Relation of heart rate recovery after exercise testing to coronary artery calcification.
We examined whether slow heart rate recovery (HRR) after exercise testing as an estimate of impaired autonomic function is related to coronary artery calcification (CAC), an emerging marker of coronary atherosclerosis.



We evaluated 2088 men who participated in a health-screening program that included measures of CAC and peak or symptom-limited cardiopulmonary exercise testing. HRR was calculated as the difference between peak heart rate (HR) during exercise testing and the HR at 2 min of recovery after peak exercise. We measured CAC using multidetector computed tomography to calculate the Agatston coronary artery calcium score. Advanced CAC was defined as a mean CAC >75th percentile for each age group.



HRR was negatively correlated with CAC (r = -.14, p < .01). After adjusting for conventional risk factors, participants in the lowest quartile of HRR (<38 bpm) were 1.59 times (95% CI: 1.17-2.18; p < .05) more likely to have advanced CAC than their counterparts in the highest quartile of HRR (>52 bpm). Each 1 bpm decrease in HRR was associated with 1% increase in advanced CAC after adjusting for potential confounders.



An attenuated HRR after exercise testing is associated with advanced CAC, independent of coronary risk factors and other related hemodynamic response. KEY MESSAGES Slow heart rate recovery (HRR) after maximal exercise testing, indicating decreased autonomic function, is associated with an increased risk of cardiovascular event and mortality. Slow HRR has been linked with the occurrence of malignant ventricular arrhythmias, but it remains unclear whether slow HRR is associated with an increased risk of coronary artery calcification (CAC), an emerging marker of coronary atherosclerosis. An attenuated HRR after exercise testing was associated with advanced CAC, independent of coronary risk factors and other potential hemodynamic confounder, supporting the hypothesis that slow HRR is related to the burden of atherosclerotic coronary artery disease.
a Department of Sport Science , University of Seoul , Seoul , South Korea.
Sae Young
SY
Jae
b Department of Medicine , Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Kuopio , Finland.
Sudhir
S
Kurl
b Department of Medicine , Institute of Public Health and Clinical Nutrition, University of Eastern Finland , Kuopio , Finland.
Jari A
JA
Laukkanen
a Department of Sport Science , University of Seoul , Seoul , South Korea.
Eun Sun
ES
Yoon
c Center for Health Promotion, Samsung Medical Center , School of Medicine, Sungkyunkwan University , Seoul , South Korea.
Yoon-Ho
YH
Choi
d Department of Kinesiology and Nutrition , University of Illinois at Chicago , Chicago , IL , USA.
Bo
B
Fernhall
e Preventive Cardiology and Cardiac Rehabilitation , William Beaumont Hospital , Royal Oak , MI , USA.
Barry A
BA
Franklin
D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology*; D003331:Coronary Vessels / Q000503:physiopathology; D015444:Exercise / Q000502:physiology; D005080:Exercise Test; D017079:Exercise Tolerance; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D061205:Vascular Calcification / Q000175:diagnosis / Q000503:physiopathology*
Coronary artery calcification; exercise testing; heart rate recovery