title: Predictive value of heart rate recovery after exercise testing in addition to brain natriuretic peptide levels in ambulatory patients with nonischemic dilated cardiomyopathy.
abstract: BACKGROUND
  Heart rate recovery (HRR) is related to autonomic function and is a prognostic marker in cardiovascular disease. We sought to investigate the clinical utility of HRR in addition to BNP levels in ambulatory outpatients with nonischemic dilated cardiomyopathy (NICM).
  
  
  METHODS
  Seventy-nine NICM outpatients were followed for a mean of 19 months. HRR was defined as the difference in heart rate between peak exercise and 1 minute later. On the basis of the lower tertile value, we allocated the patients to two groups: with HRR >12 bpm (n = 48; normal) and with HRR ≤12 bpm (n = 31, abnormal).
  
  
  RESULTS
  The probability of cardiac event-free survival was significantly lower in the abnormal HRR group than in the normal HRR group (P = 0.002). Stepwise multivariate analysis revealed that plasma BNP and HRR were independent predictors of cardiac events. Patients with both HRR ≤12 bpm and BNP ≥200 pg/mL had significantly higher rates of cardiac events than those in whom only one, or neither, of these variables was abnormal.
  
  
  CONCLUSIONS
  HRR after exercise testing, in addition to plasma BNP level, might be a useful indicator as a predictor for admission due to worsening heart failure and its combination is able to provide additive prognostic information in ambulatory outpatients with NICM.
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Shinoda
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hirashiki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Okumura
authors.forename: Rie
authors.initials: R
authors.lastname: Okamoto
authors.forename: Xian
authors.initials: X
authors.lastname: Wu Cheng
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kono
authors.forename: Kyosuke
authors.initials: K
authors.lastname: Takeshita
authors.forename: Sumio
authors.initials: S
authors.lastname: Yamada
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002311:Cardiomyopathy, Dilated / Q000097:blood* / Q000503:physiopathology*; D018572:Disease-Free Survival; D004562:Electrocardiography / Q000379:methods / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010045:Outpatients / Q000706:statistics & numerical data; D011237:Predictive Value of Tests
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain