The authors declare that they have no conflicts of interest.
Predictive Value of Heart Rate Recovery after Exercise Testing in Addition to Brain Natriuretic Peptide Levels in Ambulatory Patients with Nonischemic Dilated Cardiomyopathy
Article first published online: 13 AUG 2012
© 2012, Wiley Periodicals, Inc.
Annals of Noninvasive Electrocardiology
Volume 17, Issue 4, pages 378–386, October 2012
How to Cite
Shinoda, N., Hirashiki, A., Okumura, T., Okamoto, R., Wu Cheng, X., Kono, Y., Takeshita, K., Yamada, S. and Murohara, T. (2012), Predictive Value of Heart Rate Recovery after Exercise Testing in Addition to Brain Natriuretic Peptide Levels in Ambulatory Patients with Nonischemic Dilated Cardiomyopathy. Annals of Noninvasive Electrocardiology, 17: 378–386. doi: 10.1111/j.1542-474X.2012.00542.x
- Issue published online: 25 OCT 2012
- Article first published online: 13 AUG 2012
- heart failure;
- parasymapthetic nerve system;
Background: Heart rate recovery (HRR) is related to autonomic function and is a prognostic marker in cardiovascular disease. We sought to investigate the clinical utility of HRR in addition to BNP levels in ambulatory outpatients with nonischemic dilated cardiomyopathy (NICM).
Methods: Seventy-nine NICM outpatients were followed for a mean of 19 months. HRR was defined as the difference in heart rate between peak exercise and 1 minute later. On the basis of the lower tertile value, we allocated the patients to two groups: with HRR >12 bpm (n = 48; normal) and with HRR ≤12 bpm (n = 31, abnormal).
Results: The probability of cardiac event-free survival was significantly lower in the abnormal HRR group than in the normal HRR group (P = 0.002). Stepwise multivariate analysis revealed that plasma BNP and HRR were independent predictors of cardiac events. Patients with both HRR ≤12 bpm and BNP ≥200 pg/mL had significantly higher rates of cardiac events than those in whom only one, or neither, of these variables was abnormal.
Conclusions: HRR after exercise testing, in addition to plasma BNP level, might be a useful indicator as a predictor for admission due to worsening heart failure and its combination is able to provide additive prognostic information in ambulatory outpatients with NICM.