Heart Rate Recovery Predicts Clinical Worsening in Patients with Pulmonary Arterial Hypertension

Minai, Omar A.; Gudavalli, Ravindra; Mummadi, Srinivas R.; Liu, Xiaobo; McCarthy, Kevin; Dweik, Raed A.

doi:10.1164/rccm.201105-0848oc

Cited by 80 publications

(112 citation statements)

References 41 publications

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“…Attention has recently been focused on neurohormonal alterations in PAH patients and abnormalities of the sympathetic nervous system, similar to those described in left ventricular dysfunction [5,6,17]. Our clinical findings correlate with the accumulating evidence of sympathetic overactivation in patients with …”

Section: Discussionsupporting

confidence: 81%

“…In this context, we reported that patients with IPAH had a reduced TtCW if they had reduced heart rate recovery (HRR) after 6MWT [6]. Interestingly, the reduced HRR was associated with a reduced chronotropic response during 6MWT and the majority (67%) of the patients taking β-blockers had a reduced HRR.…”

Section: Figurementioning

confidence: 99%

“…In contrast, recent evidence indicates that there is an excessive sympathetic activation in PAH patients [5,6] which may portend a worse prognosis [6][7][8]. Attention has also focused on the diverse role of β-blockers on RV function in PAH patients.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of β-blocker use in pulmonary arterial hypertension: a propensity-matched analysis

et al. 2015

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The utility and safety of β-blockers in pulmonary hypertension is controversial. Anecdotal reports suggest that β-blockers may be harmful in these patients. The aim of our study was to evaluate outcomes of β-blocker use in pulmonary hypertension.We reviewed patients from our pulmonary hypertension registry between 2000 and 2011. Patients who continued to use β-blockers were compared to those who never used β-blockers for all-cause mortality, time to clinical worsening events, defined as death, lung transplantation and hospitalisation due to pulmonary hypertension. We also evaluated the effect of β-blockers on 6-min walking distance and New York Heart Association (NYHA) functional class.133 patients used β-blockers and 375 patients never used β-blockers. Mean±SD age was 57±16 years and the median follow-up period was 78 months. Propensity-matched analysis showed that the adjusted odds ratio (95% CI) for mortality with β-blocker use was 1.13 (0.69-1.82) and for clinical worsening events was 0.96 (0.55-1.68). No significant difference was noted in probability of survival and time to clinical worsening events. Patients on β-blockers walked a shorter distance on follow-up 6 min walk test; follow-up NYHA class was similar between groups.Pulmonary hypertension patients receiving β-blockers had a similar survival and time to clinical worsening events compared to patients not receiving them. Functional outcomes were similar, although β-blocker use was associated with a tendency towards shorter walking distance. @ERSpublications β-blocker use does not affect survival, symptom worsening or functional capacity in pulmonary hypertension

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Section: Discussionsupporting

confidence: 81%

Section: Figurementioning

confidence: 99%

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Outcomes of β-blocker use in pulmonary arterial hypertension: a propensity-matched analysis

et al. 2015

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“…It has been theorized that nocturnal hypoxia may cause increased catecholamine release possibly leading to autonomic dysfunction (38)(39)(40), which is known to be associated with mortality (41)(42)(43). HRR after stress testing has been well recognized as a measure of autonomic function (44) and a risk factor for adverse clinical outcomes in several disease states (48,49). Maeder and colleagues (50) studied HRR in patients with OSA and concluded that the severity of OSA, as defined by the AHI, was independently associated with abnormal HRR.…”

Section: Discussionmentioning

confidence: 99%

Impaired Functional Capacity Predicts Mortality in Patients with Obstructive Sleep Apnea

et al. 2014

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“…Such abnormalities may be visible in heart rate response during recovery from exercise and readily measured in variables such as HRR1, which is the fall in HR during the first minute of recovery. Minai et al [153] have measured this following a 6MWT in idiopathic PAH and found it to complement the ability of 6MWD to predict clinical worsening. Similarly in an older study with a limited multivariate analysis on a small cohort (n = 34) [154], the size of fall in S p O 2 during the 6MWT was found to be of prognostic value with a 27% increase in risk of death over the study period (1992-1997) for each percentage point fall in saturation.…”

Section: Field Exercise Testsmentioning

confidence: 99%

The Role of Exercise Testing in the Modern Management of Pulmonary Arterial Hypertension

Johnson

Thomson

2014

Diseases

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A culture of exercise testing is firmly embedded in the management of pulmonary arterial hypertension (PAH) but its clinical relevance and utility have recently been under some debate. The six minute walk test (6MWT) has been used as a primary outcome measure to enable the licensing of many of the medications used for this condition. Recent reviews have questioned the validity of this test as a surrogate of clinical outcomes. At the same time, other questions are emerging where exercise testing may be the solution. With the rise in understanding of genetic markers of idiopathic PAH (IPAH), the screening of an otherwise healthy population for incipient pulmonary hypertension (PH) will be required. The proliferation in treatment choices and identification of populations with PH where PAH treatment is not indicated, such as left heart and lung disease, requires more definitive differentiation from patients with PAH. There is a continuing question about the existence and clinical relevance of exercise induced PAH as a cause of unexplained dyspnoea and fatigue and as a latent phase of resting PH. This review presents a summary and critical analysis of the current role of exercise testing in PAH and speculates on future trends.

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Heart Rate Recovery Predicts Clinical Worsening in Patients with Pulmonary Arterial Hypertension

Abstract: HRR1 after 6MW test is a strong predictor of clinical worsening and TCW in patients with IPAH. The addition of HRR1 to 6MWD increases the capacity of 6MWD to predict clinical worsening and TCW in patients with IPAH.

Cited by 80 publications

References 41 publications

Outcomes of β-blocker use in pulmonary arterial hypertension: a propensity-matched analysis

Outcomes of β-blocker use in pulmonary arterial hypertension: a propensity-matched analysis

Impaired Functional Capacity Predicts Mortality in Patients with Obstructive Sleep Apnea

The Role of Exercise Testing in the Modern Management of Pulmonary Arterial Hypertension

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