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, 11 (5), e0154534

Post-Exercise Heart Rate Recovery Independently Predicts Clinical Outcome in Patients With Acute Decompensated Heart Failure


Post-Exercise Heart Rate Recovery Independently Predicts Clinical Outcome in Patients With Acute Decompensated Heart Failure

Jong-Chan Youn et al. PLoS One.


Background: Post-exercise heart rate recovery (HRR) is an index of parasympathetic function associated with clinical outcome in patients with chronic heart failure. However, its relationship with the pro-inflammatory response and prognostic value in consecutive patients with acute decompensated heart failure (ADHF) has not been investigated.

Methods: We measured HRR and pro-inflammatory markers in 107 prospectively and consecutively enrolled, recovered ADHF patients (71 male, 59 ± 15 years, mean ejection fraction 28.9 ± 14.2%) during the pre-discharge period. The primary endpoint included cardiovascular (CV) events defined as CV mortality, cardiac transplantation, or rehospitalization due to HF aggravation.

Results: The CV events occurred in 30 (28.0%) patients (5 cardiovascular deaths and 7 cardiac transplantations) during the follow-up period (median 214 days, 11-812 days). When the patients with ADHF were grouped by HRR according to the Contal and O'Quigley's method, low HRR was shown to be associated with significantly higher levels of serum monokine-induced by gamma interferon (MIG) and poor clinical outcome. Multivariate Cox regression analysis revealed that low HRR was an independent predictor of CV events in both enter method and stepwise method. The addition of HRR to a model significantly increased predictability for CV events across the entire follow-up period.

Conclusion: Impaired post-exercise HRR is associated with a pro-inflammatory response and independently predicts clinical outcome in patients with ADHF. These findings may explain the relationship between autonomic dysfunction and clinical outcome in terms of the inflammatory response in these patients.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.


Fig 1
Fig 1. Serum levels of MIG and hsCRP according to HRR in ADHF patients.
Fig 2
Fig 2. Cumulative Kaplan-Meier estimates of CV events according to HRR in ADHF patients.
Fig 3
Fig 3. Time-dependent receiver operating curve analysis derived from the Cox regression models with and without HRR(1 min) and HRR(2 min) in enter method (A) and in stepwise method (B).
The area under the curve (AUC) indicated predictive accuracy at the indicated time. Throughout the study period, the model with HRR was superior to the model without HRR in distinguishing patients who will exhibit CV events from those who will not.

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Grant support

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2015R1C1A1A02036645). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.