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Diabetes Care Publish Ahead of Print published online ahead of print May 28, 2008
DOI: 10.2337/dc08-0616
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Original Research

Impaired Chronotropic Response to Exercise Stress Testing in Patients with Diabetes Predicts Future Cardiovascular Events

P. Michael Ho, MD, PhD1,,2,,3, Thomas M. Maddox, MD, SM1,,2,,3, Colleen Ross, MS3, John S. Rumsfeld, MD, PhD1,,2,,3 and David J. Magid, MD, MPH2,,3

1Denver VA Medical Center
2University of Colorado Denver
3Institute for Health Research, Kaiser Permanente of Colorado

Michael.ho{at}uchsc.edu

ABSTRACT

Objectives: To assess the association between impaired chronotropic response (CR) and adverse events among patients with diabetes referred for exercise treadmill testing (ETT).

Research design and methods: Impaired CR was defined as achievement of less than 80% of a patient's heart rate reserve. Multivariable Cox proportional hazards regression assessed the independent association between impaired CR and adverse outcomes adjusting for demographics, co-morbidities and treadmill variables including the Duke Treadmill score.

Results: Of 1,341 patients with diabetes, 35.7% (n=479) demonstrated impaired CR during ETT. Patients with impaired CR were at increased risk of all-cause mortality, myocardial infarction, or coronary revascularization procedures. In multivariable analyses, impaired CR remained significantly associated with adverse outcomes (HR 1.53; 95% CI 1.10-2.14).

Conclusions: Among patients with diabetes, impaired CR is common during ETT and is associated with adverse outcomes. Impaired CR can be used as another non-invasive tool to risk stratify patients with diabetes following ETT.


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Copyright © 2008 by the American Diabetes Association.