Speed of Heart Rate Recovery in Response to Orthostatic Challenge

McCrory, Cathal; Berkman, Lisa F.; Nolan, Hugh; O’Leary, Neil; Foley, Margaret; Kenny, Rose Anne

doi:10.1161/circresaha.116.308577

Cited by 58 publications

(61 citation statements)

References 38 publications

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“…PNS reactivation during the early resting phase is thought to be solely mediated by changes in response to the activity in arterial baroreceptors 23. A recent study of McCrory et al9 took these findings into a clinical setting by studying the predictive value of HRR after a standing challenge, in which the primary physiological event of interest was the changing activity of the arterial baroreceptors, strengthening our hypothesis that HRR after termination of exercise may be more important immediately after exercise. Compared with McCrory's study, we studied HRR changes after exercise cessation, which is a more complex physiological state in which sympathetic nervous system activity and circulating catecholamines are still high, making a one‐to‐one comparison difficult.…”

Section: Discussionmentioning

confidence: 65%

“…Poor physical activity was defined as no physical activity at all, while intermediate physical activity was defined as anything in between. Covariates were selected based on previous studies of HRR,3, 9 but also on the relationship of variables in the UK Biobank potentially related with HRR or mortality, and which were significantly associated with HRR ( P <0.01) after age and sex adjustments (eg, blood cell parameters or maximum heart rate).…”

Section: Methodsmentioning

confidence: 99%

“…Four Cox regression models were used to systematically study the predictive value of HRR on mortality at multiple time intervals: (1) a univariable model; (2) a multivariate model correcting for the known confounders including age, sex, BMI, and exercise capacity; (3) an extended multivariate model based on previous studies on HRR after exercise3 with traditional cardiovascular risk factors that included age, sex, BMI, exercise capacity, exercise duration, systolic blood pressure, diabetes mellitus, hyperlipidemia, smoking behavior, current physical activity behavior, and a family history of cardiovascular disease; and (4) another extended multivariate model to adjust for risk factors associated with all‐cause mortality as well,9 including age; sex; BMI; exercise capacity; exercise duration; systolic blood pressure; hyperlipidemia; use of diuretics, β‐blockers, calcium channel blockers, or angiotensin‐converting enzyme inhibitors; ever receiving a doctor diagnosis of cancer, lung disease, or diabetes mellitus; smoking behavior; physical activity behavior; a family history of cardiovascular disease; the Townsend deprivation index; and resting heart rate.…”

Section: Methodsmentioning

confidence: 99%

“…Despite this knowledge, HRR is commonly determined at 1 minute after termination of exercise 1, 3, 6. Recently, a study by McCrory et al9 described HRR within a 1‐minute interval after an orthostatic challenge, and found that speed of HRR in the immediate 20 seconds was the strongest predictor of all‐cause mortality. Whether HRR measured early after exercise cessation is also of increased value for prediction models remains to be determined.…”

Section: Introductionmentioning

confidence: 99%

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Heart Rate Recovery 10 Seconds After Cessation of Exercise Predicts Death

Vegte

Harst

Verweij

2018

JAHA

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BackgroundHeart rate recovery (HRR) is commonly defined as the decrease of heart rate at 1 minute after cessation of exercise and is an important predictor of all‐cause mortality and death associated with coronary artery disease. However, HRR at earlier time intervals after cessation has not been well evaluated and might better reflect PNS reactivation. We hypothesize that early HRR indices within the first minute is better associated with all‐cause and coronary artery disease mortality compared with HRR at 1 minute.Methods and ResultsThe prognostic value of HRR at 10, 20, 30, 40, and 50 seconds after cessation of exercise was investigated in 40 727 selected UK Biobank participants (mean age 56 years, 45% male) free from cardiovascular disease. During a median follow‐up period of 6 years, 536 participants died (including 39 of coronary artery disease). In multivariable analyses, including adjustments for aerobic exercise capacity, cardiovascular risk factors, and factors associated with mortality in general, only HRR at 10 seconds remained predictive of both all‐cause and coronary artery disease mortality. Effects of HRR were larger and more significant when measured early after exercise cessation. Moreover, the association of change in heart rate between 10 seconds and 1 minute after exercise cessation with mortality was dependent on HRR at 10 seconds.ConclusionsWe provide evidence that decreased HRR at 10 seconds after cessation of exercise is a superior predictor of outcome compared with HRR at later time intervals. This observation might have important implications for the future reporting and interpretation of exercise tests.

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Section: Discussionmentioning

confidence: 65%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Heart Rate Recovery 10 Seconds After Cessation of Exercise Predicts Death

Vegte

Harst

Verweij

2018

JAHA

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“…Intrinsic HRR was calculated as the slope in seconds of the gradual decrease in heart rate following a spontaneous heart rate surge such as often occurs in connection with activities of daily living including, but not limited to, postural changes, (McCrory et al, 2016) emotions, and physical exertion.…”

Section: Intrinsic Heart Rate Recovery Analysismentioning

confidence: 99%

Novel method to assess intrinsic heart rate recovery in ambulatory ECG recordings tracks cardioprotective effects of chronic autonomic regulation therapy in patients enrolled in the ANTHEM‐HF study

Carlson

Libbus

Amurthur

et al. 2017

Noninvasive Electrocardiol

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BackgroundPostexercise heart rate recovery (HRR) is a powerful and independent predictor of mortality. Autonomic regulation therapy (ART) with chronic vagus nerve stimulation (VNS) has been shown to improve ventricular function in patients with chronic heart failure. However, the effect of ART on HRR in patients with heart failure remains unknown.MethodsA new measure involving quantification of intrinsic HRR was developed for 24‐hr ambulatory ECG (AECG) recordings based on spontaneous heart rate changes observed during daily activity in patients with symptomatic heart failure and reduced ejection fraction. Intrinsic HRR values were compared in 21 patients enrolled in the ANTHEM‐HF study (NCT01823887) before and after 12 months of chronic ART (10 Hz, 250 μs pulse width, 18% duty cycle, maximum tolerable current amplitude after 10 weeks of titration) and to values from normal subjects (PhysioNet database, n = 54).ResultsWith chronic ART, average intrinsic HRR was improved as indicated by a shortening of the rate‐recovery time constant by 8.9% (from 12.3 ± 0.1 at baseline to 11.2 ± 0.1 s, p < .0001) among patients receiving high‐intensity stimuli (≥2 mA). In addition, mean heart rate decreased by 8.5 bpm (from 75.9 ± 2.6 to 67.4 ± 2.9 bpm, p = .005) and left ventricular ejection fraction (LVEF) increased by 4.7% (from 32.6 ± 2.0% to 37.3 ± 1.9%, p < .005).ConclusionUsing a new technique adapted for 24‐hr AECG recordings, intrinsic HRR was found to be impaired in patients with symptomatic HF compared to normal subjects. Chronic ART significantly improved intrinsic HRR, indicating an improvement in autonomic function.

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Impaired orthostatic heart rate recovery is associated with smaller thalamic volume: Results from The Irish Longitudinal Study on Aging (TILDA)

Looze

Williamson

Hirst

et al. 2020

Human Brain Mapping

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The thalamus is a central hub of the autonomic network and thalamic volume has been associated with high‐risk phenotypes for sudden cardiac death. Heart rate response to physiological stressors (e.g., standing) and the associated recovery patterns provide reliable indicators of both autonomic function and cardiovascular risk. Here we examine if thalamic volume may be a risk marker for impaired heart rate recovery in response to orthostatic challenge. The Irish Longitudinal Study on Aging involves a nationally representative sample of older individuals aged ≥50 years. Multimodal brain magnetic resonance imaging and orthostatic heart rate recovery were available for a cross‐sectional sample of 430 participants. Multivariable regression and linear mixed‐effects models were adjusted for head size, age, sex, education, body mass index, blood pressure, history of cardiovascular diseases and events, cardiovascular medication, diabetes mellitus, smoking, alcohol intake, timed up‐and‐go (a measure of physical frailty), physical exercise and depression. Smaller thalamic volume was associated with slower heart rate recovery (−1.4 bpm per 1 cm 3 thalamic volume, 95% CI −2.01 to −0.82; p < .001). In multivariable analysis, participants with smaller thalamic volumes had a mean heart rate recovery −2.7 bpm slower than participants with larger thalamic volumes (95% CI −3.89 to −1.61; p < .001). Covariates associated with smaller thalamic volume included age, history of diabetes, and heavy alcohol consumption. Thalamic volume may be an indicator of the structural integrity of the central autonomic network. It may be a clinical biomarker for stratification of individuals at risk of autonomic dysfunction, cardiovascular events, and sudden cardiac death.

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Speed of Heart Rate Recovery in Response to Orthostatic Challenge

Cited by 58 publications

References 38 publications

Heart Rate Recovery 10 Seconds After Cessation of Exercise Predicts Death

Heart Rate Recovery 10 Seconds After Cessation of Exercise Predicts Death

Novel method to assess intrinsic heart rate recovery in ambulatory ECG recordings tracks cardioprotective effects of chronic autonomic regulation therapy in patients enrolled in the ANTHEM‐HF study

Impaired orthostatic heart rate recovery is associated with smaller thalamic volume: Results from The Irish Longitudinal Study on Aging (TILDA)

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