Value of heart rate recovery in female patients with pulmonary arterial hypertension due to systemic lupus erythematosus

Abstract

Objective This study intended to explore the relation between heart rate recovery at 1 minutes (HRR1) during the recovery phase of cardiopulmonary exercise test (CPET) and exercise capacity in female systemic lupus erythematosus associated pulmonary arterial hypertension (SLE‐PAH) patients. Methods Twenty‐one female SLE‐PAH patients underwent right heart catheterization (RHC), pulmonary function test (PFT) and CPET. Forty‐two healthy subjects matched with SLE‐PAH patients in age, sex and BMI were recruited as a control group. The correlations between HRR1 with clinical and CPET parameters were performed. Results Peak HR, ΔHR, HRR1, Peak HR‐warm HR1min, Peak HR‐warm HR2min and CR were significantly lower in SLE‐PAH than in controls (P < .01). Increased incidence of CRI was seen in SLE‐PAH. Except for the Peak PETO2, which was higher in controls, all other CPET parameters were lower in SLE‐PAH. SLE‐PAH patients with HRR1 ≥ 16 had longer 6MWD, lower NT‐proBNP, better percent of predicted gas transfer index or diffusing capacity for carbon monoxide (DLco% pred) as well as better CO and CI. Peak HR, ΔHR, HRR1, Peak HR‐warm HR1min, Peak HR‐warm HR2min, CR, Peak Load, Peak VO2, Peak PETCO2, OUEP and OUES were lower and duration of exercise was shorter in patients with HRR1 < 16. HRR1 had positive correlation with 6MWD, DLco% pred, CO, CI and some key CPET parameters. Conclusions HRR1 is an easily obtained auxiliary parameter in SLE‐PAH patients to reflect an altered autonomic tone. SLE‐PAH patients with HRR1 < 16 have more severe hemodynamics, worse clinical findings and marked oxygen uptake inefficiency than those with HRR1 ≥ 16.

Heart Rate Recovery at 1 Min after Exercise Is a Marker of Disease Severity and Prognosis in Chronic Thromboembolic Pulmonary Hypertension

“…of mortality in patients with heart failure [7,19]. The cutoff value in the current study was 16 beats, which was in accordance with the study conducted by Minai et al [9] and Yang et al [20]. The discrepancy in cutoff value may be attributable to diversity in study population, sample size, and different methods of measuring heart rate recovery.…”

Heart rate recovery in 1 minute after the 6-minute walk test predicts adverse outcomes in pulmonary arterial hypertension

“…Reduced HRR1 was associated with worse WHO-FC and gas exchange, oxygen use, intermediate or high PAH risk stratification and decreased exercise capacity. These associations have been previously reported using CPET, a gold-standard method that assess the true cardiopulmonary functional status of patients [6,10,[18][19][20], but it is available only at a few centers. The present finding reinforces HRR1 as an independent biomarker of PAH severity and is an accessible, simple to perform, reliable and safe variable obtained through the 6MWT [5].…”

“…chronotropic response, provide prognostic information in PAH [7][8][9][10][11]18]. However, the exact HRR1 that predicts morbidity and mortality events has not yet been definitively established.…”

Diagnosis and management of lung involvement in systemic lupus erythematosus and Sjögren’s syndrome: a literature review

“…The six-minute walk distance (6MWD) is reduced, in association with oxygen desaturation ⩾5%, often with an inflated heart rate response. 86 When PAH is caused by advanced ILD, lung volumes will show a restrictive pattern. Transthoracic Doppler echocardiography can be useful for PAH screening because it allows to estimate pulmonary artery pressures and right atrial and right ventricular size and function.…”