Heart rate recovery in patients with hypertrophic cardiomyopathy

Abstract

Recovery in heart rate (HR) after exercise is a measure of autonomic function and a prognostic indicator in cardiovascular disease. The aim of this study was to characterize heart rate recovery (HRR) and to determine its relation to cardiac function and morphology in patients with hypertrophic cardiomyopathy (HC). We studied 18 healthy volunteers and 41 individuals with HC. All patients underwent clinical assessment and transthoracic echocardiography. Continuous beat-by-beat assessment of HR was obtained during and after cardiopulmonary exercise testing using finger plethysmography. HRR and power spectral densities were calculated on 3 minutes of continuous RR recordings. Absolute HRR was lower in patients than that in controls at 1, 2, and 3 minutes (25.7 ± 8.4 vs 35.3 ± 11.0 beats/min, p <0.001; 36.8 ± 9.4 vs 53.6 ± 13.2 beats/min, p <0.001; 41.2 ± 12.2 vs 62.1 ± 14.5 beats/min, p <0.001, respectively). HRR remained lower in patients at 2 and 3 minutes after normalization to peak HR. After normalization to the difference in HR between peak exercise and rest, HRR was significantly impaired in individuals with obstructive HC at 3 minutes compared with controls. HR at 3 minutes correlated with peak left ventricular outflow tract gradient (B 0.154 beats/min/mm Hg, confidence interval 0.010 to 0.299, p = 0.037) and remained a significant predictor of HRR after multivariable analysis. Spectral analysis showed a trend toward an increased low-frequency to high-frequency ratio in patients (p = 0.08) suggesting sympathetic predominance. In conclusion, HRR is impaired in HC and correlates with the severity of left ventricular outflow tract gradient. Prospective studies of the prognostic implications of impaired HRR in HC are warranted.

Figure 1

(A) Absolute HRR after symptom limited cardiopulmonary exercise between control and HC groups. The change in mean absolute heart rate with time after cessation of exercise is shown, with 95% CIs calculated by the Loess function. (B) HRR normalized to peak HR after symptom limited cardiopulmonary exercise between control and HC groups. The change in mean normalized heart rate with time after cessation of exercise is shown, with 95% CIs calculated by the Loess function.

Figure 2

(A) Absolute HRR after symptom limited cardiopulmonary exercise among control, nonobstructive, and obstructive groups. The change in mean absolute heart rate with time after cessation of exercise is shown, with 95% CIs calculated by the Loess function. (B) HRR normalized to peak HR after symptom limited cardiopulmonary exercise among control, nonobstructive, and obstructive groups. The change in mean normalized heart rate with time after cessation of exercise is shown, with 95% CIs calculated by the Loess function.

Figure 3

(A) Averaged low-frequency to high-frequency (LF:HF) ratio over 3 minutes between control and HC groups. Median and interquartile range. p Values on graph. (B) Averaged LF:HF ratio over 3 minutes among control, nonobstructive, and obstructive groups. Median and interquartile range. p Values on graph.