Decreased heart rate recovery after exercise in patients with congestive heart failure: Effect of β-blocker therapy

Racine, Normand; Blanchet, Martine; Ducharme, Anique; Marquis, Johanne; Boucher, Jean‐Marc; Juneau, Martin; White, Michel

doi:10.1054/jcaf.2003.47

Cited by 65 publications

(43 citation statements)

References 41 publications

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“…However, in another study, Racine, et al reported that longterm beta-blocker therapy did not change HRR in patients with heart failure. 9) In our study group half of the patients were on beta-blockers, and there were no differences between the groups regarding the frequency of beta-blocker usage. Although our study population was small, we also may conclude that beta-blockers have no prominent effect on HRR in heart failure patients.…”

Section: Discussionmentioning

confidence: 62%

“…The fall in heart rate immediately after exercise is considered to be a function of the reactivation of the parasympathetic nervous system which is thought to be primarily important during the first minute after exercise. Although some studies have demonstrated that HRR is attenuated in patients with left ventricular systolic dysfunction, 8,9) prognostic data based on HRR are unavailable for patients with CHF.…”

Section: Discussionmentioning

confidence: 99%

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

Bilsel¹,

Terzi²,

Akbulut³

et al. 2006

Int. Heart J.

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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)

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

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

Bilsel¹,

Terzi²,

Akbulut³

et al. 2006

Int. Heart J.

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“…9,10 Patients with chronic heart failure present an impaired chronotropic response to exercise 18,19 and a delayed HRR after exercise, 20,21 both predictors of poor prognosis 11,22 that can be improved by exercise training. 23,24 In patients with pulmonary hypertension, a blunted chronotropic response to exercise has been also reported during symptom-limited CPET, [25][26][27] during constant workload exercise testing 28 and during a 6-minute walking test, 29 whereas an attenuated HR recovery has been noted during symptom-limited CPET 26 and during constant workload exercise testing.…”

Section: Discussionmentioning

confidence: 99%

Impairment of Autonomic Nervous System Activity in Patients With Pulmonary Arterial Hypertension: A Case Control Study

Dimopoulos¹,

Anastasiou-Nana²,

Katsaros³

et al. 2009

Journal of Cardiac Failure

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“…23 Moreover, the improvement of CR and HRR are indices of response of these patients to treatment. 24,25 Evaluation of the early phase of recovery after exercise is of special interest to physicians, as parameters of recovery entail important information on exercise pathophysiology in several disorders. In particular, VO 2 /t slope, which expresses the oxygen (O 2 ) debt, is less steep in several disorders including chronic heart failure 26,27 and cystic fibrosis.…”

Section: Introductionmentioning

confidence: 99%

Heart Rate Recovery and Oxygen Kinetics After Exercise in Obstructive Sleep Apnea Syndrome

Nanas

Sakellariou

Kapsimalakou

et al. 2010

Clinical Cardiology

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Background: Patients who suffer from obstructive sleep apnea (OSA) have a decreased exercise capacity and abnormal autonomic nervous function. However, the kinetics of early oxygen (O 2 ) and heart rate recovery (HRR) have not been described. Materials and Methods:We evaluated 21 men with moderate to severe OSA (mean age: 48 ± 11 yrs, mean apnea-hypopnea index [AHI]: 55 ± 13) and without known heart disease and 10 healthy men matched for age and body mass index (BMI; controls). Men with OSA underwent overnight polysomnography, and both groups underwent symptom-limited incremental cardiopulmonary exercise testing (CPET). We recorded the CPET parameters including peak O 2 uptake (VO 2 p), kinetics of early O 2 recovery by the first degree slope of VO 2 during the first minute (VO 2 /t slope), the time required for a 50% decline of VO 2 p during recovery (T 1/2 ), and early heart rate recovery (HRR = HR at maximal exercise − HR at 1 min of recovery), as well as the chronotropic reserve to exercise ([CR] = [peak HR − resting HR/220 − age − resting HR] × 100). Patients with OSA had a lower VO 2 p (28.7 ± 4.0 vs 34.7 ± 6.2 mL/kg/min), VO 2 /t slope (1.04 ± 0.3 vs 1.4 ± 0.17 mL/kg/min 2 ), and T 1/2 (74 ± 10 vs 56 ± 6 sec) compared to controls (all P < 0.001). In addition, both HRR and CR were lower in the OSA group (22.0 ± 7.0 vs 31.0 ± 6.0 bpm,P:0.003, and 79.0% ± 15% vs 99.0% ± 13.0%, P:0.01, respectively). Conclusions: Patients with OSA demonstrate reduced exercise capacity, delayed oxygen kinetics, and reduced HRR. These data point to abnormal oxygen delivery and/or oxidative function of the peripheral muscles and impaired autonomic nervous activity in OSA patients.

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Decreased heart rate recovery after exercise in patients with congestive heart failure: Effect of β-blocker therapy

Cited by 65 publications

References 41 publications

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

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

Impairment of Autonomic Nervous System Activity in Patients With Pulmonary Arterial Hypertension: A Case Control Study

Heart Rate Recovery and Oxygen Kinetics After Exercise in Obstructive Sleep Apnea Syndrome

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