Early heart rate recovery after exercise predicts mortality in patients with chronic heart failure

Nanas, Serafim; Anastasiou-Nana, Maria; Dimopoulos, Stavros; Sakellariou, Dimitrios; Alexopoulos, George P.; Kapsimalakou, Smaragda; Papazoglou, Panagiotis; Tsolakis, Elias; Papazachou, Ourania; Roussos, Charis; Nanas, John N.

doi:10.1016/j.ijcard.2005.10.032

Cited by 81 publications

(69 citation statements)

References 46 publications

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“…22 Furthermore, the severity of OSA, as expressed by AHI, correlated with O 2 kinetics, and with HRR indicating that the severity of OSA is associated with both parasympathetic dysfunction and O 2 debt. Both of these indices have been shown to contain significant prognostic information for patients with heart failure 21,26,27 ; however, whether these indices are potent prognostic markers in patients with OSA must be confirmed by larger prospective studies. Future studies aiming to evaluate treatment strategies such as β-blockers or exercise training programs in patients with OSA might also be an interesting field of research.…”

Section: Discussionmentioning

confidence: 99%

“…18,19 Heart rate recovery has been shown to entail prognostic significance in the general population 20 and in chronic heart failure. 21 The impairment of the CR to exercise observed in patients suffering from chronic heart failure 22 has been related to a poor prognosis. 23 Moreover, the improvement of CR and HRR are indices of response of these patients to treatment.…”

Section: Introductionmentioning

confidence: 99%

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Heart Rate Recovery and Oxygen Kinetics After Exercise in Obstructive Sleep Apnea Syndrome

Nanas

Sakellariou

Kapsimalakou

et al. 2010

Clinical Cardiology

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Background: Patients who suffer from obstructive sleep apnea (OSA) have a decreased exercise capacity and abnormal autonomic nervous function. However, the kinetics of early oxygen (O 2 ) and heart rate recovery (HRR) have not been described. Materials and Methods:We evaluated 21 men with moderate to severe OSA (mean age: 48 ± 11 yrs, mean apnea-hypopnea index [AHI]: 55 ± 13) and without known heart disease and 10 healthy men matched for age and body mass index (BMI; controls). Men with OSA underwent overnight polysomnography, and both groups underwent symptom-limited incremental cardiopulmonary exercise testing (CPET). We recorded the CPET parameters including peak O 2 uptake (VO 2 p), kinetics of early O 2 recovery by the first degree slope of VO 2 during the first minute (VO 2 /t slope), the time required for a 50% decline of VO 2 p during recovery (T 1/2 ), and early heart rate recovery (HRR = HR at maximal exercise − HR at 1 min of recovery), as well as the chronotropic reserve to exercise ([CR] = [peak HR − resting HR/220 − age − resting HR] × 100). Patients with OSA had a lower VO 2 p (28.7 ± 4.0 vs 34.7 ± 6.2 mL/kg/min), VO 2 /t slope (1.04 ± 0.3 vs 1.4 ± 0.17 mL/kg/min 2 ), and T 1/2 (74 ± 10 vs 56 ± 6 sec) compared to controls (all P < 0.001). In addition, both HRR and CR were lower in the OSA group (22.0 ± 7.0 vs 31.0 ± 6.0 bpm,P:0.003, and 79.0% ± 15% vs 99.0% ± 13.0%, P:0.01, respectively). Conclusions: Patients with OSA demonstrate reduced exercise capacity, delayed oxygen kinetics, and reduced HRR. These data point to abnormal oxygen delivery and/or oxidative function of the peripheral muscles and impaired autonomic nervous activity in OSA patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Heart Rate Recovery and Oxygen Kinetics After Exercise in Obstructive Sleep Apnea Syndrome

Nanas

Sakellariou

Kapsimalakou

et al. 2010

Clinical Cardiology

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“…9,10 Patients with chronic heart failure present an impaired chronotropic response to exercise 18,19 and a delayed HRR after exercise, 20,21 both predictors of poor prognosis 11,22 that can be improved by exercise training. 23,24 In patients with pulmonary hypertension, a blunted chronotropic response to exercise has been also reported during symptom-limited CPET, [25][26][27] during constant workload exercise testing 28 and during a 6-minute walking test, 29 whereas an attenuated HR recovery has been noted during symptom-limited CPET 26 and during constant workload exercise testing.…”

Section: Discussionmentioning

confidence: 99%

“…11 However, autonomic activity during exercise in patients with PAH has not yet been thoroughly investigated.…”

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confidence: 99%

Impairment of Autonomic Nervous System Activity in Patients With Pulmonary Arterial Hypertension: A Case Control Study

Dimopoulos¹,

Anastasiou-Nana²,

Katsaros³

et al. 2009

Journal of Cardiac Failure

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“…Exercise-based heart rate recovery (HRR) has been shown to be a powerful and independent predictor of cardiovascular mortality, (Watanabe, Thamilarasan, Blackstone, Thomas, & Lauer, 2001;Nishime, Cole, Blackstone, Pashkow, & Lauer, 2000;Tang, Dewland, Wencker, & Katz, 2009) morbidity, (Tang et al, 2009;Sheppard et al, 2007), and sudden cardiac death, (Jouven et al, 2005) as it reflects impaired parasympathetic nerve activity and lessened capacity to withdraw sympathetic activity as influenced by baroreceptor gain. It is suitable for risk stratification of patients with heart failure (Nanas et al, 2006). However, changes in intrinsic HRR in response to chronic VNS have not been investigated.…”

Section: Introductionmentioning

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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Early heart rate recovery after exercise predicts mortality in patients with chronic heart failure

Cited by 81 publications

References 46 publications

Heart Rate Recovery and Oxygen Kinetics After Exercise in Obstructive Sleep Apnea Syndrome

Heart Rate Recovery and Oxygen Kinetics After Exercise in Obstructive Sleep Apnea Syndrome

Impairment of Autonomic Nervous System Activity in Patients With Pulmonary Arterial Hypertension: A Case Control Study

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

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