Longitudinal Changes in Heart Rate Recovery After Maximal Exercise in Pediatric Heart Transplant Recipients: Evidence of Autonomic Re-innervation?

Singh, Tajinder P.; Rhodes, Jonathan; Blume, Elizabeth D.

doi:10.1016/j.healun.2007.08.013

Cited by 29 publications

(47 citation statements)

References 30 publications

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“…This finding is consistent with other publications. 3,14 The reason for abnormal HRR soon after HTx is unknown, but severing of parasympathetic cardiac fibers during surgery is likely to be the cause. 3,15 Autonomic reinnervation of the graft is likely to be the mechanism underpinning a progressive improvement in HRR in the first 6 years after HTx.…”

Section: Discussionmentioning

confidence: 99%

“…3,14 The reason for abnormal HRR soon after HTx is unknown, but severing of parasympathetic cardiac fibers during surgery is likely to be the cause. 3,15 Autonomic reinnervation of the graft is likely to be the mechanism underpinning a progressive improvement in HRR in the first 6 years after HTx. 16 Indeed, 2 main components determine HRR in the first minute of recovery after exercise: the initial rapid decrease that occurs promptly when exercise ceases is entirely because of increase in cardiac vagal activity (partly mediated by arterial baroreceptors), 17 and the subsequent slow exponential decay in heart rate results from algebraic summation of an increasing vagal inhibitory effect and a gradually subsiding excitatory sympathoadrenal action.…”

Section: Discussionmentioning

confidence: 99%

“…6,17 One other convincing aspect is that the pattern of parasympathetic reinnervation noted herein is similar to the pattern of parasympathetic reinnervation noted by others who found progressive improvement in HRR from exercise in the first few years after HTx in children. 3 A recent study from Toronto investigated cardiac autonomic reinnervation in pediatric HTx recipients by means of heart rate variability. 18 Using this alternative technique to assess autonomic function, the authors were able to demonstrate various degrees of reinnervation in up to 57% of hearts, with the majority of children showing signs of reinnervation by the fourth year after HTx.…”

Section: Discussionmentioning

confidence: 99%

“…13 Recovery in the first minute was selected because of its recognized use as a measure of vagal reinnervation and demonstration of its strong relationship with outcome data. 3,6,8,9 …”

Section: Calculation Of Hrrmentioning

confidence: 99%

“…2,3 Although the evidence for cardiac sympathetic reinnervation is robust, 2,4 the evidence for cardiac parasympathetic reinnervation is limited, and the exact timing is uncertain. 3,5 Evidence suggests that heart rate recovery (HRR) after exercise is a marker of cardiac vagal tone, 6,7 with the first 30 seconds of recovery being a pure index of cardiac parasympathetic activation and the following 30 seconds representing a combination of parasympathetic activity and adrenergic withdrawal. If measured longitudinally, HRR could provide important information regarding the extent and timing of cardiac parasympathetic reinnervation.…”

mentioning

confidence: 99%

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Impairment of Heart Rate Recovery After Peak Exercise Predicts Poor Outcome After Pediatric Heart Transplantation

et al. 2013

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Background-A blunted heart rate recovery (HRR) from peak exercise is associated with adverse outcome in adults with ischemic heart disease. We assessed HRR after pediatric heart transplantation (HTx) and its prognostic use. Methods and Results-Between 2004 and 2010 we performed 360 maximal exercise tests (median, 2 tests/patient; range, 1-7) in 128 children (66 men; age at test, 14±3 years) who received HTx (age, 8.5±5.1 years) because of cardiomyopathy (66%) or congenital heart defects (34%). The change in heart rate from peak exercise to 1 minute of recovery was measured as HRR and was expressed as Z score calculated from reference data obtained in 160 healthy children. HRR was impaired soon after HTx (average in first 2 years Z=−1.9±3.5) but improved afterward (Z=+0.52/y), such that HRR Z score normalized in most patients by 6 years after HTx (average, 0.6±1.8). A subsequent decline in HRR Z score was noted from 6 years after HTx (rate of Z=−0.11/y). After 27±15 months from the most recent exercise test, 19 patients died or were re-heart transplantation. For the follow-up after 6 years, HRR Z score was the only predictor of death/re-heart transplantation (P=0.003). Patients in the lowest quartile of HRR Z score had a much higher 5-year event rate (event-free rate, 29% versus 84%; hazard ratio, 7.0; P=0.0013). Conclusions-HRR is blunted soon after HTx but normalizes at ≈6 years, potentially as a result of parasympathetic reinnervation of the graft, but then declines. This late decline in HRR Z score is associated with worse outcome. (Circulation. 2013;128[Suppl 1]:S199-S204.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…13 Recovery in the first minute was selected because of its recognized use as a measure of vagal reinnervation and demonstration of its strong relationship with outcome data. 3,6,8,9 …”

Section: Calculation Of Hrrmentioning

confidence: 99%

mentioning

confidence: 99%

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Impairment of Heart Rate Recovery After Peak Exercise Predicts Poor Outcome After Pediatric Heart Transplantation

et al. 2013

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Socioeconomic Position and Heart Rate Recovery After Maximal Exercise in Children

Singh

Evans²

2010

Arch Pediatr Adolesc Med

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To determine whether socioeconomic (SE) position is associated with first-minute (1-minute) heart rate (HR) recovery in healthy children and adolescents (hereafter referred to as children). Design: In a cross-sectional study, we compared 1-minute HR recovery in 3 groups of children (low, medium, and high SE) using multivariable analysis. The groups were based on neighborhood SE data extracted from the US 2000 census database. Setting: Children's Hospital Boston. Participants: Four hundred eighty children referred for exercise testing to exclude cardiac disease and discharged as showing normal results. Main Exposures: Socioeconomic position and body mass index (BMI). Main Outcome Measure: Heart rate recovery after a maximal treadmill exercise test (Bruce protocol) following a consistent 1-minute cool-down period. Results: The low SE group had a higher proportion of children with a high BMI (Ն85th percentile) (P=.07) and exercised for a shorter duration, controlling for age, sex, and BMI (PϽ.001). After adjusting for age (PϽ.001) and sex (PϽ.001), a significant interaction of SE group with BMI was found (P =.04). There was no difference in HR recovery in the 3 SE groups in children with a normal BMI (Ͻ85th percentile). Among children with a high BMI, only those from low and middle SE neighborhoods had impaired 1-minute HR recovery. Conclusion: Children with a high BMI in low and middle SE positions appear to have worse cardiovascular health compared with children with a high BMI in a high SE position.

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Exercise Limitation Following Transplantation

Williams

McKenna

2012

Comprehensive Physiology

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Organ transplantation is one of the medical miracles or the 20th century. It has the capacity to substantially improve exercise performance and quality of life in patients who are severely limited with chronic organ failure. We focus on the most commonly performed solid‐organ transplants and describe peak exercise performance following recovery from transplantation. Across all of the common transplants, evaluated significant reduction in o 2 peak is seen (typically renal and liver 65%‐80% with heart and/or lung 50%‐60% of predicted). Those with the lowest o 2 peak pretransplant have the lowest o 2 peak posttransplant. Overall very few patients have a o 2 peak in the normal range. Investigation of the cause of the reduction of o 2 peak has identified many factors pre‐ and posttransplant that may contribute. These include organ‐specific factors in the otherwise well‐functioning allograft (e.g., chronotropic incompetence in heart transplantation) as well as allograft dysfunction itself (e.g., chronic lung allograft dysfunction). However, looking across all transplants, a pattern emerges. A low muscle mass with qualitative change in large exercising skeletal muscle groups is seen pretransplant. Many factor posttransplant aggravate these changes or prevent them recovering, especially calcineurin antagonist drugs which are key immunosuppressing agents. This results in the reduction of o 2 peak despite restoration of near normal function of the initially failing organ system. As such organ transplantation has provided an experiment of nature that has focused our attention on an important confounder of chronic organ failure‐skeletal muscle dysfunction. © 2012 American Physiological Society. Compr Physiol 2:1937‐1979, 2012.

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Longitudinal Changes in Heart Rate Recovery After Maximal Exercise in Pediatric Heart Transplant Recipients: Evidence of Autonomic Re-innervation?

Cited by 29 publications

References 30 publications

Impairment of Heart Rate Recovery After Peak Exercise Predicts Poor Outcome After Pediatric Heart Transplantation

Impairment of Heart Rate Recovery After Peak Exercise Predicts Poor Outcome After Pediatric Heart Transplantation

Socioeconomic Position and Heart Rate Recovery After Maximal Exercise in Children

Exercise Limitation Following Transplantation

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