Heart Rate Recovery In Patients Research Articles

Heart rate recovery in patients with inflammatory bowel disease in clinical remission

Heart rate recovery in patients with inflammatory bowel disease in clinical remission

EXERCISE IMPROVES HEART RATE RECOVERY GREATER THAN STANDARD CARE IN TYPE 2 DIABETES

INTRODUCTION An attenuated heart rate recovery (HRR) immediately after exercise is considered an index of autonomic imbalance and is a predictor of all cause mortality in patients with type 2 diabetes (T2D). Because autonomic dysfunction in T2D patients has shown to be reversible with glycemic control, weight loss, and fitness gain, we investigated the effect of a 12 week aerobic exercise (AE) intervention compared to standard care on HRR in patients with T2D. METHODS T2D patients (n=32) were randomized to a 12-week AE intervention (n=19) or standard of care (n=13). The AE intervention consisted of supervised exercise training for 1h/day 5/wk for 12 weeks at 80% VO2peak. All subjects completed body composition analysis (DEXA), oral glucose tolerance test (OGTT), and maximal exercise testing before and after the study period. HRR was measured every minute for 10 minutes after cessation of maximal exercise testing. RESULTS Baseline HRR 1-minute values were negatively associated with ASCVD Risk (rho = 0.623; p = 0.002) and positively associated with VO2peak (rho = 0.361; p = 0.042). Body weight was unchanged in both control (p = 0.989) and AE group (p = 0.248) after the study period. Following AE training intervention, VO2peak increased by 7.4 ± 1.9% (p < 0.001), glucose metabolism, as measured by OGTT area under the curve (AUC), improved by 11.6 ± 6.0% (p = 0.040), and HRR 1-minute increased by 10.4 ± 6.1% (p = 0.234). The control group showed no significant changes as VO2peak increased by 0.7 ± 2.6% (p = 0.826), AUC improved by 3.1 ± 3.5% (p = 0.585), and HRR 1-minute increased 3.9 ± 9.0% (p = 0.915). Baseline HRR predicted change in HRR after the study period in the control group (rho = −0.817; p = 0.002) but not in the AE group (rho = −0.054, p = 0.860). Upon controlling for baseline HRR, AE group possessed a significantly higher post intervention HRR 1-minute value than control by 28.5% (p = 0.036). We found the AE group also had higher HRR values than control during the post-intervention 10-minute recovery resulting in a main effect of group (p < 0.001). CONCLUSIONS T2D patients with higher HRR, only receiving standard of care, are more susceptible to chronic detriments in HRR indicative of gradual autonomic function loss. To our knowledge these are the first data showing regular moderate-vigorous intensity exercise, which improved glycemic control and fitness gain independent of weight loss, outperforms standard of care alone for greater HRR.

IDF21-0335 Does serum vitamin D level effects post exercise heart rate recovery in patients with diabetes mellitus?

Background: Vitamin D deficiency is very common irrespective of age, race, and geographic location. Studies showed that the prevalence of vitamin D deficiency is higher in people with diabetes than those without diabetes. Autonomic neuropathy is a common complication of diabetes mellitus. Autonomic dysfunction has been associated with all-cause mortality, cardiac disease morbidity, and mortality in diabetes. Heart Rate Variability (HRV) and Heart Rate Recovery (HRR) both are the measures of autonomic nervous system function.

The Effect of Asthma Controlling on Heart Rate Recovery in Patients with Asthma

The Effect of Asthma Controlling on Heart Rate Recovery in Patients with Asthma

Biochemical and Hematological Relationship with the Evaluation of Autonomic Dysfunction by Heart Rate Recovery in Patients with Asthma and Type 2 Diabetes.

There are several methods to assess the function of the autonomic nervous system. Among them, heart rate recovery (HRR) is an accepted, easy, low-cost technique. Different pathological conditions have been related to the development of autonomic dysfunction. Our study aimed to evaluate the relationship between HRR and HRR-derived parameters in ambulatory patients with asthma or type 2 diabetes followed at the National Institutes of Health in Mexico City. A total of 78 participants, 50 women and, 28 men were enrolled; anthropometric, respiratory evaluations, and fasting blood samples were taken before participants performed a 6-min walking test (6MWT). Abnormal HRR was defined as a drop of ≤8 and ≤11 beats/min at 1 or 2 min and correlated negatively with basal oxygen saturation at 1 min. Heart rate at 1 min, correlated negatively with final oxygen saturation (p < 0.01). Statistically significant negative correlations were also observed between red cell count and white blood cell count and HOMA-IR with a p < 0.01. Since discrete hematological but significant changes correlated with HRR and HRR-derived parameters, we consider that these measures are helpful in clinical settings to identify subclinical autonomic dysfunction that permits us to prevent or anticipate chronic and fatal clinical outcomes.

Evaluation of Heart Rate Recovery in Patients with Diabetes Mellitus Type 2 and Elevated Urine Albumin/Creatinine Ratio After an Individualized Exercise Program

Evaluation of Heart Rate Recovery in Patients with Diabetes Mellitus Type 2 and Elevated Urine Albumin/Creatinine Ratio After an Individualized Exercise Program

Pulmonary Rehabilitation Effects on Heart Rate Recovery in Restrictive Lung Disease Patients

Objective: The study aimed to evaluate heart rate recovery in subjects with restrictive lung disease (RLD) and healthy age matched subjects before and after a rehabilitation program (RP). Methods: This is a cross-sectional study on subjects of both genders, with over 40 years old with and without any diagnosis of restrictive lung disease and who were able to perform physical tasks were included in the study. They were evaluated for sociodemographic profile, lifestyle (ILP), Framingham score, physical capacity (6MWT and treadmill incremental testing) and heart rate recovery before and after RP. Results: 65 subjects were assigned into either G1 (patients with RLD, n=26) or G2 (healthy subjects, n= 39). Initially, patients with RLD increased their heart rate (HR) from 79 to 120bpm, and after the recovery post-exercise, the first minute they reduced HR by nine beats. In the fifth minute after the exercise, HR returned to baseline values. After the RP, mean HR was 71bpm and 79bpm in G1 and G2, respectively. Increased mean 6MWT peak HR in both the groups was seen (110bpm and 120bpm, G1 and G2, respectively). In the first minute of resting, mean HR decreased to 86bpm (- 24bpm) and 72 (-48bpm) in G1 and G2, respectively. In the fifth minute after exercise, HR recovery in both the groups was complete. Conclusion: The RP was effective in improving the first-minute heart rate recovery in patients with restrictive lung disease and, there was an inverse correlation of heart rate recovery with disease severity.

P328 Relation between CHA2DS2-VASc and impaired heart rate recovery in patients without inducible myocardial ischemia

Abstract Background Heart rate recovery (HRR) has been shown to predict cardiovascular and all-cause morbidity and mortality in different populations. Recent studies have indicated the CHA2DS2-VASc score can be used as predictor of mortality in patients with coronary artery disease, without atrial fibrillation. However, the relation between these two parameters has not yet been documented. The Aim: The aim of this study was to determine the relation between CHA2DS2-VASc score and impaired heart rate recovery in patients without inducible myocardial ischemia. Methods Our study comprised of 2699 consecutive patients (1319 male, 42.8%, average age 60 ± 11 years) who underwent treadmill exercise testing (stress echocardiography or stress echocardiography) according to Bruce protocol for the assessment of myocardial ischemia. We excluded patients with the systolic heart failure (left ventricle ejection fraction &amp;lt;45%) and those with inducible ischemia. CHA2DS2-VASc score was calculated according to the guidelines. Duke treadmill score, functional capacity (Metabolic Equivalents - METs), chronotropic competence (CC), body mass index (BMI) were calculated in all patients. HRR was calculated as the difference between heart rate at the peak stress and heart rate in the first minute of rest. Slow HRR was defined as ≤18 beats/min. Results Out of 2699 patients, 378 (12.3%) had a positive test and they were excluded from further analysis. Of the remaining 2321 patients, 251 (10.8%) had an impaired HRR, whereas 2070 (89.2%) had normal HRR. Previously known coronary artery disease (previous myocardial infarction, percutaneous coronary intervention or coronary artery bypass graft surgery) had 78 (3.4%) patients. Patients with impaired HRR had significantly higher CHA2DS2-VASc score (3.1 ± 1.3 vs 2.3 ± 1.2, p &amp;lt; 0.001), higher resting heart rate (76.9 ± 16.1 vs 73.3 ± 12.3bpm, p &amp;lt; 0.001), higher systolic blood pressure at rest (122.1 ± 13.9 vs 117.2 ± 13.4mmHg, p &amp;lt; 0.001), higher diastolic blood pressure at rest (73.7 ± 7.5 vs 72.3 ± 7.2mmHg, p &amp;lt; 0.001), higher rate of hyperlipproteinemia (176/251, 70.1% vs 1294/2070, 62.5%, p &amp;lt; 0.001), higher BMI (27.3 ± 3.6 vs 26.4± 3.6kg/m2, p &amp;lt; 0.001), shorter duration of the test (5.2 ± 1.8 vs 6.4 ± 1.9 minutes, p &amp;lt; 0.001). lower Duke score (4.6 ± 2.4 vs 6.1 ± 2.4 minutes, p &amp;lt; 0.001). lower MET (6.3 ± 1.8 vs 7.5 ± 1.9, p &amp;lt; 0.001) and higher rate of chronotropic incompetence (173/251, 68.9% vs 1036/2070, 50%, p &amp;lt; 0.001) compares to the patients with normal HRR. Multivariate predictors of impaired HRR were higher CHA2DS2-VASc score (p &amp;lt; 0.001), not achieved THR (p &amp;lt; 0.001), higher heart rate at rest (p = 0.001), higher systolic blood pressure at rest (p = 0.001) and shorter duration of test (p = 0.046). Conclusion CHA2DS2-VASc score is an independent predictor of impaired HRR in patients without inducible ischemia.

Acquired loss of cardiac vagal activity is associated with myocardial injury in patients undergoing noncardiac surgery: prospective observational mechanistic cohort study

BackgroundMyocardial injury is more frequent after noncardiac surgery in patients with preoperative cardiac vagal dysfunction, as quantified by delayed heart rate (HR) recovery after cessation of cardiopulmonary exercise testing. We hypothesised that serial and dynamic measures of cardiac vagal activity are also associated with myocardial injury after noncardiac surgery. MethodsSerial autonomic measurements were made before and after surgery in patients undergoing elective noncardiac surgery. Cardiac vagal activity was quantified by HR variability and HR recovery after orthostatic challenge (supine to sitting). Revised cardiac risk index (RCRI) was calculated for each patient. The primary outcome was myocardial injury (high-sensitivity troponin ≥15 ng L−1) within 48 h of surgery, masked to investigators. The exposure of interest was cardiac vagal activity (high-frequency power spectral analysis [HFLn]) and HR recovery 90 s from peak HR after the orthostatic challenge. ResultsMyocardial injury occurred in 48/189 (25%) patients, in whom 41/48 (85%) RCRI was <2. In patients with myocardial injury, vagal activity (HFLn) declined from 5.15 (95% confidence interval [CI]: 4.58–5.72) before surgery to 4.33 (95% CI: 3.76–4.90; P<0.001) 24 h after surgery. In patients who remained free of myocardial injury, HFLn did not change (4.95 [95% CI: 4.64–5.26] before surgery vs 4.76 [95% CI: 4.44–5.08] after surgery). Before and after surgery, the orthostatic HR recovery was slower in patients with myocardial injury (5 beats min−1 [95% CI: 3–7]), compared with HR recovery in patients who remained free of myocardial injury (10 beats min−1 [95% CI: 7–12]; P=0.02). ConclusionsSerial HR measures indicating loss of cardiac vagal activity are associated with perioperative myocardial injury in lower-risk patients undergoing noncardiac surgery.

Impaired heart rate recovery as a predictor for poor health-related quality in patients with transient ischemic attack.

We aimed to investigate heart rate recovery (HRR) in patients with transient ischemic attack (TIA) and the relationship between HRR and health-related quality of life (HRQOL).All available patients were enrolled during the enrollment period. A total of 120 patients with TIA and 120 healthy controls were included in this study. A treadmill stress test was performed to calculate the HRR. The HRR were calculated as follows: HRR 1, 2, 3, and 5 minutes = heart rate at peak during exercise − heart rate at 1, 2, 3, and 5 minutes at rest. All patients enrolled were asked to fill in the Short Form 36 Health Survey to calculate HRQOL.We found that the maximum heart rate of TIA patients was significantly higher than that of healthy controls (166 ± 11 vs. 162 ± 14 beats/min, P = .015). Similarly, maximum systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in TIA group compared with healthy control group (SBP: 172 ± 15 vs. 165 ± 14 mm Hg, P < .001; DBP: 102 ± 12 vs. 93 ± 16 mm Hg, P < .001). The HRR were significantly lower in TIA group compared with control group (TIA vs. controls, HRR1: 17 ± 7 vs. 30 ± 8 beats/min, HRR2: 32 ± 11 vs. 49 ± 9 beats/min, HRR3: 43 ± 13 vs. 63 ± 12 beats/min, HRR5: 54 ± 16 vs. 73 ± 15 beats/min, all P < .001). Multivariate analysis showed that older age (P = .03) and high BMI (P = .04) were risk factors associated with abnormal HRR in patients with TIA. With regard to HRQOL, we found that role limitations due to physical problems, general health, vitality, and role limitations due to emotional problems were significantly lower in patients with abnormal HRR compared with patients with normal HRR. Multivariate analysis showed that older age (P = .04) and abnormal HRR (P = .03) were predictors for poor HRQOL in TIA patients.HRR was impaired in patients with TIA. In addition, TIA patients with abnormal HRR suffered from a significantly poorer HRQOL. Hence, given the prognostic value of HRR, patients with TIA should be monitored to prevent cardiovascular events and to improve HRQOL.

Traditional risk factors as determinants of heart rate recovery in patients with diabetes mellitus type 2 without known coronary artery disease

The impact of Traditional risk factors on heart rate recovery (HRR) has not been studied in patients Diabetes Mellitus type 2 without known coronary artery disease (CAD). For this reason, we sought to determine the association between HRR as cardiac autonomic dysfunction marker and traditonal risk factors. The study was conducted with a cross-sectional study involving 89 patients with Type 2 Diabetes Mellitus without known having coronary artery disease. The data was taken through anamnese and laboratory tests, and subjects who met the criteria were tested for a treadmill exercise to assess heart rate recovery in the first minute. In bivariate analysis Dyslipidemia, Hypertension, smoker, age, duration of DM≥ 5 years, HbA1C ≥7.5, Peak Heart rate, functional capacity and ST depression ischemic have an association with heart rate recovery. In multivariate analysis patients with hyper triglyceride, smoker, overweight, duration of diabetes ≥ five years and HbA1C ≥ 7,5 have lower heart rate recovery significantly. Traditional risk factors are determinant factors for heart rate recovery in patients with Diabetes Mellitus type 2 without known coronary artery disease.

Elevated Hemoglobin A1C is Significantly Associated with Decreased Post-Exercise Heart Rate Recovery in Patients with Diabetes Mellitus

The prevalence and incidence of diabetes mellitus has been increasing all over the world. International Diabetes Federation (IDF) estimated in 2015 that there were 415 million adults aged 20-79 living with diabetes worldwide, including 193 million who were undiagnosed. These trends are not projected to decrease over the next several years. The prevalence of diabetes is very high throughout the Middle East region and estimated around 14.6% in the United Arab Emirates.

Reproducibility of heart rate recovery in patients with intermittent claudication.

Postexercise heart rate recovery (HRR) is a non-invasive tool for cardiac autonomic function assessment. Reproducibility of HRR has been established in healthy subjects; however, no study has evaluated this reproducibility in clinical populations who may present autonomic dysfunction. Patients with peripheral artery disease and intermittent claudication (IC) often present altered cardiac autonomic function and HRR could be an interesting tool for evaluating autonomic responses to interventions in this population. Therefore, the reproducibility of HRR should be determined in this specific population. To determine the reproducibility of HRR indices in patients with IC. Nineteen men with IC underwent two repeated maximal treadmill tests. Raw HR and relative HRR (difference to exercise peak) indices measured at 30, 60, 120, 180, 240 and 300s of recovery were evaluated. The presence of systematic bias was assessed by comparing test and retest mean values via paired t-test. Reliability was assessed by intraclass correlation coefficient (ICC), and agreement by typical error (TE), coefficient of variation (CV) and minimal detectable difference (MDD). There were no significant differences between the test and retest values of all raw HR and relative HRR indices (P≥0·05), except for HR120s (P=0·032). All indices exhibited excellent reliability (ICC≥0·78). Raw HR and relative HRR indices showed TEs≤6·4bpm and MDDs≤17·8bpm. In addition, all indices showed CVs≤13·2%, except HRR30s (CV=45·6%). The current results demonstrated that most HRR indices were highly reproducible with no systematic error, excellent reliability and good agreement in patients with IC following maximal graded exercise.

Attenuated post-exercise heart rate recovery in patients with systemic lupus erythematosus: the role of disease severity and beta-blocker treatment.

Objective Sinus tachycardia is frequently reported in systemic lupus erythematosus (SLE), while there are limited data on post-exercise ability to slow heart rate (i.e. heart rate recovery, HRR) in this group of patients. Methods We studied consecutive 70 patients with SLE and 30 healthy controls. All examined individuals underwent detailed clinical examination, echocardiography, Holter monitoring with heart rate variability and treadmill stress test using Bruce's protocol. HRR values were calculated as the difference between maximum HR during exercise and HR at the first (HRR1) and third (HRR3) minute of rest. Individuals with coronary artery disease, diabetes mellitus and suspected pulmonary hypertension were excluded from further analysis ( n = 15). Results Fifty-five SLE patients were eligible for this study: aged 41.5 ± 12.4 years, 87.3% women, SLICC/ACR-DI score 3.58 ± 1.85. In the SLE group 36.4% patients received beta-blockers, usually for previously detected sinus tachycardia and/or arterial hypertension. Mean HRR1 (36.9 ± 12.6 vs 49.5 ± 18.6, p = 0.0004) and HRR3 (55.5 ± 14.3 vs 69.2 ± 16.4, p = 0.0001) were significantly lower in SLE than in healthy individuals. Significantly negative correlations between SLICC/ACR-DI score and HRR1 ( r = -0.299, p = 0.01), HRR3 ( r = -0.361, p = 0.001) and exercise capacity ( r = -0.422, p < 0.0001) were revealed. Additionally, beta-blocker treatment was also revealed to alter significantly HRR1, HRR3 and exercise capacity in SLE. Conclusion Patients with SLE are characterized by attenuated HRR after exercise. In our study impaired HRR was associated with disease severity and beta-blocker treatment and probably with disease duration. The use of HRR assessment in SLE can be used as an additional marker of cardiac autonomic nervous system dysfunction.

The Influence of Epicardial Fat and Nonalcoholic Fatty Liver Disease on Heart Rate Recovery in Metabolic Syndrome.

Epicardial adipose tissues reflecting visceral fat accumulations of the heart are associated with metabolic syndrome (MetS) and can be a predictor of other cardiometabolic diseases. It can adversely influence autonomic nervous system (ANS) of heart. Heart rate recovery (HRR) is an easy method for measuring ANS dysfunction. The purpose of this study was to determine whether epicardial fat thickness (EFT) and nonalcoholic fatty liver disease (NAFLD) are related to HRR in patients with MetS. We enrolled 772 consecutive patients from a health-screening center who underwent abdominal ultrasonography, treadmill test, and cardiac echocardiography. EFT using echocardiography and HRR by symptom-limited exercise testing was assessed. According to the presence of MetS and NAFLD, patients were classified into the four groups. In NAFLD patients, EFT was higher and HRR was lower, especially in patients with MetS and NAFLD, compared to non-MetS participants without NAFLD (MetS with NAFLD, EFT 7.5 ± 4.4 mm, HRR 31.9 ± 12.7; MetS without NAFLD, EFT 4.9 ± 3.0 mm, HRR 39.5 ± 11.1; non-MetS with NAFLD, EFT 5.9 ± 3.6 mm, HRR 36.6 ± 12.7; and non-MetS without NAFLD, EFT 4.4 ± 3.5 mm, HRR 43.4 ± 14.5, p < 0.001). Patients with severe liver steatosis (LS) showed significantly higher EFT than those with moderate LS (14.2 ± 2.0 vs. 7.5 ± 3.1 mm, P < 0.001), and EFT was positively correlated with severity of LS (r = 0.431, P < 0.001). HRR was significantly correlated with EFT (r = -0.386, P < 0.001) and severity of LS (r = -0.324, P < 0.001). EFT and NAFLD were significantly correlated with HRR in patients with MetS and they may be highly related to increased cardiovascular risk. These results suggest a cross-link among EFT, NAFLD, and cardiac autonomic dysfunction in patients with MetS.

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.

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.

Association of Heart Rate Recovery With Microalbuminuria in Non-Obstructive Coronary Artery Disease.

BackgroundNon-obstructive coronary artery disease (CAD) is associated with significantly increased risk for myocardial infarction. Heart rate recovery (HRR), a measure of autonomic function, is a strong predictor of all-cause mortality. Microalbuminuria, a marker of early arterial disease, is an independent risk factor for cardiovascular disease and mortality. We aimed to investigate HRR and determine its relationship with microalbuminuria in patients with non-obstructive CAD.MethodsWe prospectively studied 565 patients who underwent elective coronary angiography. All participants underwent urinary analysis and then an exercise test. Microalbuminuria was defined as an urinary albumin-to-creatinine ratio (UACR) of 30 - 299 mg/g. The HRR was abnormal if ≤ 12 beats/min during the first minute after exercise. First, all patients were divided into two groups, patients with microalbuminuria (n = 152) and patients without microalbuminuria (n = 413). Then, all patients were re-divided into two groups, those with lower HRR (≤ 12 beats/min, n = 126) and those with higher HRR (> 12 beats/min, n = 439).ResultsPatients with microalbuminuria had lower HRR and patients with lower HRR had higher UACR. While UACR was negatively correlated with HRR in patients with microalbuminuria (r = -0.424; P < 0.001) and in patients with lower HRR (r = -0.192; P= 0.042), there was no correlation of UACR with HRR in neither patients with normoalbuminuria nor patients with higher HRR, respectively. In the all study population, there was a significant inverse association between UACR and HRR (r = -0.445, P < 0.001), and UACR independently predicted the presence of lower HRR (P < 0.001).ConclusionsOur findings showed that there was a significant inverse association between UACR and HRR in patients especially with microalbuminuria, and that albuminuria might predict cardiac autonomic imbalance evaluated by HRR in patients with non-obstructive CAD.

ATraditional Risk Factors as Determinants of Heart Rate Recovery in Patients with Diabetes Mellitus type 2 Without Known Coronary Artery Disease

ATraditional Risk Factors as Determinants of Heart Rate Recovery in Patients with Diabetes Mellitus type 2 Without Known Coronary Artery Disease

Relationship Between Peak Oxygen Pulse and Heart Rate Recovery in COPD Patients During an Incremental Cardiopulmonary Exercise Test in Cycle Ergometer

SESSION TITLE: Pulmonary Physiology SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: It has been previously described that patients with chronic obstructive pulmonary disease (COPD) have showed a decreased peak oxygen pulse (O2 pulse), but the relationship with the levels of heart rate recovery (HHR) percentage has not been described clearly. METHODS: It is a non-experimental descriptive study transactional. The total sample (N = 100) included a group of patients with COPD (n = 33) and a group of healthy subjects (n = 67), including men and women between 46 and 69 years for the first group included and between 16 and 57 years for the second. All patients performed spirometry, and symptom-limited cardiopulmonary exercise test (CPET). We analyzed maximal work (Watts), oxygen consumption, O2 pulse, exercise time, maximal heart rate and post exercise heart rate recovery on the third minute in cycle ergometer. RESULTS: We found a significant reduced peak oxygen pulse and the percentage of the heart rate recovery in patients with COPD compared to healthy subjects ( 9.7 ± 0.6 was found and 25.7 ± 2.1 % vs . 14.2 ± 0.6 and 91.8 ± 3.2 % ; p < 0.001 respectively). COPD patients showed that those patients with low maximum pulse or showed a lower percentage of heart rate recovery in the third minute, but the correlation was not statistically significant ( Spearman r: 0.19 ; range -0.17 to 0.5 Between; p = 0.28 ) . The control group showed greater variability correlated with greater or lesser association (Spearman r: 0.6 , range -0.19 to -0.31 p = 0.6). CONCLUSIONS: The present study showed that COPD patients in addition to marked reduction of work capacity and lower exercise duration are associated with lower O2 pulse and delay in exercise heart rate recovery more than healthy subjects. CLINICAL IMPLICATIONS: These data suggest that Pulse O2 and HHR should be evaluated in patient with COPD in clinical practice and pay more attention to HHR in the intervals inter and intra exercise recovery during rehabilitation programs. DISCLOSURE: The following authors have nothing to disclose: Xavier Bocca, Claudio Xavier, Glenda Ernst, Alejandro Salvado No Product/Research Disclosure Information

PS 11-49 EPICARDIAL FAT AND NON-ALCOHOLIC FATTY LIVER DISEASE ARE RELATED TO HEART RATE RECOVERY IN METABOLIC SYNDROME

Objective: Liver fat and visceral adiposity are involved in the development of the metabolic syndrome (MetS), and epicardial adipose tissue reflects visceral fat deposit which affects the cardiac autonomic system. The aim of this study was to determine if, and to what extent, epicardial fat thickness (EFT) and non-alcoholic fatty liver disease (NAFLD) are related to heart rate recovery (HRR) as a simple cardiac autonomic indicator in patients with MetS. Design and Method: A total of 772 consecutive patients in health screening center who underwent abdominal ultrasonography, echocardiography and a treadmill test were enrolled. Echocardiographic EFT and HRR, defined as peak heart rate minus heart rate after a 1-minute recovery time, were measured. Patients were classified according to the presence of metabolic syndrome and NAFLD. Results: EFT was significantly higher and HRR was significantly lower in NAFLD patients, especially in the MetS with NAFLD, compared to the non-MetS without NAFLD (MetS with NAFLD, EFT 7.5 ± 4.4 mm and HRR 31.9 ± 12.7; MetS without NAFLD, EFT 4.9 ± 3.0 mm and HRR 39.5 ± 11.1; non-MetS with NAFLD, EFT 5.9 ± 3.6 mm and HRR 36.6 ± 12.7; non-MetS without NAFLD, EFT 4.4 ± 3.5 mm and HRR 43.4 ± 14.5; p < 0.001). Patients with severe (n = 24, ultrasound score 3) showed significantly higher EFT than those with moderate liver steatosis (n = 123, score 2) (p's < 0.001), and EFT was positively correlated with the severity of liver steatosis (r = 0.431, p < 0.001). Moreover, HRR was significantly correlated with EFT (r = −0.386, p < 0.001) and the severity of liver steatosis (r = −0.324, p < 0.001). Conclusions: EFT and NLFLD were significantly correlated with HRR in patients with MetS, and therefore may be best related to cardiovascular increased risk. Our result suggests a cross-link between epicardial fat, NLFLD and autonomic dysregulation in MetS.