Predictors of abnormal heart rate recovery in patients with heart failure reduced and preserved ejection fraction
Open accessAbstract
BACKGROUND: Heart rate recovery (HRR) is becoming an important prognostic maker in heart failure (HF), but very little is known about the underlying mechanisms responsible for its clinical efficacy. Therefore, we examined echocardiographic and exercise (submaximal and maximal) characteristics to gain a better appreciation of HRR and factors responsible for the development of abnormal HRR in patients with both heart failure reduced ejection fraction (HFrEF) and heart failure preserved ejection fraction (HFpEF). METHODS: Cardiopulmonary exercise testing (CPX), a 6-minute walk test (6MWT), and resting 2D echocardiography were randomly performed in 240 HF patients (200 HFrEF, 40 HFpEF) after which HRR was measured. HRR was defined as the difference between heart rate at peak exercise and 1 minute following test termination. RESULTS: Bivariate correlation analyses found significant relationships among most CPX and 6MWT measurements with the highest correlations between 6MWT HRR and 6MWT peak HR (r = 0.65; p < 0.001) and CPX HRR and CPX HRreserve (r = 0.63; p < 0.001). The relationship between 6MWT HRR and CPX HRR was very good (r = 0.91; p < 001). Multivariate logistic regression of submaximal and maximal exercise found 6MWT peak HR and exercise oscillatory ventilation (EOV), respectively, were the strongest predictors (p < 0.001) of abnormal HRR. The E/E' was a significant predictor (p < 0.001) of abnormal HRR, but EOV was the strongest predictor of abnormal HRR (OR = 6.5). CONCLUSIONS: HRR after both CPX and the 6MWT is significantly related to many exercise and echocardiographic measures with the most significant predictors of abnormal HRR being related to indices of cardiorespiratory performance in patients with HFrEF and HFpEF.
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Heart rate variability and heart rate recovery are non-invasive methods that provide information regarding cardiac sympathetic and parasympathetic modulations of heart rate during and after exercise.
“Heart rate variability (HRV) and heart rate recovery (HRR) are non-invasive methods that provide information regarding the cardiac sympathetic and parasympathetic modulations of HR during and after exercise.8,9”
From Caffeine delays autonomic recovery following acute exercise (2015) · cites this paper as [9]
The Introduction and Discussion (page numbers not provided) say that heart rate recovery after exercise reflects parasympathetic reactivation and sympathetic deactivation. The paper does not make the corresponding claim about heart rate variability; it appears only in the title of a cited reference. Thus the source supports the HRR portion, but not the statement about both methods. (LLM, conf=0.87)
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Cites
Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method.
Devereux, R. B., & Reichek, N. (1977) · Circulation · doi:10.1161/01.cir.55.4.613 · Cited by 4,499 · see citing works
A new method for detecting anaerobic threshold by gas exchange
Beaver, W. L., Wasserman, K., & Whipp, B. J. (1986) · Journal of Applied Physiology · doi:10.1152/jappl.1986.60.6.2020 · Cited by 4,103 · see citing works
Nagueh, S. F., Middleton, K. J., Kopelen, H. A., Zoghbi, W. A., & Quiñones, M. A. (1997) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(97)00344-6 · Cited by 3,024 · see citing works
Paulus, W. J., Tschöpe, C., Sanderson, J. E., Rusconi, C., Flachskampf, F. A., Rademakers, F. E., Marino, P. N., Smiseth, O. A., Keulenaer, G. W. D., Leite-Moreira, A. F., et al. (2007) · European Heart Journal · doi:10.1093/eurheartj/ehm037 · Cited by 2,646 · see citing works
Heart-rate Recovery Immediately After Exercise as a Predictor of Mortality
Cole, C. R., Blackstone, E. H., Pashkow, F. J., Snader, C. E., & Lauer, M. S. (1999) · New England Journal of Medicine · doi:10.1056/nejm199910283411804 · Cited by 1,935 · see citing works
今井, 克., Sato, H., Hori, M., Kusuoka, H., 尾崎, 仁., Yokoyama, H., Takeda, H., Inoue, M., & Kamada, T. (1994) · Journal of the American College of Cardiology · doi:10.1016/0735-1097(94)90150-3 · Cited by 993 · see citing works
Nishime, E. O. (2000) · JAMA · doi:10.1001/jama.284.11.1392 · Cited by 713 · see citing works
Brubaker, P. H., & Kitzman, D. W. (2011) · Circulation · doi:10.1161/circulationaha.110.940577 · Cited by 643 · see citing works
Cole, C. R., Foody, J. M., Blackstone, E. H., & Lauer, M. S. (2000) · Annals of Internal Medicine · doi:10.7326/0003-4819-132-7-200004040-00007 · Cited by 586 · see citing works
Kašner, M., Westermann, D., Paul Steendijk, A., Gaub, R., Wilkenshoff, U. M., Weitmann, K., Hoffmann, W. U., Poller, W. C., Schultheiss, H., Pauschinger, M., et al. (2007) · Circulation · doi:10.1161/circulationaha.106.661983 · Cited by 564 · see citing works
Roul, G., Germain, P., & Bareiss, P. (1998) · American Heart Journal · doi:10.1016/s0002-8703(98)70219-4 · Cited by 255 · see citing works
Morshedi‐Meibodi, A., Larson, M. G., Levy, D. A., O’Donnell, C. J., & Vasan, R. S. (2002) · The American Journal of Cardiology · doi:10.1016/s0002-9149(02)02706-6 · Cited by 228 · see citing works
Six-Minute Walk Test and Cardiopulmonary Exercise Testing in Patients With Chronic Heart Failure
Guazzi, M., Dickstein, K., Vicenzi, M., & Arena, R. A. (2009) · Circulation Heart Failure · doi:10.1161/circheartfailure.109.881326 · Cited by 223 · see citing works
Self-citationHEART-RATE RECOVERY IMMEDIATELY AFTER EXERCISE AS A PREDICTOR OF MORTALITY
Ole, C. H. R. C., Lackstone, E. U. H. B., Ashkow, J. P., Nader, C., & Auer, S. (2012) · Cited by 177 · see citing works
Prognostic value of heart rate recovery in patients with heart failure
Arena, R. A., Guazzi, M., MYERS, J. N., & Peberdy, M. A. (2006) · American Heart Journal · doi:10.1016/j.ahj.2005.09.012 · Cited by 172 · see citing works
Self-citationAssessing autonomic function by analysis of heart rate recovery from exercise in healthy subjects
Pierpont, G. L., & Voth, E. J. (2004) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2004.03.032 · Cited by 159 · see citing works
Autonomic control of heart rate by metabolically sensitive skeletal muscle afferents in humans
Fisher, J. P., Seifert, T., Hartwich, D., Young, C. N., Secher, N. H., & Fadel, P. J. (2010) · The Journal of Physiology · doi:10.1113/jphysiol.2009.185470 · Cited by 137 · see citing works
Dimopoulos, S. K., ANASTASIOU‐NANA, M. I., Sakellariou, D., Drakos, S. G., Kapsimalakou, S., Maroulidis, G., Roditis, P., Papazachou, O., Vogiatzis, I., Roussos, C., et al. (2006) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000198449.20775.7c · Cited by 136 · see citing works
Exercise Oscillatory Ventilation May Predict Sudden Cardiac Death in Heart Failure Patients
Guazzi, M., Raimondo, R., Vicenzi, M., Arena, R. A., Proserpio, C., Braga, S. S., & Pedretti, R. F. E. (2007) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2007.03.042 · Cited by 129 · see citing works
Self-citationSwigris, J. J., Swick, J., Wamboldt, F. S., Sprunger, D. B., du Bois, R. M., Fischer, A., Cosgrove, G. P., Frankel, S. K., Pérez, E. R. F., Kervitsky, D. J., et al. (2009) · CHEST Journal · doi:10.1378/chest.09-0211 · Cited by 111 · see citing works
Exercise Oscillatory Ventilation in Systolic Heart Failure
Murphy, R. M., Shah, R. V., Malhotra, R. K., Pappagianopoulos, P. P., Hough, S. S., Systrom, D. M., Semigran, M. J., & Lewis, G. D. (2011) · Circulation · doi:10.1161/circulationaha.111.024141 · Cited by 109 · see citing works
Guazzi, M., Arena, R. A., Ascione, A., Piepoli, M. F., & Guazzi, M. D. (2007) · American Heart Journal · doi:10.1016/j.ahj.2007.02.034 · Cited by 107 · see citing works
Self-citationBen-Dov, I., Sietsema, K. E., Casaburi, R. H., & Wasserman, K. (1992) · American Review of Respiratory Disease · doi:10.1164/ajrccm/145.4_pt_1.776 · Cited by 105 · see citing works
Autonomic effects on the spectral analysis of heart rate variability after exercise
Ng, J., Sundaram, S., Kadish, A. H., & Goldberger, J. J. (2009) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00217.2009 · Cited by 93 · see citing works
Arena, R. A., MYERS, J. N., Abella, J. P., et al. (2008) · International Journal of Cardiology · doi:10.1016/j.ijcard.2008.08.010 · Cited by 81 · see citing works
Self-citationHuang, P., Leu, H., Chen, J., Cheng, C.-M., Huang, C., Tuan, T., Ding, P. Y., & Lin, S. (2003) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2003.09.004 · Cited by 76 · see citing works
Assessment of Left Ventricular Diastolic Function and Recognition of Diastolic Heart Failure
Gaasch, W. H., & Little, W. C. (2007) · Circulation · doi:10.1161/circulationaha.107.716647 · Cited by 61 · see citing works
Lipinski, M. J., Vetrovec, G. W., Gorelik, D. D., & Froelicher, V. F. (2005) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2005.06.429 · Cited by 55 · see citing works
Olson, T. P., Frantz, R. P., Snyder, E. M., O’Malley, K. A., Beck, K. C., & Johnson, B. D. (2006) · American Heart Journal · doi:10.1016/j.ahj.2006.10.003 · Cited by 53 · see citing works
Huang, P., Leu, H., Chen, J., & Lin, S. (2005) · Preventive Cardiology · doi:10.1111/j.1520-037x.2005.3847.x · Cited by 43 · see citing works
Heart rate recovery predicts sudden cardiac death in heart failure
Guazzi, M., MYERS, J. N., Peberdy, M. A., et al. (2009) · International Journal of Cardiology · doi:10.1016/j.ijcard.2008.12.149 · Cited by 23 · see citing works
Self-citationJehn, M., Halle, M., Schuster, T., et al. (2011) · Heart & Lung · doi:10.1016/j.hrtlng.2011.01.005 · Cited by 10 · see citing works
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- [31]31. Brubaker PH and Kitzman DW. Chronotropic incompe- tence: causes, consequences, and management. Circulation 2011; 123: 1010-1020.
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Caffeine delays autonomic recovery following acute exercise
Bunsawat, K., White, D. W., Kappus, R. M., & Baynard, T. (2015) · European Journal of Preventive Cardiology · doi:10.1177/2047487314554867 · Cited by 61 · see citing works
- Authors
- Cahalin, L. P., Arena, R., Labate, V., Bandera, F., & Guazzi, M.
- Affiliations
- University of Miami (US)
- University of New Mexico (US)
- University of Milan (IT)
- Corresponding author
- Guazzi, Marco
- Venue
- European Journal of Preventive Cardiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-01-18
- Volume
- 21
- Issue
- 7
- Pages
- 906-914
- ISSN
- 2047-4873 (ISSN-L)
- 2047-4881
- OpenAlex
- W2314409090
- Cited by
- 11
- References
- 32
- Citations by year
- 2025: 2 · 2024: 1 · 2021: 1 · 2019: 1 · 2017: 1 · 2015: 2 · 2014: 2 · 2013: 1
- FWCI
- 3.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Preventive Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- INFM-OAR (INFN Catania) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- heart rate recovery, heart failure, heart failure with reduced ejection fraction, heart failure with preserved ejection fraction, exercise oscillatory ventilation, 6-minute walk test, cardiopulmonary exercise testing, E/e' ratio, prognostic factors
- MeSH terms
- Aged, Echocardiography, Exercise Test, Female, Heart Failure, Heart Rate, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Stroke Volume, Exercise, Logistic Models, Exercise Tolerance, Ultrasonography, Doppler, Color
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