The importance of heart rate recovery in patients with heart failure or left ventricular systolic dysfunction.
BACKGROUND
The ability to better predict outcome with exercise testing in patients with heart failure (HF) and left ventricular systolic dysfunction (LVSD) may prove extremely valuable in determining which patients are at increased risk. This study evaluated the ability of heart rate recovery (HRR) to predict outcome in patients with HF and validate previous findings in LVSD.


RESULTS
HRR was measured at 1-, 2-, 3-, and 5-minute time points after treadmill testing in 2,193 males being evaluated for chest pain at the Palo Alto and Long Beach VA Hospitals. Left ventricular ejection fraction (LVEF) was calculated using biplane ventriculography and patients were considered to have LVSD if they had an LVEF <50%. Angiographic and clinical data was available for all patients. Of the 2,193 patients, 314 patients had LVSD and 109 had a history of HF. Both HF patients and patients with LVSD with a normal HRR at 2 minutes had improved survival compared with patients that had an abnormal HRR at 2 minutes when adjusted for age and beta-blocker use (HF adjusted odds ratio 0.25, 95% CI 0.10-0.66, P < .006; LVSD alone adjusted odds ratio 0.25, 95% CI 0.13-0.47, P < .0001). Stepwise proportional hazard regression analysis revealed that only 2-minute HRR, age, LVEF, and chronic obstructive pulmonary disorder were significant predictors of mortality in patients with LVSD and only HRR at 2 minutes and LV hypertrophy were significant predictors of mortality in patients with HF.


CONCLUSIONS
HRR is a significant predictor of mortality in patients with HF and patients with LVSD and may be useful in better determining prognosis.
Lipinski
Michael J
MJ
Division of Cardiology, Veterans Affairs Palo Alto Health Care System, Stanford University, Palo Alto, California 94304, USA.
Vetrovec
George W
GW
Gorelik
Dmitry
D
Froelicher
Victor F
VF
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D003324:Coronary Artery Disease / Q000503:physiopathology; D005080:Exercise Test; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D020127:Recovery of Function / Q000187:drug effects; D013318:Stroke Volume / Q000187:drug effects; D016019:Survival Analysis; D013599:Systole / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000187:drug effects
D000319:Adrenergic beta-Antagonists