Normal Heart Rate Recovery Research Articles

Long-term prognostic value of heart rate recovery in patients with left bundle branch block without inducible ischemia and without known coronary artery disease

Abstract Background Heart rate recovery (HRR) has been shown to predict cardiovascular and all-­cause morbidity and mortality. Left bundle branch block (LBBB) is often associated with significant heart disease and is often the result of underlying coronary artery disease (CAD), myocardial injury, strain or hypertrophy. However, there are insufficient data on the prognostic value of HRR in patients with LBBB without inducible ischemia and without known CAD. Aim The aim of this study was to determine the long-term prognostic value of HRR in patients with LBBB without inducible ischemia and without known CAD. Methods This retrospective study included 182 patients (64, 35.2% male gender, average age 63 ± 10 years) with LBBB and without known CAD who were referred to the SECHO test for chest pain. All the patients had negative SECHO test according the Bruce protocol. Risk factors for CAD (diabetes, smoking, hypertension, high cholesterol and positive family history of CAD), functional capacity (Metabolic Equivalents - METs) and heart rate recovery (HRR) were recorded 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. Median follow up of the patients was 102.5 months (IQR 68-146 months) for the occurrence of MACE (all-cause mortality, non-fatal myocardial infarction (MI), coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI)). Results Overall, 16pts (8.8%) had slow HRR. During the follow-up period 34 out of 182 patients (18.7%) had an adverse event (16 deaths, 10 non-fatal MI, 1 CABG and 7 PCI). Using the Cox regression analysis, univariate predictors of MACE were age (B=0.050, HR 1.051 [95% CI 1.011-1.093], p=0.012), hypertension (B=-1.219, HR 3.385 [95% CI 1.071-10.699], p=0.038), MET (B=-0.183, HR 0.833 [95% CI 0.706-0.982], p=0.030), diabetes (B=0.981, HR 2.667 [95% CI 1.267-5.612], p=0.010) and slow HRR (B=1.171, HR 3.225 [95% CI 1.307-7.959], p=0.011). However, in the multivariate analysis only slow HRR remained the independent predictor of MACE (B=0.974, HR 2.648 [95% CI 0.980-7.151], p=0.048). Using the Kaplan-Meier survival curve we see that the patients with slow HRR had much shorter event-free time compared to the patients with normal HRR (106.9 ± 14.9 months vs 157.9 ± 24 months, Log Rank 7.227, p=0.007) (Figure 1.). Conclusion Slow HRR is an independent long-term predictor of adverse events in patients with left bundle branch block without inducible ischemia and without known coronary artery disease.Kaplan-Meier survival curve for the MACE

Negative long-term prognostic value of stress echocardiography in patients with incomplete revascularization after successful primary PCI

Abstract Background The role of stress echocardiography (SECHO) in a risk stratification of patients with incomplete revascularization after primary percutaneous coronary intervention (pPCI) has not been extensively documented. The Aim The aim of our study was to assess the negative long-term prognostic value of SECHO after successful pPCI and incomplete revascularization of non-culprit lesions. Methods Our study consisted of 194 patients (mean age 59±10years, male 136; 70.1%) successfully treated with pPCI, who performed SECHO according to Bruce protocol in order to assess residual ischemia in coronary artery with non-culprit lesion other than treated vessel. Lesion severity of non-culprit coronary arteries was assessed by quantitative coronary angiography. Duke treadmill score, functional capacity (Metabolic Equivalents - METs), achieved target heart rate (THR), chronotropic incompetence, heart rate recovery (HRR), wall motion score index (WMSI) and ejection fraction were calculated in all patients. Slow HRR was defined as ≤18 beats/min. Median follow up of the patients was 96 ± 32.5 months for the occurrence of all-cause mortality and non-fatal myocardial infarction (MI). Results Out of 194 patients, 38 (19.6%) had positive SECHO test, and 7 patients (3.6%) were lost to follow up so they were excluded from further analysis. During the follow-up period 29 out of 149 patients (18.8%) had an adverse event (20 deaths and 9 non-fatal MI). Negative predictive value of SECHO test was 81.2%. Median time from MI to SECHO test was 8 months. Using the Cox regression analysis, univariate predictors of adverse events were slow HRR (HR 3.750 [95% CI 1.620-8.679], p=0.002), Duke score (HR 0.866 [95% CI 0.755-0.994], p=0.040) and chronotropic incompetence (HR 0.310 [95% CI 0.107-0.895], p=0.030). In the multivariate analysis only the slow HRR remained an independent predictor of adverse events (HR 3.329 [95% CI 1.417-7.825], p=0.006). Using the Kaplan-Meier survival curve we see that the patients with slow HRR had much shorter event-free time (slow HRR 117.2 ± 13.4 months vs normal HRR test 139.4 ± 4.2 months, Log Rank 4.988, p=0.026). (Figure 1.) Conclusion SECHO test has excellent negative long-term prognostic value in patients with incomplete revascularization of non-culprit lesions after successful pPCI while patients with slow HRR have more pronounced risk for the occurrence of adverse events.Figure 1.Kaplan-Meier survival curve

Factors Associated with Heart Rate Recovery in People with Chronic Obstructive Pulmonary Disease: An Analytical Cross-Sectional Study

Introduction: Heart rate recovery (HRR) delay is a marker of cardiac autonomic dysfunction. In people with chronic obstructive pulmonary disease (COPD) attending pulmonary rehabilitation programs, assessing HRR could have prognostic utility, yielding valuable information for setting treatment goals and targets in therapeutic interventions. Therefore, this study aimed to establish the sociodemographic, pulmonary function, and functional aerobic capacity differences in people with COPD with normal and abnormal HRR during the 6-minute walk test (6MWT) and explore factors associated with abnormal HRR. Method: Analytical cross-sectional study. Sociodemographic, anthropometric characteristics, pulmonary function, aerobic capacity, BODE index, and Hospital Anxiety and Depression Scale (HADS) were assessed in COPD patients. An HRR cut-off point of 14 beats or more was used to define HRR delay. Results: Of 128 patients included, 89 (69.5%) showed abnormal HRR. Patients with abnormal HRR were classified with higher overweight/obesity, lower resting SpO2 and lower distance walked, predicted percentage, and estimated VO2 in the 6MWT, with more significant symptoms at one minute after the end of the test (dyspnea and fatigue). In the multivariate regression model adjusted for age, sex, resting heart rate, and FEV1, findings showed that distance walked in the 6MWT (OR 0.994, p-value=0.010), fatigue at 1 minute (OR 2.12, p-value=0.000), and HADS depression domain (OR 0.87, p-value=0.018) are factors associated with HRR. Conclution: In outpatients with COPD, HRR relates to the distance walked in the 6MWT, fatigue, and depression measured with the HADS.

Heart rate recovery in adult individuals with asthma.

Slow heart rate recovery (HRR) after exercise is a predictor of overall mortality in individuals with and without cardiovascular or respiratory disorders. No data on adults with asthma are available. The purpose of the study is to evaluate the prevalence of slow HRR in these individuals as compared with those with chronic obstructive pulmonary disease (COPD). We performed a retrospective analysis of baseline characteristics and physiological response to the six-minute walking distance test of stable individuals with asthma or COPD. Slow HRR was defined as HRpeak - HR at 1 minute after end exercise <12 bpm. Individuals with asthma walked significantly longer (median (IQR): 455 (385-512) vs 427 (345-485) meters; p=0.005) with a lower prevalence of slow HRR (30.3% vs 49.0%, respectively: p<0.001) than those with COPD. Individuals with asthma and slow HRR were older and walked less than those with normal HRR, without any difference in airway obstruction or in disease severity. Multivariate analysis showed that only the difference HRpeak - baseline HR (∆HR), was a predictor of slow HRR in both groups. More than 30% of adult individuals with asthma may show slow HRR. Only exercise ∆HR but no baseline characteristic seems to predict the occurrence of slow HRR.

Heart rate recovery is improved after locomotor training in persons with incomplete spinal cord injury: implications for health and prevention

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Heart rate recovery after exercise provides meaningful information about physical fitness and prognosis in both health and disease. A more rapid decrease in heart rate after exercise has been associated with higher levels of fitness as well as better health and survival. In fact, heart rate recovery (HRR) ≤ 12 beats at one minute after maximal and sub-maximal exercise is a significant prognostic index of poorer health and survival. However, little research has examined HRR in persons with spinal cord injury (SCI) despite the need for a responsive measure of fitness and health in this population. Purpose The purpose of this study was to examine HRR before and after locomotor training (LT) in persons with SCI. Methods Twenty-nine subjects with incomplete SCI performed LT 5 days per week for 12 weeks using one of four training approaches: treadmill-based training with manual assistance (TMM), treadmill-based training with stimulation (TMS), over-ground training with stimulation (OGS), and treadmill-based training with robotic assistance (TMR). Before and after 12 weeks of LT the HRR was measured one minute after 2-3 minutes of walking at each subject’s maximal capacity. Heart rate data was captured via a recording band placed on each subjects’ chest that transmitted wireless signals to a data collection system which recorded heart rate data continuously. Results The peak HR during maximal walking of the cohort before and after LT was 75 ±15% and 71 ±14% of the age-predicted maximal HR, respectively. Fifteen of the 29 subjects (52%) had an abnormal HRR (≤ 12 beats) at baseline; following LT, HRR was improved in 11/15 (73%) of these subjects. In addition, 50% of subjects with a normal baseline HRR improved HRR after LT. There was no significant difference in HRR among training approaches at baseline or after LT. Conclusions Twelve weeks of LT was associated with an improvement in HRR in almost three-quarters of the subjects with an abnormal HRR at baseline, and HRR improved in one-half of the subjects with a normal HRR at baseline. These findings suggest that HRR may be of value for tracking fitness and prognosis in persons with SCI. Further investigation of HRR in subjects with SCI is warranted.

Association between Circulating Adiponectin and Heart Rate Recovery in Women with Polycystic Ovarian Syndrome

ABSTRACT Context Adiponectin (APN) is reported to be correlated closely with autonomic nervous function in different clinical settings. Heart rate recovery (HRR) is a noninvasive and readily obtainable indicator, which reflects the coordinated interplay between parasympathetic reactivation and sympathetic withdrawal. Objective This study aimed to investigate the relationship between serum APN and HRR in polycystic ovarian syndrome (PCOS) women. Design Eighty-nine PCOS women were enrolled and divided into two groups. Women with HRR values slower than 12 beats were defined as Blunted HRR Group. APN levels were compared between Blunted HRR Group and Normal HRR Group. Multivariate logistic regression analysis and multiple linear regression analysis were performed to determine which clinical variables were independently associated with HRR and APN levels, respectively. Results Twenty-three women were categorized into Blunted HRR Group, in which APN level was significantly lower than Normal HRR Group. Age, body mass index, hypertension, and APN were independent factors of attenuated HRR in PCOS women. Meanwhile, multiple linear regression analysis showed age, dyslipidemia, and homeostasis model assessment-insulin resistance (HOMA-IR) were closely associated with APN levels in PCOS women. Conclusions Our findings suggested that decreased APN concentration was closely associated with HRR blunt in PCOS women. Further studies are needed to explore the underlying interactions between APN and autonomic nervous function.

Effect of Exercise Duration Toward Heart Rate Recovery in Elderly

Background: Age-related change in autonomic nerves covers parasympathetic function decrease that hampers heart rate (HR) control. The effective attempt to improve autonomic nervous function for elderly is routine exercise, however exercise duration among elderly is not always standardized. This study is aimed to compare the effect of different exercise duration to post-exercise Heart Rate Recovery (HRR) between two elderly groups with the same frequency, intensity, type criteria of routine exercise.&#x0D; Method: Method was cross-sectional study which compared exercise duration of standardized group (3x90 minutes/week) and unstandardized group (3x30 minutes/week). Group 1 was elders with standardized duration from Healthy Heart Club and Group 2 was elders who take unstandardized duration from Elderly Home in Bandung city. Each group consisted of 43 elders and data were collected in July-August 2019. After one hour of medium intensity exercise, all respondents were examined for resting HR (HRrest), maximum HR (HRmax), one minute post-exercise HR, and four minutes post-exercise HR. HRR was obtained by subtracting HRmax by one minute post-exercise HR and normal if &gt; 12 bpm. Analysis data was done by SPSS with Mann-Whitney U Test, Fisher Chi Square and Logistic regression.&#x0D; Result: Most of respondents were 60-69 years old and female. Respondents in unstandardized group were more low education, hypertension and smoking. The HRrest of both groups was categorized as normal but increased greater (30x/min) in standardized group. The result showed a significant difference in comparation of median HRR (p=0.001) and number of normal and abnormal HRR (p=0.001) between both groups. Gender, smoking and standardized duration of exercise associated with abnormality of HRR, elders who take unstandardized duration have 12.7 times risk to get abnormal HRR.&#x0D; Conclusion: Routine exercise for elderly is recommended in standardized duration with minimal 150 minutes per week in order to increase post-exercise HRR.

Association of Cardiorespiratory Fitness and Hemodynamic Responses to Submaximal Exercise Testing With the Incidence of Chronic Kidney Disease: The Framingham Heart Study

ObjectiveTo relate cardiorespiratory fitness (CRF) and hemodynamic responses to exercise to the incidence of chronic kidney disease (CKD). MethodsWe evaluated 2715 Framingham Offspring Study participants followed up (mean, 24.8 years) after their second examination (1979-1983) until the end of their ninth examination (2011-2014). Participants (mean age, 43 years; 1397 women [51.5%]) without prevalent CKD or cardiovascular disease at baseline were included. We examined the associations of CRF and hemodynamic response to exercise with incident CKD using multivariable Cox proportional hazards regression with discrete intervals. ResultsCompared with low CRF (first tertile), participants with moderate (second tertile) or high (third tertile) CRF had a lower risk of CKD (hazard ratios [95% CIs]: 0.74 [0.61-0.91] and 0.73 [0.59-0.91], respectively). Participants with chronotropic incompetence (hazard ratio, 1.38 [95% CI, 1.06 to 1.79]), higher exercise systolic blood pressure (hazard ratio per SD, 1.20 [95% CI, 1.07 to 1.34]), and impaired heart rate recovery (hazard ratio, 1.51 [95% CI, 1.08 to 2.10]) had a higher risk of CKD compared with those with chronotropic competence, lower exercise systolic blood pressure, and normal heart rate recovery, respectively. These associations remained robust when the exercise variables were mutually adjusted for. The third tertile of a standardized exercise test score comprising the statistically significant variables was associated with a higher risk of CKD compared with the first tertile (hazard ratio, 1.85; 95% CI, 1.45 to 2.36). ConclusionHigher CRF and favorable hemodynamic responses to submaximal exercise in young adulthood may be markers of lower risk of CKD in later life.

The Effect of Routine Gymnastics toward Post-Exercise Heart Rate Recovery in Elderly

Background: Age-related change in autonomic nerves covers parasympathetic function decrease that hampers heart rate (HR) control. The effective attempt to improve autonomic nervous function for elderly is routine exercise, however exercise duration among elderly is not always standardized. This study is aimed to compare the effect of different exercise duration to post-exercise Heart Rate Recovery (HRR) between two elderly groups with the same frequency, intensity, type criteria of routine exercise.&#x0D; Method: Method was cross-sectional study which compared exercise duration of standardized group (3x90 minutes/week) and unstandardized group (3x30 minutes/week). Group 1 was elders with standardized duration from Healthy Heart Club and Group 2 was elders who take unstandardized duration from Elderly Home in Bandung city. Each group consisted of 43 elders and data were collected in July-August 2019. After one hour of medium intensity exercise, all respondents were examined for resting HR (HRrest), maximum HR (HRmax), one minute post-exercise HR, and four minutes post-exercise HR. HRR was obtained by subtracting HRmax by one minute post-exercise HR and normal if &gt; 12 bpm. Analysis data was done by SPSS with Mann-Whitney U Test, Fisher Chi Square and Logistic regression.&#x0D; Result: Most of respondents were 60-69 years old and female. Respondents in unstandardized group were more low education, hypertension and smoking. The HRrest of both groups was categorized as normal but increased greater (30x/min) in standardized group. The result showed a significant difference in comparation of median HRR (p=0.001) and number of normal and abnormal HRR (p=0.001) between both groups. Gender, smoking and standardized duration of exercise associated with abnormality of HRR, elders who take unstandardized duration have 12.7 times risk to get abnormal HRR.&#x0D; Conclusion: Routine exercise for elderly is recommended in standardized duration with minimal 150 minutes per week in order to increase post-exercise HRR.

Relationship between Heart Rate Recovery Index and Erectile Dysfunction

OBJECTIVE:Heart rate recovery (HRR) is a cardiac parameter that can be used to evaluate autonomic nervous system (ANS) function problems. We examined the possible relationship between erectile dysfunction (ED) and HRR which is a clinical condition associated with ANS dysfunction.METHODS:Seventy-six male patients that were examined with an exercise stress test and completed the International Index of Erectile Function Questionnaire Form (IIEF-5) were included in the study. The patients were divided into two groups as those with a normal HRR index (≥12, n=42) and those with an abnormal HRR index (<12, n=34). Then, statistical analyses were conducted to evaluate the correlations between ED and HRR.RESULTS:There were no differences between the groups in terms of risk factors, such as laboratory findings, age, BMI, hypertension, and smoking. However, in the group with an abnormal HRR index, the IIEF-5 score was significantly lower than the other group (11.2±4.2 vs. 20.3±4.6, p<0.001). A statistically significant positive correlation was observed between the IIEF-5 score and HRR index (r=0.702, p<0.001). In addition, the presence of diabetes mellitus and HRR index was independent risk factors for lowering the IIEF-5 score.CONCLUSION:The HRR index can be considered as an independent predictor of ED since a reduced value, which is associated with cardiovascular mortality and also causes ANS dysfunction.

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.

Abstract MP08: Higher Fitness Level and Favorable Hemodynamic Responses to Submaximal Exercise Test in Young Adults are Associated With Lower Risk of Chronic Kidney Disease in Later Life: The Framingham Heart Study

Introduction: Studies have demonstrated that higher cardiorespiratory fitness (CRF) and a favorable heart rate (HR) and blood pressure (BP) response to submaximal exercise, including during the recovery period, are associated with lower cardiovascular disease (CVD) risk. However, there are limited studies examining the association of CRF and hemodynamic response to exercise test with incidence of chronic kidney disease (CKD). Hypothesis: We hypothesized that high CRF and a favorable HR and BP response to submaximal exercise test and during recovery will be associated with lower risk of CKD prospectively. Methods: We evaluated 3,535 Framingham Offspring Study participants (mean age 43.5 yrs, 52.1% women) without CKD, who completed a submaximal exercise test between 1979-1983. CKD incidence was defined as eGFR &lt;60ml/min/1.73m 2 on follow-up. Multivariable-adjusted Cox regression models with discrete time intervals were used to relate CRF and hemodynamic responses to exercise test at baseline with the incidence of CKD on follow-up. Results: At baseline, 23% of participants had chronotropic incompetence and 19.6% had impaired HR recovery after exercise (Δ HR 1 &lt; 12 bpm). On follow-up (median 25.7 years), 801 individuals (22.8%; 434 women) developed CKD. Participants in the second and third tertile of CRF (defined based on age and sex-specific treadmill exercise duration) had lower risk of CKD compared to those in the first tertile of CRF ( Table ). Participants with chronotropic incompetence, higher peak SBP during exercise and impaired HR recovery had higher risk of CKD, compared to those with chronotropic competence, lower peak SBP during exercise, and normal HR recovery post-exercise ( Table ). Conclusions: Higher CRF and favorable HR and BP responses to exercise test in young adulthood may be a marker of lower risk of CKD in later life. The biological mechanisms underlying the observed association warrant further investigation.

Abnormal Heart Rate Recovery as a Predictor of Coronary Artery Disease in Patients Undergoing Exercise Stress Myocardial Perfusion Imaging: A 4-Year Retrospective Study in Chong Hua Hospital

Background: Abnormal heart rate recovery (HRR) after exercise is associated with an increase in all-cause mortality in both asymptomatic individuals and patients with established heart disease. In clinical practice, myocardial perfusion imaging (MPI) is used to establish the diagnosis and prognosis of coronary artery disease (CAD). This study aimed to determine the relationship between the HRR and the MPI findings of patients who underwent exercise stress test using sestamibi MPI. Methods: This was a four-year retrospective chart review study that included all patients who underwent exercise stress test using the sestamibi MPI at Chong Hua Hospital from January 2014 through December 2017. HRR was computed as the difference between peak HR and HR at the 60th second. Abnormal HRR was defined as either &lt;12 beats per minute (bpm) from the peak HR after one minute with post-exercise cooldown. Patient demographics and clinical factors were reviewed and analyzed using parametric and nonparametric statistical tools. Results: A total of 304 patients were included in the study: 68% were male, 86% were aged &gt;40 years. The most common comorbidity was combined hypertension and dyslipidemia (35%). The mean HRR was 31 bpm, and the mean percentage of chronotropic response (PCR) was 86. Eighty-eight percent of the patients had normal HRR. Eighty-six percent had MPI results within normal ranges. The chi squared test results showed no significant relationship between HRR and the diagnosis of inducible ischemia (p=0.141). Conclusion: About 88% of the study subjects were identified with normal HRR, while only 12% were classified as having abnormal HRR. There was no significant correlation between HRR and MPI findings of inducible ischemia among Filipino who underwent exercise stress MPI in this study.

Heart rate recovery is associated with ventilatory constraints and excess ventilation during exercise in patients with chronic obstructive pulmonary disease.

Background Heart rate recovery delay is a marker of cardiac autonomic dysfunction. In chronic obstructive pulmonary disease patients, the ventilatory response to exercise during incremental cardiopulmonary exercise test may add information about dynamic hyperinflation by low values of inspiratory capacity/total lung capacity ratio (at peak) and excess ventilation by the slope of minute ventilation to carbon dioxide output ratio (VE/VCO2 slope). We aimed to assess if the ventilatory response to exercise might be a determinant for heart rate recovery delay. Design An observational, prospective study. Methods Anthropometric characteristics, lung function and cardiopulmonary exercise test data were recorded in chronic obstructive pulmonary disease outpatients. A cut-off of heart rate recovery of 12 or more beats was used to define heart rate recovery delay. Results Of 254 patients enrolled, 156 (61%) showed heart rate recovery delay. As compared to patients with normal heart rate recovery, patients with delay were older, with a worse lung function and with lower values of peak oxygen uptake, maximal workload, oxygen pulse at rest and at peak, and inspiratory capacity/total lung capacity at peak. Conversely, VE/VCO2 slope and dyspnoea and leg fatigue perception at peak were higher in patients with heart rate recovery delay. In the multivariate regression model adjusted for age, sex, fat-free mass, heart rate at rest and use of β-blockers, we found that inspiratory capacity/total lung capacity at peak (<0.25) (odds ratio 2.61; P = 0.007) and VE/VCO2 slope (>32) (odds ratio 2.26; P = 0.018) predict the risk of heart rate recovery delay. Conclusions In chronic obstructive pulmonary disease outpatients, heart rate recovery is associated with dynamic hyperinflation and excess ventilation during exercise.

Tanısal Egzersiz Elektrokardiyografi Testi Yapılan Hastalarda Serum Tiyol Disulfid Dengesi ve Endokan Düzeyleri

Introduction: Inflammation and oxidative stress are associated with increased risk of cardiovascular diseases. Parameters derived from exercise electrocardiography (ECG) test, such as Duke treadmill score and heart rate recovery (HRR), have prognostic importance and can be used to predict cardiovascular risk. Endocan and thiol/disulfide homeostasis are emerging biomarkers that reflect the inflammatory and oxidative status. The aim of this study was to investigate serum thiol/disulfide homeostasis and endocan levels in an exercise ECG testing patient cohort and to evaluate the association of these markers with Duke treadmill score and HRR. Patients and Methods: Patients who underwent diagnostic exercise ECG test were divided into two groups according to Duke treadmill score and HRR. Serum endocan levels and thiol/disulfide homeostasis were compared between high and low/intermediate Duke treadmill score groups and blunted and normal HRR groups. Results: Serum endocan levels were similar between the groups according to Duke treadmill score and HRR. Thiol/disulfide ratio was significantly lower in patients with blunted HRR than in those with normal HRR. Serum native thiol levels, total thiol levels, and total thiol/disulfide ratio were significantly elevated in patients with a high Duke treadmill score than in those with low/intermediate Duke treadmill score. Native thiol levels and total thiol levels were significantly correlated with Duke treadmill score. Multivariate regression analysis revealed that hypertension and diabetes were independent predictors of blunted HRR, whereas hypertension and low endocan levels were those of low/intermediate Duke treadmill score. Conclusion: Serum thiol levels are correlated with Duke treadmill score, and low endocan levels are associated with low/intermediate Duke treadmill score.

Vagal reactivation after exercise and cardiac autonomic nervous activity in adult Fontan patients without pacemakers

PurposePatients with Fontan circulation have reduced heart rate variability (HRV) in supine position. However, neither cardiac autonomic nervous activity (CANA) in response to orthostatic challenge nor vagal reactivation by means of heart rate (HR) recovery after cessation of exercise have previously been investigated in Fontan patients. The aim of this study was to compare HRV in supine and standing position, as well as HR recovery between Fontan patients and healthy controls. MethodsEight Fontan patients (4 male/4 female) without pacemakers and 12 healthy volunteers (5m/7f) with minimum age of 18years were recruited. HR was measured by Holter-electrocardiogram. HRV was measured in supine position and after orthostatic challenge. The power of the high frequency (HF: 0.15Hz–0.4Hz) and low frequency (LF: 0.04Hz–0.15Hz) bands was analysed by fast-Fourier transformation. HR recovery was determined at 30s and 60s after termination of a maximal exercise test. ResultsIn both supine and standing position, total power, HF and LF power were reduced in Fontan patients compared to controls (by approximately a factor of 10) while there was no differences in LF/HF power ratio. Response to orthostatic challenge was blunted in absolute power but normal in relative power. HR recovery was not different between groups. ConclusionFontan patients have greatly reduced HRV, a blood-pressure dependent marker of CANA, but normal HR recovery, a blood pressure independent marker of vagal reactivation, suggesting that vagal activity may be normal, and only vascular capacitance reduced.

Association of impaired heart rate recovery with cardiopulmonary complications after lung cancer resection surgery

Patients who undergo lung resection surgery are at risk for postoperative morbidity and mortality. Appropriate selection of the surgical candidate is crucial in the treatment of lung cancer. Heart rate recovery is a measure of physical fitness. We aimed to investigate the association of impaired heart rate recovery with cardiopulmonary complications after lung resection surgery for treatment of lung cancer. Data from consecutive patients who, between 2009 and 2013, underwent heart rate recovery evaluation after 6-minute walk tests before lung resection surgery were retrospectively reviewed. Impaired heart rate recovery was defined as a 12-beat or less decrease in peak heart rate at 1 minute after the 6-minute walk test. Postoperative cardiopulmonary complications were as defined by the Society of Thoracic Surgeons General Thoracic Surgery Database. Logistic regression was performed, including previously known risk factors for postoperative complications after lung resection surgery. A total of 96 patients had heart rate recovery evaluated within 6 months of lung resection surgery for treatment of lung cancer. Thirty-one patients had impaired heart rate recovery, 17 of whom (55%) had cardiopulmonary complications. A total of 65 patients had normal heart rate recovery, 17 of whom (26%) had cardiopulmonary complications. In multivariable logistic regression analysis, impaired heart rate recovery was significantly associated with postoperative cardiopulmonary complications (odds ratio, 4.97; confidence interval, 1.79-13.8; P=.002). No patient died within 30 days after surgery. Impaired heart rate recovery after the 6-minute walk test is associated with postoperative cardiopulmonary complications in patients who underwent lung resection surgery for treatment of lung cancer.

Heart rate recovery normality data recorded in response to a maximal exercise test in physically active men

Despite a growing clinical interest in determining the heart rate recovery (HRR) response to exercise, the limits of a normal HRR have not yet been well established. This study was designed to examine HRR following a controlled maximal exercise test in healthy, physically active adult men. The subjects recruited (n = 789) performed a maximal stress test on a treadmill. HRR indices were calculated by subtracting the first and third minute heart rates (HRs) during recovery from the maximal HR obtained during stress testing and designated these as HRR-1 and HRR-3, respectively. The relative change in HRR was determined as the decrease in HR produced at the time points 1 and 3 min after exercise as a percentage of the peak HR (%HRR-1/HR(peak) and %HRR-3/HR(peak), respectively). Percentile values of HRR-1 and HRR-3 were generated for the study population. Mean HHR-1 and HHR-3 were 15.24 ± 8.36 and 64.58 ± 12.17 bpm, respectively, and %HRR-1/HR(peak) and %HRR-3/HR(peak) were 8.60 ± 4.70 and 36.35 ± 6.79%, respectively. Significant correlation was detected between Peak VO2 and HRR-3 (r = 0.36; p < 0.001) or %HRR-3/HR(peak) (r = 0.23; p < 0.001). Our study provides normality data for HRR following a maximal Ergometry test obtained in a large population of physically active men.

P.1.b.001 Heart rate variability spectral analysis in patients with panic disorder compared with healthy controls

Patients with Fontan circulation have reduced heart rate variability (HRV) in supine position. However, neither cardiac autonomic nervous activity (CANA) in response to orthostatic challenge nor vagal reactivation by means of heart rate (HR) recovery after cessation of exercise have previously been investigated in Fontan patients. The aim of this study was to compare HRV in supine and standing position, as well as HR recovery between Fontan patients and healthy controls.Eight Fontan patients (4 male/4 female) without pacemakers and 12 healthy volunteers (5 m/7 f) with minimum age of 18 years were recruited. HR was measured by Holter-electrocardiogram. HRV was measured in supine position and after orthostatic challenge. The power of the high frequency (HF: 0.15 Hz–0.4 Hz) and low frequency (LF: 0.04 Hz–0.15 Hz) bands was analysed by fast-Fourier transformation. HR recovery was determined at 30 s and 60 s after termination of a maximal exercise test.In both supine and standing position, total power, HF and LF power were reduced in Fontan patients compared to controls (by approximately a factor of 10) while there was no differences in LF/HF power ratio. Response to orthostatic challenge was blunted in absolute power but normal in relative power. HR recovery was not different between groups.Fontan patients have greatly reduced HRV, a blood-pressure dependent marker of CANA, but normal HR recovery, a blood pressure independent marker of vagal reactivation, suggesting that vagal activity may be normal, and only vascular capacitance reduced.

Predictive Value of Heart Rate Recovery after Exercise Testing in Addition to Brain Natriuretic Peptide Levels in Ambulatory Patients with Nonischemic Dilated Cardiomyopathy

Heart rate recovery (HRR) is related to autonomic function and is a prognostic marker in cardiovascular disease. We sought to investigate the clinical utility of HRR in addition to BNP levels in ambulatory outpatients with nonischemic dilated cardiomyopathy (NICM). Seventy-nine NICM outpatients were followed for a mean of 19 months. HRR was defined as the difference in heart rate between peak exercise and 1 minute later. On the basis of the lower tertile value, we allocated the patients to two groups: with HRR >12 bpm (n = 48; normal) and with HRR ≤12 bpm (n = 31, abnormal). The probability of cardiac event-free survival was significantly lower in the abnormal HRR group than in the normal HRR group (P = 0.002). Stepwise multivariate analysis revealed that plasma BNP and HRR were independent predictors of cardiac events. Patients with both HRR ≤12 bpm and BNP ≥200 pg/mL had significantly higher rates of cardiac events than those in whom only one, or neither, of these variables was abnormal. HRR after exercise testing, in addition to plasma BNP level, might be a useful indicator as a predictor for admission due to worsening heart failure and its combination is able to provide additive prognostic information in ambulatory outpatients with NICM.