P328 Relation between CHA2DS2-VASc and impaired heart rate recovery in patients without inducible myocardial ischemia
Authors: Boskovic N , Popovic A , Petrovic M T , Dedic S , Aleksandric S , Tesic M , Dobric M , Nedeljkovic I , Beleslin B , Djordjevic-Dikic A , Giga V 
Published: January 2020

Abstract

Background
Heart rate recovery (HRR) has been shown to predict cardiovascular and all-cause morbidity and mortality in different populations. Recent studies have indicated the CHA2DS2-VASc score can be used as predictor of mortality in patients with coronary artery disease, without atrial fibrillation. However, the relation between these two parameters has not yet been documented.
The Aim: The aim of this study was to determine the relation between CHA2DS2-VASc score and impaired heart rate recovery in patients without inducible myocardial ischemia.

Methods
Our study comprised of 2699 consecutive patients (1319 male, 42.8%, average age 60 ± 11 years) who underwent treadmill exercise testing (stress echocardiography or stress echocardiography) according to Bruce protocol for the assessment of myocardial ischemia. We excluded patients with the systolic heart failure (left ventricle ejection fraction &lt;45%) and those with inducible ischemia. CHA2DS2-VASc score was calculated according to the guidelines. Duke treadmill score, functional capacity (Metabolic Equivalents - METs), chronotropic competence (CC), body mass index (BMI) were calculated in all patients. HRR was calculated as the difference between heart rate at the peak stress and heart rate in the first minute of rest. Slow HRR was defined as ≤18 beats/min.

Results
Out of 2699 patients, 378 (12.3%) had a positive test and they were excluded from further analysis. Of the remaining 2321 patients, 251 (10.8%) had an impaired HRR, whereas 2070 (89.2%) had normal HRR. Previously known coronary artery disease (previous myocardial infarction, percutaneous coronary intervention or coronary artery bypass graft surgery) had 78 (3.4%) patients. Patients with impaired HRR had significantly higher CHA2DS2-VASc score (3.1 ± 1.3 vs 2.3 ± 1.2, p &lt; 0.001), higher resting heart rate (76.9 ± 16.1 vs 73.3 ± 12.3bpm, p &lt; 0.001), higher systolic blood pressure at rest (122.1 ± 13.9 vs 117.2 ± 13.4mmHg, p &lt; 0.001), higher diastolic blood pressure at rest (73.7 ± 7.5 vs 72.3 ± 7.2mmHg, p &lt; 0.001), higher rate of hyperlipproteinemia (176/251, 70.1% vs 1294/2070, 62.5%, p &lt; 0.001), higher BMI (27.3 ± 3.6 vs 26.4± 3.6kg/m2, p &lt; 0.001), shorter duration of the test (5.2 ± 1.8 vs 6.4 ± 1.9 minutes, p &lt; 0.001). lower Duke score (4.6 ± 2.4 vs 6.1 ± 2.4 minutes, p &lt; 0.001). lower MET (6.3 ± 1.8 vs 7.5 ± 1.9, p &lt; 0.001) and higher rate of chronotropic incompetence (173/251, 68.9% vs 1036/2070, 50%, p &lt; 0.001) compares to the patients with normal HRR. Multivariate predictors of impaired HRR were higher CHA2DS2-VASc score (p &lt; 0.001), not achieved THR (p &lt; 0.001), higher heart rate at rest (p = 0.001), higher systolic blood pressure at rest (p = 0.001) and shorter duration of test (p = 0.046).

Conclusion
CHA2DS2-VASc score is an independent predictor of impaired HRR in patients without inducible ischemia.