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ȣ - 520492 8 |
| Angina patients with chronotropic incompetence tend to undergo percutaneous coronary artery intervention(PCI) |
| 전남대학교병원 심장센터 |
| 윤남식, 송영아, 고점석, 이민구, 강원유, 이신은, 김수현, 박근호, 심두선, 윤현주, 김계훈, 홍영준, 박형욱, 김주한, 안영근, 정명호, 조정관, 박종춘, 강정채 |
Background: The goal of this study is to identify the impact of chronotropic incompetence in patients with angina. Method: We reviewed 133 consecutive angina patients(Group I, 55.8±10.0 year, 87 male) who had chronotropic incompetence and 722 consecutive angina patients(Group II, 53.1±12.3 year, 418 male) without chronotropic incompetence, and their 24 months clinical follow-up datum were reviewed. Chronotropic incompetence was defined as failure to achieve 85% of the maximal age-predicted heart rate during treadmill exercise test. Result: No difference of gender and age was identified. The prevalence of chronotropic incompetence was 15.5%. Group I had more coronary artery disease risk factor. There was no association between underlying disease entity and severity of chronotropic incompetence(p>0.05). In group I, severity of chronotropic incompetence was higher in beta-blocker user(HR-Ex/HR-Mx=0.75±0.06 vs. 0.78±0.05, p=0.001; HRR=0.55±0.12 vs. 0.60± 0.09, p=0.006). Calcium channel blocker and Angiotensin converting enzyme inhibitor(ACEi) had no influence to chronotropic incompetence(p>0.05). Chronotropic incompetence was less severe in patients who recived combination therapy with statin and one of angiotensin II receptor blocker(ARB) or ACEi(HR-Ex/HR-Mx, 0.80±0.04 vs. 0.77±0.06, p=0.007; HRR, 0.64±0.07 vs. 0.58±0.11, p=0.003). The mortality, myocardial infarction occurrence, and PCI undergoing were not different between groups at 24 month clinical follow-up. In group I, patients with severe chronotropic incompetence(HR-Ex/HR-Mx<0.769 or HRR<0.557) underwent PCI commonly(29% vs. 9%, p=0.035, sensitivity=62.5%, specificity=71.4%). Chronotropic incompetence (HR-Ex/HR-Mx<0.769 and HRR<0.557) was a predictor of PCI undergoing independently of hypertension, diabetes, smoking, hyperlipidemia(p=0.035). Conclusion: The prevalence of chronotropic incompetence was 15.5%. Statin with ARB or ACEi seems to lower chronotropic incometence. Angina patients with chronotropic incompetence had tendency to undergo percutaneous coronary artery intervention(PCI) in their follow-up period.
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