Heart rate recovery in pulmonary arterial hypertension: Relationship with exercise capacity and prognosis

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• 作者：Roberta P. Ramos ; MD ; Jaquelina S.O. Arakaki ; MD ; Priscila Barbosa ; MSc ; Erika Treptow ; MD ; Fabricio M. Valois ; MD ; Eloara V.M. Ferreira ; MD ; Luiz Eduardo Nery ; MD ; J. Alberto Neder ; MD ; ^{nederalb@gmail.com}
• 刊名：American Heart Journal
• 出版年：2012
• 期刊代码：7_00028703
• 类别：med
• 出版时间：April, 2012
• 卷：163
• 期：4
• 页码：580-588
• 文件大小：665 K

摘要

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Background

Delayed postexercise heart rate recovery (HRR) has been associated with disability and poor prognosis in chronic cardiopulmonary diseases. The usefulness of HRR to predict exercise impairment and mortality in patients with pulmonary arterial hypertension (PAH), however, remains largely unexplored.

Methods

Seventy-two patients with PAH of varied etiology (New York Heart Association classes I-IV) and 21 age- and gender-matched controls underwent a maximal incremental cardiopulmonary exercise test (CPET), with heart rate being recorded up to the fifth minute of recovery.

Results

Heart rate recovery was consistently lower in the patients compared with the controls (m>Pm> < .05). The best cutoff for HRR in 1 minute (HRR_1min) to discriminate the patients from the controls was 18 beats. Compared with patients with HRR_1min 鈮?8 (n = 40), those with HRR_1min >18 (n = 32) had better New York Heart Association scores, resting hemodynamics and 6-minute walking distance. In fact, HRR_1min >18 was associated with a range of maximal and submaximal CPET variables indicative of less severe exercise impairment (m>Pm> < .05). The single independent predictor of HRR_1min 鈮?8 was the 6-minute walking distance (odds ratio [95%CI] 0.99 [0.98-1.00], m>Pm> < .05). On a multiple regression analysis that considered only CPET-independent variables, HRR_1min 鈮?8 was the single predictor of mortality (hazard ratio [95%CI] 1.19 [1.03-1.37], m>Pm> < .05).

Conclusions

Preserved HRR_1min (>18 beats) is associated with less impaired responses to incremental exercise in patients with PAH. Conversely, a delayed HRR_1min response has negative prognostic implications, a finding likely to be clinically useful when more sophisticated (and costlier) analyses provided by a full CPET are not available.