089 Heart rate recovery is a powerful prognostic factor in patients with chronic heart failure

• Published in: Archives of Cardiovascular Diseases Supplements Vol. 3; no. 1; p. 29
• Main Authors: Ben Driss, Ahmed, Tabet, Jean-Yves, Weber, Hélène, Meurin, Philippe, Renaud, Nathalie, Cohen-Solal, Alain
• Format: Journal Article
• Language: English
• Published: Elsevier France 2011
• ISSN: 1878-6480
• DOI: 10.1016/S1878-6480(11)70091-X

Heart rate recovery (HRR) prognostic value is well established in patients with coronary artery disease but poorly documented in patients with heart failure (HF) and not established in those with advanced HF. 144 patients with compensated HF underwent cardiopulmonary exercise testing (CPX) and were followed for a combined death/transplantation/hospitalization end point. Patients with advanced HF were defined as those with peak VO2 ≤ 14 ml/kg/mn (n = 41/144; 28%). Mean age and left ventricular ejection fraction (LVEF) were 53 ± 12 years and 29 ± 7% respectively in all population and 58 ± 11 years and 28 ± 7% respectively in the advanced HF group. Ninety one percent of patients received betablockers (93% in advanced HF group). HRR at 1-minute post-CPX was calculated as the difference between heart rate at peak exercise and after 1 minute of active recovery. Among the 144 patients, we recorded 10 mortality, 7 cardiac transplantation and 8 hospitalization for acute HF outcome events over 16 months of follow-up. The baseline mean peak respiratory exchange ratio (RER), peak VO2, VE/VCO2 slope, and HRR1 were 1.13 ± 0.09, 16 ± 4 ml/kg/mn, 35 ± 8, 13 ± 12 beat/mn, respectively. Although LVEF, peak VO2, VE/VCO2 slope and HRR1 were significant univariate predictors of the composite end point (p < 0.05), multivariate Cox regression analysis only retained LVEF (chi2 = 5.5, p = 0.01) and HRR1 (chi2 = 5.2, p = 0.02) in the equation. In the group of patients with advanced HF the mean peak RER, peak VO2, VE/VCO2 slope, and HRR1 were 1.10 ± 0.07, 12 ± 1 ml/kg/mn, 39 ± 11, 9 ± 8 beat/mn, respectively. Kaplan-Meier analysis revealed a significant difference in survival according to a 5 bpm HRR1 threshold: 68% in patients with HRR1 ≤5 bpm vs 96% in those with HRR1 >5 bpm (logrank = 5, p = 0.02) (HR = 2.66; CI: 2.08–2.66, p = 0.02). HRR is an easily measured noninvasive variable that can be used to further prognostically risk stratify patients with advanced HF.