The prognostic value of the heart rate response during exercise and recovery in patients with heart failure: influence of beta-blockade.
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.
Arena
Ross
R
Department of Internal Medicine, Virginia Commonwealth University, Health Sciences Campus, Richmond, Virginia 23298-0224, USA. raarena@vcu.edu
Myers
Jonathan
J
Abella
Joshua
J
Peberdy
Mary Ann
MA
Bensimhon
Daniel
D
Chase
Paul
P
Guazzi
Marco
M
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
D000319:Adrenergic beta-Antagonists; D002245:Carbon Dioxide