{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T22:03:40Z","timestamp":1791237820117,"version":"4.1.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Societ\u00e0 Italiana di Ecocardiografia e Cardiovascular Imaging"},{"name":"SIECVI"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Chronotropic incompetence (CI) is a biomarker of cardiac autonomic dysfunction. The aim of the study is to assess the risk stratification value of CI during exercise or pharmacological stress echocardiography in patients with chronic coronary syndromes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>In a prospective, multicenter, international, observational study, we enrolled 13 445 patients with known or suspected chronic coronary syndromes who underwent stress echocardiography in 19 clinical sites from 10 countries using either exercise (n = 2594), dobutamine (n = 2440), or dipyridamole (n = 8411). Heart rate was automatically measured from the 1-lead ECG in the echocardiography monitor. We considered CI as failure to reach 85% of the maximal predicted (220-age) heart rate for exercise and dobutamine, and heart rate reserve (peak\/rest heart rate) \u2264 1.22 (\u22641.17 if in permanent atrial fibrillation) for dipyridamole stress. The primary outcome was all-cause death. CI was observed in 5045 patients (38%) and stress-induced regional wall motion abnormalities in 1648 (13%). Over a median follow-up time of 3.4 years (interquartile range, 1.6\u20139.1 years), there were 2426 (18%) deaths. The 10-year mortality was 39% in patients with and 21% in patients without CI (P &amp;lt; 0.0001). CI was associated with a significant increase in 10-year mortality in all age groups ranging from \u226454 years to \u226575 years (P &amp;lt; 0.0001). In addition, it was associated with increased mortality (P &amp;lt; 0.0001) irrespective of \u03b2-blocker use. Cox multivariable analysis revealed that CI was an independent predictor of mortality (HR: 1.60, 95% confidence interval: 1.47\u20131.74; P &amp;lt; 0.0001) together with age, male sex, diabetes mellitus, left ventricular ejection fraction, and resting heart rate.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In patients with chronic coronary syndromes, CI during exercise or pharmacological stress is a simple and objective predictor of survival.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwaf492","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T11:47:26Z","timestamp":1756900046000},"source":"Crossref","is-referenced-by-count":7,"title":["Chronotropic incompetence during exercise or pharmacological stress is associated with reduced survival in patients with chronic coronary syndromes"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1804-4939","authenticated-orcid":false,"given":"Lauro","family":"Cortigiani","sequence":"first","affiliation":[{"name":"Cardiology Department, San Luca Hospital , via Gulielmo Lippi Francesconi, 55100 Lucca ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quirino","family":"Ciampi","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Fatebenefratelli Hospital , Benevento ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9085-4872","authenticated-orcid":false,"given":"Angela","family":"Zagatina","sequence":"additional","affiliation":[{"name":"Cardiosurgery Department, St. Petersburg State University Hospital , St. Petersburg ,","place":["Russian Federation"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Kalinina","sequence":"additional","affiliation":[{"name":"Cardiosurgery Department, St. Petersburg State University Hospital , St. Petersburg ,","place":["Russian Federation"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1233-3924","authenticated-orcid":false,"given":"Ratnasari","family":"Padang","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garvan C","family":"Kane","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hector R","family":"Villarraga","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelaide M","family":"Arruda-Olson","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2207-3388","authenticated-orcid":false,"given":"Nicola","family":"Gaibazzi","sequence":"additional","affiliation":[{"name":"University of Parma, Cardiology Department , Parma ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7895-2840","authenticated-orcid":false,"given":"Davide","family":"Donelli","sequence":"additional","affiliation":[{"name":"University of Parma, Cardiology Department , Parma ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosina","family":"Arbucci","sequence":"additional","affiliation":[{"name":"Cardiodiagnosticos, Investigaciones Medicas and Bioimagenes Medical Center , Buenos Aires ,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelena","family":"Celutkiene","sequence":"additional","affiliation":[{"name":"Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, State Research Institute Center for Innovative Medicine \u00a0 Vilnius LT-03101 ,","place":["Lithuania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina","family":"Wierzbowska-Drabik","sequence":"additional","affiliation":[{"name":"Department of Internal Diseases and Clinical Pharmacology, Bieganski Hospital, Medical University , Lodz ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alla","family":"Boshchenko","sequence":"additional","affiliation":[{"name":"Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences , Tomsk ,","place":["Russian Federation"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Zhuravleva","sequence":"additional","affiliation":[{"name":"Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences , Tomsk ,","place":["Russian Federation"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Sviazova","sequence":"additional","affiliation":[{"name":"Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences , Tomsk ,","place":["Russian Federation"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Amor","sequence":"additional","affiliation":[{"name":"Hospital Echocardiography Laboratory, Ramos Mejia Hospital , Buenos Aires ,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Haberka","sequence":"additional","affiliation":[{"name":"University of Silesia, Cardiology Department , Katowice ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaroslaw D","family":"Kasprzak","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bieganski Hospital, Medical University , Lodz ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0336-5593","authenticated-orcid":false,"given":"Hugo","family":"Rodriguez-Zanella","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Instituto Nacional de Cardiologia Ignacio Chavez , Mexico City ,","place":["Mexico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Varga","sequence":"additional","affiliation":[{"name":"Institute of Family Medicine, University of Szeged , Szeged ,","place":["Hungary"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Merli","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Ospedale per gli Infermi , Faenza ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesus Peteiro","family":"Vazquez","sequence":"additional","affiliation":[{"name":"Department of Cardiology, CHUAC- Complexo Hospitalario Universitario A Coruna- University of A Coruna , La Coruna ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fausto","family":"Rigo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Villa Salus Foundation\/IRCCS San Camillo Hospital , Venice Venezia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Djordjevic-Dikic","sequence":"additional","affiliation":[{"name":"Cardiology Clinic, University Center Serbia, Medical School, University Clinical Center Serbia, University of Belgrade , Belgrade ,","place":["Serbia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Saad","sequence":"additional","affiliation":[{"name":"Divisio\u0301n de Cardiologi\u0301a, Hospital de Cl\u00ednicas Jos\u00e9 de San Mart\u00edn , Buenos Aires ,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Lowenstein","sequence":"additional","affiliation":[{"name":"Cardiodiagnosticos, Investigaciones Medicas and Bioimagenes Medical Center , Buenos Aires ,","place":["Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego M","family":"Lowenstein 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Orsola-Malpighi Hospital \u00a0 Bologna 40100 ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni L","family":"Tripepi","sequence":"additional","affiliation":[{"name":"CNR, Institute of Clinical Physiology , Pisa-Roma-Reggio Calabria ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2524-6288","authenticated-orcid":false,"given":"Mauro","family":"Pepi","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, IRCCS , Milano ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scipione","family":"Carerj","sequence":"additional","affiliation":[{"name":"Cardiology Division, University Hospital Policlinico G. 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