCRF0.47 (0.37–0.59), p<0.001 and HRHRR0.57 (0.48–0.67), p<0.001 with HR estimates corresponding to one SD increase in the exposure variables) and with CRF, HRR and LVEF in the same model (HRCRF0.60 (0.45–0.79), p<0.001, HRHRR0.65 (0.51–0.82), p<0.001) or adjusting additionally for all significant risk factors for SCD (LVEF, sex, creatinine level, history of myocardial infarction and atrial fibrillation, corrected QT interval) (HRCRF0.69 (0.52–0.93), p<0.01, HRHRR0.74 (0.58–0.95) p=0.02).Conclusions CRF and HRR are significantly associated with the risk of SCD regardless of LVEF.