Recovery of rate-pressure product and cardiac mortality in coronary artery disease patients with type 2 diabetes
Kiviniemi, Antti M.; Kenttä, Tuomas V.; Lepojärvi, Samuli; Perkiömäki, Juha S.; Piira, Olli-Pekka; Ukkola, Olavi; Huikuri, Heikki V.; Junttila, M. Juhani; Tulppo, Mikko P. (2019-03-11)
Antti M. Kiviniemi, Tuomas V. Kenttä, Samuli Lepojärvi, Juha S. Perkiömäki, Olli-Pekka Piira, Olavi Ukkola, Heikki V. Huikuri, M. Juhani Junttila, Mikko P. Tulppo, Recovery of rate-pressure product and cardiac mortality in coronary artery disease patients with type 2 diabetes, Diabetes Research and Clinical Practice, Volume 150, 2019, Pages 150-157, ISSN 0168-8227, https://doi.org/10.1016/j.diabres.2019.03.007
© 2019 Elsevier B.V. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/.
https://creativecommons.org/licenses/by-nc-nd/4.0/
https://urn.fi/URN:NBN:fi-fe2019111838526
Tiivistelmä
Abstract
Aims: To investigate prognostic significance of post-exercise recovery of rate-pressure product (RPP) in patients with stable coronary artery disease (CAD) and type 2 diabetes (T2D).
Methods: Patients with angiographically documented CAD and T2D (n = 697) underwent symptom-limited bicycle exercise test. Exercise capacity (EC), heart rate, blood pressure and RPP responses to peak exercise and recovery (2′ and 5′ after cessation of exercise) were analyzed. Cardiac death was the primary and sudden cardiac death (SCD) secondary endpoint.
Results: During a median follow-up of 76 months, 49 cardiac deaths (7.0%) and 28 SCDs (4.0%) were observed. The recovery of RPP at 5′ was the strongest univariate predictor of cardiac death (hazard ratio [HR]: 2.55 per SD decrease, 95%CI: 1.82–3.58, p < 0.001) and SCD (HR: 2.34, 95%CI: 1.51–3.62, p < 0.001). In multivariate analysis, it remained significantly associated to cardiac death and SCD without (HR: 1.66, 95%CI: 1.14–2.41, p < 0.01 and HR: 1.75, 95%CI: 1.08–2.85, p < 0.05, respectively) and with additional adjustment for EC and peak RPP (HR: 1.45, 95%CI: 1.09–1.92, p < 0.05 and HR: 1.52, 95%CI: 1.01–2.27, p < 0.05, respectively).
Conclusions: The recovery of RPP after exercise is a potent predictor of cardiac death in patients with CAD and T2D. It provides significant prognostic information beyond EC and peak RPP.
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