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Little is known if heart rate responses during and after exercise test may be associated with the risk of sudden cardiac death (SCD). Our aim was to determine if exercise heart rate reserve and recovery, providing non-invasive indices, may predict SCD risk in general male population.We evaluated the impact of delayed heart rate reserve and slow heart rate recovery and the risk of SCD in the Kuopio Ischemic Heart Disease prospective cohort study of randomly selected 1967 men aged 42-61 years at recruitment. Heart rate reserve was calculated as the difference between the maximal attained heart rate and resting heart rate, whereas heart rate recovery was defined as maximal heart rate minus the heart rate measured at 2 min of recovery, on a symptom-limited cardiopulmonary exercise testing.During a median follow-up interval of 25 years, 209 events of SCD occurred. The age and examination adjusted relative hazards of SCD were in the lowest third of heart rate reserve 3.86 (95% confidence interval (CI) 2.56-5.80, p 0.001) and the lowest third of heart rate recovery 2.86 (95% CI 1.95-4.20, p 0.001) as compared to men in the highest third of heart rate reserve and heart rate recovery, respectively. After adjusting for potential confounders, the respective relative hazards were 1.96 (95% CI 1.24-3.12) and 1.75 (95% CI 1.16-2.64). Each unit increment (1 beat/min) in heart rate reserve and heart rate recovery decreased the incidence of SCD by 1-2%.Delayed exercise heart rate reserve and slow heart rate recovery predicted the risk of SCD, suggesting that heart rate responses may be associated with an increased risk for SCD in general population.

We sought to determine whether the chronic total occlusions (CTO) recanalization results differ between circumflex artery (CX) and other coronary arteries in our center. The study dataset encompassed 428 consecutive procedures. J-CTO score was highest in the right coronary artery (RCA) and lowest in CX lesions. After adjusting for the J-CTO score, age, body mass index, baseline creatinine, diabetes, dyslipidemia and hypertension the odds ratio for procedural success in CX compared to the other arteries was not statistically significant. We found no difference in success rates of recanalizing CTO in CX compared to other coronary arteries.

The aim of this study was to investigate whether information on both cardiorespiratory fitness (CRF) and exercise-induced ST segment depression improves the prediction of sudden cardiac death (SCD) in men.The study was based on a population sample of 2328 men aged 42-60 years, who were followed up for on average 19 years. CRF was assessed with maximal exercise test using respiratory gas analysis, expressed in metabolic equivalents (METs) and dichotomised at eight METs. Exercise-induced ST segment depression was defined as 1 mm ST segment depression in ECG.Altogether 165 SCDs occurred during the follow-up. Men with low CRF (8 METs) and exercise-induced ST segment depression had 4.8-fold (95% CI 2.9 to 7.9) higher risk of SCD than men with high CRF and without exercise-induced ST segment depression (p=0.013 for interaction) after adjustment for other cardiovascular risk factors. Men with high CRF and exercise-induced ST segment depression did not have a statistically significantly higher risk of SCD (HR 1.9, 95% CI 0.9 to 3.8) than men with high CRF and without exercise-induced ST segment depression.The combination of low CRF and exercise-induced ST segment depression was associated with a markedly increased risk of SCD in men.

Background We studied the independent and joint associations of leisure-time physical activity (LTPA) and cardiorespiratory fitness (CRF) with the risk of sudden cardiac death (SCD) among middle-aged men. Methods The participants were 2656 randomly selected men aged 42-60 years at baseline who were followed for 19 years. LTPA was assessed using a questionnaire modified from the Minnesota LTPA Questionnaire and CRF using a respiratory gas exchange analyzer during maximal exercise test. The participants were divided into 4 groups according to the level of LTPA and CRF dichotomized at the lowest tertiles. Results Men with low CRF had a 1.6 (95% confidence interval [CI], 1.1-2.3; P = 0.011) times higher risk of SCD than men with high CRF after adjustment for conventional risk factors. Men with low LTPA had a 1.4 (95% CI, 1.0-2.0; P = 0.032) times higher SCD risk than men with high LTPA after these adjustments. Men with low CRF and low LTPA had a 2.2 (95% CI, 1.4-3.3) times higher SCD risk than men with high CRF and high LTPA adjusting for conventional risk factors ( P = 0.044 for interaction). Conclusions It seems that low LTPA increases the risk of SCD particularly among men with low CRF but the level of LTPA does not modify the incidence of SCD among men with high CRF.

Aim: We investigated whether cardiorespiratory fitness (CRF) modifies the association between leisure-time physical activity (LTPA) and the risk of sudden cardiac death (SCD) among middle-aged men. Methods: The participants were a population sample of 2656 Finnish men aged 42-60 years at baseline. The mean follow-up time was 21 years. LTPA was assessed with a questionnaire and was expressed in kilocalories per day (kcal/d). CRF was measured directly using respiratory gas analysis during maximal exercise test and was expressed in metabolic equivalents (METs). The participants were divided into following 4 groups using the lowest tertiles of CRF (7.9 METs) and LTPA (< 191 kcal/d) as cut-offs: high CRF and LTPA, high CRF and low LTPA, low CRF and high LTPA and low CRF and LTPA. The risk of SCD was analysed using Cox regression models adjusted for age, smoking, alcohol consumption, body mass index, systolic blood pressure, low density lipoprotein cholesterol, C-reactive protein, prevalent type 2 diabetes and prevalent coronary heart disease. Results: Men with low CRF and low LTPA had a 1.8 (95% confidence interval 1.3-2.6, p=0.001) times higher risk of SCD than men with high CRF and high LTPA. The amount of LTPA did not significantly alter the risk of SCD among men with high CRF. Figure 1 shows the cumulative survival from SCD in the 4 groups. Conclusions: Our study shows that men with low CRF and low LTPA have increased risk of SCD. This finding emphasizes increasing LTPA to prevent SCD among men and particularly among those with low CRF.