Heart rate recovery and tissue Doppler echocardiography in heart failure.
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.
Guazzi
Marco
M
Cardiopulmonary Laboratory, Cardiology Division, University of Milano, San Paolo Hospital, Milano, Italy.
Myers
Jonathan
J
Ann Peberdy
Mary
M
Bensimhon
Daniel
D
Chase
Paul
P
Pinkstaff
Sherry
S
Arena
Ross
R
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