University of Oulu

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,

Recovery of rate-pressure product and cardiac mortality in coronary artery disease patients with type 2 diabetes

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Author: Kiviniemi, Antti M.1; Kenttä, Tuomas V.1; Lepojärvi, Samuli1;
Organizations: 1Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: Elsevier, 2019
Publish Date: 2020-03-11


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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Series: Diabetes research and clinical practice
ISSN: 0168-8227
ISSN-E: 1872-8227
ISSN-L: 0168-8227
Volume: 150
Pages: 150 - 157
DOI: 10.1016/j.diabres.2019.03.007
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported by Finnish Technology Development Center, TEKES, Helsinki, Finland [grant number n/a, 2007–2014]; the Academy of Finland, Helsinki, Finland [grant number #267435, 2014–2017]; the Sigrid Juselius Foundation, Helsinki, Finland [grant number n/a, 2018], the Finnish Foundation for Cardiovascular Research, Helsinki, Finland [grant number n/a, 2017] and the Paulo Foundation, Espoo, Finland [grant number n/a, 2016]. The authors appreciate the financial support received from the ARTEMIS consortium partners (Polar Electro, Kempele, Finland and Hur Oy, Kokkola, Finland).
Academy of Finland Grant Number: 267435
Detailed Information: 267435 (Academy of Finland Funding decision)
Copyright information: © 2019 Elsevier B.V. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license