title: Heart rate recovery and tissue Doppler echocardiography in heart failure.
abstract: BACKGROUND
  Previous research has demonstrated the prognostic value of echocardiography with tissue Doppler imaging (TDI) in the heart failure (HF) population. Heart rate recovery (HRR) has also recently shown promise as a prognostic marker.
  
  
  OBJECTIVE
  We hypothesize echocardiography with TDI and HRR will be significantly correlated and both will provide prognostic information.
  
  
  METHODS
  A total of 243 subjects underwent echocardiography with TDI and maximal exercise testing to determine: (1) the ratio between mitral early (E) to mitral annular (E') and E to mitral late (A) velocity; (2) left ventricular ejection fraction (LVEF); (3) left ventricular (LV) mass; (4) LV end-systolic volume (LVESV); and (5) HRR at 1 minute postexercise (HRR(1)).
  
  
  RESULTS
  HRR(1) was significantly correlated with LVEF (r = 0.14, P = .03), LV mass (r = - 0.30, P <.001), E/A (r = - 0.22, P = .001), and E/E' (r = - 0.49, P <.001). Multivariate Cox regression analysis revealed HRR(1) was the strongest predictor of cardiac mortality (chi(2): 55.5, P <.001); LV mass (residual chi(2): 13.1, P <.001), E/E' (residual chi(2): 11.2, P = .001), and LVESV (residual chi(2): 5.9, P = .015) all added significant prognostic value and were retained in the regression while LVEF was removed (residual chi(2): 0.008, P = .93).
  
  
  CONCLUSIONS
  To our knowledge, this is the first investigation demonstrating an association between HRR and variables obtained from echocardiography with TDI in subjects with HF. The combination of both assessment techniques provides improved prognostic discrimination.
authors.affiliation: Cardiopulmonary Laboratory, Cardiology Division, University of Milano, San Paolo Hospital, Milano, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Guazzi
authors.forename: Jonathan
authors.initials: J
authors.lastname: Myers
authors.forename: Mary
authors.initials: M
authors.lastname: Ann Peberdy
authors.forename: Daniel
authors.initials: D
authors.lastname: Bensimhon
authors.forename: Paul
authors.initials: P
authors.lastname: Chase
authors.forename: Sherry
authors.initials: S
authors.lastname: Pinkstaff
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D020127:Recovery of Function; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left