Elsevier

American Heart Journal

Volume 151, Issue 4, April 2006, Pages 851.e7-851.e13
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Prognostic value of heart rate recovery in patients with heart failure

https://doi.org/10.1016/j.ahj.2005.09.012Get rights and content

Background

The rate in which heart rate recovers from exercise has recently been shown to be a strong predictor of mortality in patients suspected of having coronary disease, but its prognostic value in patients with heart failure (HF) has not been explored. We sought to assess the prognostic utility of heart rate recovery (HRR) in patients with HF.

Methods

Eighty-seven subjects diagnosed with compensated HF underwent cardiopulmonary exercise testing (CPX). Mean age and ejection fraction were 50.0 (±13.9) years and 28.1% (±13.6%), respectively. Heart rate at 1-minute post-CPX was subtracted from maximal heart rate during the exercise test to produce a measure of HRR1 in beats per minute. Subjects were followed for a combined death/hospitalization end point for 1-year after CPX.

Results

The mean peak respiratory exchange ratio, peak oxygen consumption (Vo2), minute ventilation/carbon dioxide production (VE/Vco2) slope, and HRR1 were 1.06 (±0.11), 14.8 (±4.7) mL · kg−1 · min−1, 36.6 (±8.6), and 11.0 (±10.4) beat/min, respectively. Although all three variables were significant univariate predictors of the composite end point (P < .001), multivariate Cox regression analysis only retained the VE/Vco2 slope (χ2 = 33.5, P < .001) and HRR1 (residual χ2 = 15.0, P < .001) in the equation. The hazard ratio for subjects having both an abnormal VE/Vco2 slope (>34.4) and HRR1 (<6.5 beat/min) value was 9.2 (95% CI 4.5-18.5, P < .0001).

Conclusions

These results indicate that HRR provides additional prognostic information in patients with HF undergoing CPX. Moreover, given the independent prognostic value of HRR, this variable alone may provide valuable clinical information when ventilatory expired gas analysis is not available.

Section snippets

Methods

Eighty-seven subjects, assessed between May 13, 1997, and October 18, 2004, were included in the study. The subjects were tested and followed by the HF program at the Medical College of Virginia in Richmond. All subjects underwent CPX on an outpatient basis and were instructed to maintain their normal pharmacological regimen. None of the subjects were participating in a cardiac rehabilitation or secondary prevention program at the time of testing. The exercise tests were conducted as part of

Results

Termination of exercise was due to volitional fatigue for all subjects. No subject demonstrated an abnormal physiological response to exercise (ECG signs of ischemia, new onset of arrhythmias, or excessive hypotensive/hypertensive response) warranting test termination before subject request.

The mean peak RER, peak Vo2, VE/Vco2 slope, and HRR1 were 1.06 (±0.11), 14.8 (±4.7) mL · kg−1 · min−1, 36.6 (±8.6), and 11.0 (±10.4) beat/min, respectively. HRR1 was significantly correlated with peak Vo2 (r

Discussion

The results of the present study indicate that HRR provides valuable prognostic information in patients diagnosed with HF. This finding is consistent with previous investigations demonstrating the ability of HRR to predict adverse events in populations other than HF.17, 18, 19, 20 To our knowledge, the current study is the first to be conducted in subjects with compensated HF. Importantly, HRR1 appears to outperform peak Vo2, LVEF, and HF etiology in predicting risk of death or hospitalization

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