Heart Care Info - Heart Disease Prevention & Treatment

089 Heart rate recovery is a powerful prognostic factor in patients with chronic heart failure

A Ben Driss, JY Tabet, H Weber, P Meurin... - Archives of ..., 2011 - Elsevier144 patients with compensated HF underwent cardiopulmonary exercise testing (CPX) and were followed for a combined death/transplantation/hospitalization end point. Patients with advanced HF were defined as those with peak VO2 ≤ 14 ml/kg/mn (n = 41/144; 28%). Mean age ...

144 patients with compensated HF underwent cardiopulmonary exercise testing (CPX) and were followed for a combined death/transplantation/hospitalization end point. Patients with advanced HF were defined as those with peak VO2 ≤ 14 ml/kg/mn (n = 41/144; 28%). Mean age and left ventricular ejection fraction (LVEF) were 53 12 years and 29 7% respectively in all population and 58 11 years and 28 7% respectively in the advanced HF group. Ninety one percent of patients received betablockers (93% in advanced HF group). HRR at 1-minute post-CPX was calculated as the difference between heart rate at peak exercise and after 1 minute of active recovery.

Among the 144 patients, we recorded 10 mortality, 7 cardiac transplantation and 8 hospitalization for acute HF outcome events over 16 months of follow-up. The baseline mean peak respiratory exchange ratio (RER), peak VO2, VE/VCO2 slope, and HRR1 were 1.13 0.09, 16 4 ml/kg/mn, 35 8, 13 12 beat/mn, respectively. Although LVEF, peak VO2, VE/VCO2 slope and HRR1 were significant univariate predictors of the composite end point (p < 0.05), multivariate Cox regression analysis only retained LVEF (chi2 = 5.5, p = 0.01) and HRR1 (chi2 = 5.2, p = 0.02) in the equation. In the group of patients with advanced HF the mean peak RER, peak VO2, VE/VCO2 slope, and HRR1 were 1.10 0.07, 12 1 ml/kg/mn, 39 11, 9 8 beat/mn, respectively. Kaplan-Meier analysis revealed a significant difference in survival according to a 5 bpm HRR1 threshold: 68% in patients with HRR1 ≤5 bpm vs 96% in those with HRR1 >5 bpm (logrank = 5, p = 0.02) (HR = 2.66; CI: 2.08 2.66, p = 0.02).