Ann Rehabil Med.  2017 Dec;41(6):1039-1046. 10.5535/arm.2017.41.6.1039.

Relationship Between Post-exercise Heart Rate Recovery and Changing Ratio of Cardiopulmonary Exercise Capacity

• Kim JH
• Choe YR
• Song MK
• Choi IS
• Han JY

• KMID: 2400289
• DOI: http://doi.org/10.5535/arm.2017.41.6.1039

Abstract

OBJECTIVE
To determine whether heart rate recovery (HRR) following an exercise tolerance test (ETT) is correlated with a changing ratio of peak oxygen consumption (VOâ‚‚) and maximal metabolic equivalents (MET(max)).
METHODS
A total of 60 acute myocardial infarction (AMI) patients who underwent ETT at both assessment points - 3 weeks (T0) after the AMI attack and 3 months after T0 (T1) were included. After achieving a peak workload, the treadmill was stopped with a 5-minute cooldown period, and the patients recovered in a comfortable and relaxed seated position. HRR was defined as the difference between the maximal heart rate (HR(max)) and the HR measured at specific time intervals - immediately after the cool down period (HRR-0) and 3 minutes after the completion of the ETT (HRR-3).
RESULTS
HRR-0 and HRR-3 increased over time, whereas VO(2max) and METmax did not show significant changes. There was a positive correlation between HRR at T0 and the exercise capacity at T0. HRR at T0 also showed a positive correlation with the exercise capacity at T1. There was no significant correlation between HRR measured at T0 and the change in the ratio of VO(2max) and MET(max), as calculated by subtracting VO(2max) and MET(max) obtained at T0 from those obtained at T1, divided by VO(2max) at T0 and multiplied by 100.
CONCLUSION
Post-exercise HRR measured at 3 weeks after the AMI onset can reflect the exercise capacity 3 months after the first ETT. However, it may be difficult to correlate post-exercise HRR at T0 with the degree of increase in cardiopulmonary exercise capacity in patients with AMI.

Keyword

Heart rate; Myocardial infarction; Exercise tolerance; Exercise test; Autonomic nervous system

MeSH Terms

Autonomic Nervous System
Exercise Test
Exercise Tolerance
Heart Rate*
Heart*
Humans
Metabolic Equivalent
Myocardial Infarction
Oxygen Consumption
Posture

Figure

• 

  Fig. 1 The heart rate recovery (HRR) at 3 weeks after acute myocardial infarction (T0) and 3 months after first exercise tolerance test (T1). HRR-0, maximal heart rate - heart rate immediately after cool down period; HRR-3, maximal heart rate - heart rate measured 3 minutes after completion of exercise tolerance test.

Reference

1. Olshansky B, Sabbah HN, Hauptman PJ, Colucci WS. Parasympathetic nervous system and heart failure: pathophysiology and potential implications for therapy. Circulation. 2008; 118:863–871. PMID: 18711023.

2. Tang YD, Dewland TA, Wencker D, Katz SD. Postexercise heart rate recovery independently predicts mortality risk in patients with chronic heart failure. J Card Fail. 2009; 15:850–855. PMID: 19944361.

3. Vivekananthan DP, Blackstone EH, Pothier CE, Lauer MS. Heart rate recovery after exercise is a predictor of mortality, independent of the angiographic severity of coronary disease. J Am Coll Cardiol. 2003; 42:831–838. PMID: 12957428.

4. Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA. 2000; 284:1392–1398. PMID: 10989401.

5. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med. 1999; 341:1351–1357. PMID: 10536127.

6. Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, et al. Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol. 1994; 24:1529–1535. PMID: 7930286.

7. Lipinski MJ, Vetrovec GW, Gorelik D, Froelicher VF. The importance of heart rate recovery in patients with heart failure or left ventricular systolic dysfunction. J Card Fail. 2005; 11:624–630. PMID: 16230267.

8. Arena R, Guazzi M, Myers J, Peberdy MA. Prognostic value of heart rate recovery in patients with heart failure. Am Heart J. 2006; 151:851.

9. Sheppard RJ, Racine N, Roof A, Ducharme A, Blanchet M, White M. Heart rate recovery: a potential marker of clinical outcomes in heart failure patients receiving beta-blocker therapy. Can J Cardiol. 2007; 23:1135–1138. PMID: 18060099.

10. Kubrychtova V, Olson TP, Bailey KR, Thapa P, Allison TG, Johnson BD. Heart rate recovery and prognosis in heart failure patients. Eur J Appl Physiol. 2009; 105:37–45. PMID: 18797918.

11. Youn JC, Lee HS, Choi SW, Han SW, Ryu KH, Shin EC, et al. Post-exercise heart rate recovery independently predicts clinical outcome in patients with acute decompensated heart failure. PLoS One. 2016; 11:e0154534. PMID: 27135610.

12. Karjalainen JJ, Kiviniemi AM, Hautala AJ, Piira OP, Lepojarvi ES, Peltola MA, et al. Determinants and prognostic value of cardiovascular autonomic function in coronary artery disease patients with and without type 2 diabetes. Diabetes Care. 2014; 37:286–294. PMID: 23959565.

13. Bilsel T, Terzi S, Akbulut T, Sayar N, Hobikoglu G, Yesilcimen K. Abnormal heart rate recovery immediately after cardiopulmonary exercise testing in heart failure patients. Int Heart J. 2006; 47:431–440. PMID: 16823249.

14. Cohn JN, Johnson GR, Shabetai R, Loeb H, Tristani F, Rector T, et al. Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure. The V-HeFT VA Cooperative Studies Group. Circulation. 1993; 87(6 Suppl):VI5–V16. PMID: 8500240.

15. Passantino A, Scrutinio D, Lagioia R, Forleo C, Ricci A, Rizzon P. Value of peak oxygen consumption during exercise for the prognostic stratification of patients with severe systolic dysfunction of the left ventricle. Cardiologia. 1997; 42:947–952. PMID: 9410568.

16. Metra M, Faggiano P, D'Aloia A, Nodari S, Gualeni A, Raccagni D, et al. Use of cardiopulmonary exercise testing with hemodynamic monitoring in the prognostic assessment of ambulatory patients with chronic heart failure. J Am Coll Cardiol. 1999; 33:943–950. PMID: 10091820.

17. Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2001; 1:CD001800.

18. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004; 116:682–692. PMID: 15121495.

19. Heran BS, Chen JM, Ebrahim S, Moxham T, Oldridge N, Rees K, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011; 7:CD001800.

20. Lazzeroni D, Castiglioni P, Bini M, Faini A, Camaiora U, Ugolotti PT, et al. Improvement in aerobic capacity during cardiac rehabilitation in coronary artery disease patients: is there a role for autonomic adaptations? Eur J Prev Cardiol. 2017; 24:357–364. PMID: 27895211.