title: The prognostic value of the heart rate response during exercise and recovery in patients with heart failure: influence of beta-blockade.
abstract: BACKGROUND
  The heart rate increase during exercise (DeltaHR) and heart rate recovery (HRR) have demonstrated prognostic value in several investigations, but its application in the heart failure (HF) population is limited, particularly in a beta-blocked (BB) cohort.
  
  
  METHODS
  Five-hundred and twenty subjects with HF underwent cardiopulmonary exercise testing to determine peak oxygen consumption (VO(2)), the minute ventilation/carbon dioxide production (VE/VCO(2)) slope, DeltaHR and HRR at 1 min (HRR(1)).
  
  
  RESULTS
  There were 79 cardiac-related deaths during the tracking period. A HRR(1) threshold of </>or=16 beats/min was a significant prognostic marker in the overall group (hazard ratio: 4.6, 95% CI: 2.8-7.5, p<0.001) as well as no-BB (hazard ratio: 9.1, 95% CI: 4.1-20.2, p<0.001) and BB (hazard ratio: 2.9, 95% CI: 1.6-5.4, p<0.001) subgroups. The DeltaHR was a significant univariate predictor in the overall group and no-BB subgroup only. Multivariate Cox regression analysis revealed HRR(1) was the strongest prognostic marker (chi-square: 39.9, p<0.001). The VE/VCO(2) slope (residual chi-square: 21.8, p<0.001) and LVEF (residual chi-square: 9.6, p=0.002) were also retained in the regression.
  
  
  CONCLUSIONS
  These results indicate that HRR maintains prognostic value in HF irrespective of BB use. The routine inclusion of HRR in the prognostic assessment of patients with HF may be warranted.
authors.affiliation: Department of Internal Medicine, Virginia Commonwealth University, Health Sciences Campus, Richmond, Virginia 23298-0224, USA. raarena@vcu.edu
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
authors.forename: Jonathan
authors.initials: J
authors.lastname: Myers
authors.forename: Joshua
authors.initials: J
authors.lastname: Abella
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Peberdy
authors.forename: Daniel
authors.initials: D
authors.lastname: Bensimhon
authors.forename: Paul
authors.initials: P
authors.lastname: Chase
authors.forename: Marco
authors.initials: M
authors.lastname: Guazzi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001944:Breath Tests; D002245:Carbon Dioxide / Q000378:metabolism; D015444:Exercise; D005080:Exercise Test / Q000379:methods / Q000592:standards*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012307:Risk Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D002245:Carbon Dioxide