Heart rate recovery: autonomic determinants, methods of assessment and association with mortality and cardiovascular diseases

Abstract

Cardiovascular disease (CVD) is the primary cause of mortality worldwide. Cardiac autonomic dysfunction seems to be related to the genesis of several CVDs and is also linked to the increased risk of mortality in CVD patients. The quantification of heart rate decrement after exercise - known as heart rate recovery (HRR) - is a simple tool for assessing cardiac autonomic activity in healthy and CVD patients. Furthermore, since The Cleveland Clinic studies, HRR has also been used as a powerful index for predicting mortality. For these reasons, in recent years, the scientific community has been interested in proposing methods and protocols to investigate HRR and understand its underlying mechanisms. The aim of this review is to discuss current knowledge about HRR, including its potential primary and secondary physiological determinants, as well as its role in predicting mortality. Published data show that HRR can be modelled by an exponential curve, with a fast and a slow decay component. HRR may be influenced by population and exercise characteristics. The fast component mainly seems to be dictated by the cardiac parasympathetic reactivation, probably promoted by the deactivation of central command and mechanoreflex inputs immediately after exercise cessation. On the other hand, the slow phase of HRR may be determined by cardiac sympathetic withdrawal, possibly via the deactivation of metaboreflex and thermoregulatory mechanisms. All these pathways seem to be impaired in CVD, helping to explain the slower HRR in such patients and the increased rate of mortality in individuals who present a slower HRR.

Involvement of rest diastolic arterial pressure in autonomic heart rate recovery from exercise in normotensive men

“…This would then induce a decline in sympathetic and an increase in parasympathetic ctivity to the heart, resulting in HRR. 2 Accordingly, we hypothesize that in physically healthy men with lower DAP the slower blood flow could result in a late reactivation of baroreflex, leading to slower HRR and delayed HRV recovery from exercise. However, we did not measure blood flow, plasma metabolites and lactate levels to confirm this supposition.…”

“…Geometric domain -RRTri: Triangular index, TINN: Triangular interpolation of RR intervals; SD1: standard deviation of the instantaneous variability of the beat-to beat heart rate; SD2: standard deviation of long-term continuous RR interval variability. Frequency domain -low frequency -LF: 0.04 to 0.15 Hz -and high frequency -HF: 0.15 to 0.40 Hz -in absolute (ms 2 ) and in normalized units via Fast Fourier Transform.…”

“…1 Also, cardiovascular variables evaluated after exercise provide evidence that may not be recognized at rest. 2 Heart rate recovery (HRR) following exercise and heart rate variability (HRV) are well recognized methods used to investigate heart rate autonomic regulation.…”

“…2 Best et al 4 have reported that increased arterial pressure impairs HRR and resting HRV. In these situations, arterial pressure has been recognized as a strong, independent and direct factor connected with cardiovascular mortality.…”

Recuperación cardiovascular durante ejercicio intermitente en pacientes con hipertensión y diabetes tipo 2 altamente adherentes

“…Ambas patologías producen alteraciones en el tejido capilar, del músculo esquelético y cardiaco 2,3 , incluyendo una respuesta exagerada de la frecuencia cardiaca en reposo y ejercicio 4 . La recuperación cardiovascular (frecuencia cardiaca y presión arterial) post esfuerzo, es más lenta en personas sedentarias con HTA y DT2, al compararse con personas activas 5 . La frecuencia cardiaca de recuperación, es un marcador de recu-peración cardiovascular post esfuerzo que el ejercicio ha demostrado mejorar en personas de esta cohorte 6 .…”