title: Heart rate recovery after exercise in chronic heart failure: role of vital exhaustion and type D personality.
abstract: OBJECTIVE
  Vital exhaustion and type D personality previously predicted mortality and cardiac events in patients with chronic heart failure (CHF). Reduced heart rate recovery (HRR) also predicts morbidity and mortality in CHF. We hypothesized that elevated levels of vital exhaustion and type D personality are both associated with decreased HRR.
  
  
  METHODS
  Fifty-one patients with CHF (mean age 58+/-12 years, 82% men) and left ventricular ejection fraction (LVEF) < or = 40% underwent standard exercise testing before receiving outpatient cardiac rehabilitation. They completed the 9-item short form of the Maastricht Vital Exhaustion Questionnaire and the 14-item type D questionnaire asking about negative affectivity and social inhibition. HRR was calculated as the difference between heart rate at the end of exercise and 1 min after abrupt cessation of exercise (HRR-1). Regression analyses were adjusted for gender, age, LVEF, and maximum exercise capacity.
  
  
  RESULTS
  Vital exhaustion explained 8.4% of the variance in continuous HRR-1 (p=0.045). For each point increase on the vital exhaustion score (range 0-18) there was a mean+/-SEM decrease of 0.54+/-0.26 bpm in HRR-1. Type D personality showed a trend toward statistical significance for being associated with lower levels of HRR-1 explaining 6.5% of the variance (p<0.08). The likelihood of having HRR-1 < or = 18 bpm was significantly higher in patients with type D personality than in those without (odds ratio=7.62, 95% CI 1.50-38.80).
  
  
  CONCLUSIONS
  Elevated levels of vital exhaustion and type D personality were both independently associated with reduced HRR-1. The findings provide a hitherto not explored psychobiological explanation for poor cardiac outcome in patients with CHF.
authors.affiliation: Cardiovascular Prevention and Rehabilitation, Bern University Hospital, Inselspital, and University of Bern, Switzerland. roland.vonkaenel@insel.ch
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
authors.forename: Jürgen
authors.initials: J
authors.lastname: Barth
authors.forename: Sonja
authors.initials: S
authors.lastname: Kohls
authors.forename: Hugo
authors.initials: H
authors.lastname: Saner
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Znoj
authors.forename: Gaby
authors.initials: G
authors.lastname: Saner
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Schmid
mesh_terms: D001007:Anxiety / Q000523:psychology; D002908:Chronic Disease; D005221:Fatigue / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000523:psychology*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010551:Personality; D005082:Physical Exertion / Q000502:physiology*; D013318:Stroke Volume; D011795:Surveys and Questionnaires