Abnormal Heart Rate Recovery Immediately After Cardiopulmonary Exercise Testing in Heart Failure Patients

Abstract

SUMMARYAn attenuated heart rate recovery (HRR) immediately after exercise has been shown to be predictive of mortality. It is not known whether HRR predicts mortality when measured in patients with heart failure. The present study was undertaken to evaluate the ability of HRR to predict mortality in patients with heart failure.We studied 84 NYHA class II or III chronic congestive heart failure patients who had a left ventricular ejection fraction ≤ 40%. All patients underwent symptom limited cardiopulmonary exercise testing. The value for the HRR was defined as the difference in heart rate between peak exercise and one-minute later; a value ≤ 18 beats per minute was considered abnormal. The patients were divided into 2 groups according to the value of HRR. Those with abnormal HRR were assigned to group I and those with normal HRR were assigned to group II. The 2 groups were compared with each other regarding baseline characteristics and exercise capacity assessed by peak VO 2 .There were 26 patients (31%) in group I and 58 patients (69%) in group II. Group II patients had better performance on treadmill exercise testing than group I patients. They had greater exercise duration (7.5 ± 3.8 minutes versus 5 ± 3.5 minutes, P = 0.006), better heart-rate reserve (79 ± 25% versus 63 ± 27%, P = 0.01), and higher values of maximal heart-rate (141 ± 18 beats/min versus 132 ± 17 beats/min, P = 0.04). Group II patients also had higher peak VO 2 values (16.8 ± 4.4 mL/kg/min versus 14.4 ± 3.6 mL/ kg/min, P = 0.01). When we separated the groups according to beta-blocker usage, betablockers had no prominent effect on HRR.In the follow-up period (mean 14.1 ± 6.1 months), the presence of abnormal HRR and lower peak VO 2 (≤ 14 mL/kg/min) were the only significant predictors of mortality in our patient population (adjusted hazard ratio [HR] 5.2, 95% CI, 1.3 to 24, P = 0.03 and adjusted HR 13, 95% CI, 2.1 to 25.6, P = 0.005, respectively).It seems that the attenuated HRR value one minute after peak exercise appears to be a reliable index of the severity of exercise intolerance in heart failure patients and this study supports the value of HRR as a prognostic marker among heart failure patients referred for cardiopulmonary exercise testing for prediction of prognosis. (Int Heart J 2006; 47: 431-440)

Systolic Blood Pressure Response to Exercise as a Predictor of Mortality in Patients With Chronic Heart Failure

“…[10][11][12] Lipinski, et al demonstrated that HR recovery (maximum HR-HR at specified time period during recovery) at the 2nd minute after exercise was the strongest predictor of mortality as compared to HR recovery at 3 or 5 minutes after exercise for CHF patients without β-adrenergic blocking agents. 9) In this study, HR at the 3rd minute after exercise was an independent predictor of mortality in CHF.…”

“…[5][6][7] Thus, these studies were performed with ventilatory gas analysis in patients with CHF. [8][9][10][11][12] However, cardiopulmonary exercise testing cannot be always performed as a routine exercise stress test in a clinical setting. Accordingly, it may be necessary to identify the prognostic value of the exercise stress test variables in patients with CHF when ventilatory gas analysis is not available.…”

Muscle Weakness Is Associated With an Increase of Left Ventricular Mass Through Excessive Blood Pressure Elevation During Exercise in Patients With Hypertension

“…HRR was defined as the HR decrease from maximum HR during the exercise test to that measured 1 minute after completion, and was used as an indicator of parasympathetic activity. 19,20) Cardiovascular responses: The change from SBP at the resting phase to peak SBP during the exercise phase in the cycle ergometer exercise test was calculated as an indicator of BP elevation during exercise (ΔSBP).…”

From the authors

“…As summarised in the American College of Cardiology/American Heart Association Guidelines [3], impaired oxygen uptake (V'O 2 ) kinetics during recovery correlate strongly with exercise tolerance, peak V'O 2 (V'O 2, peak) and cardiac index in congestive heart failure (CHF) patients. Diagnostic and prognostic importance have been well demonstrated for several parameters, namely V'O 2 kinetics [3], heart rate recovery (HRR) [3,5], blood pressure response [3], ventricular ectopy [6] and ST changes from exercise recovery [3], in various diseases including CHF and chronic obstructive pulmonary disease. Information from the exercise recovery phase could support the interpretation of CPET results from submaximal exercise where poor effort or malingering are suspected.…”

“…Fortunately, several simple derivatives exist, including HRR, V'O 2, peak/V'O 2 recovery at the 5th minute, time to reach 50% of V'O 2, peak and respiratory exchange ratio dynamics, and have been proven to be informative [3,5,9, 10].…”