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Heart rate response and recovery in cycle exercise testing : normal values and association with mortality

Jou, Jordi ; Zhou, Xingwu ; Lindow, Thomas LU ; Brudin, Lars ; Hedman, Kristofer ; Ekström, Magnus LU orcid and Malinovschi, Andrei (2025) In European Journal of Preventive Cardiology 32(1). p.32-42
Abstract

Aims. Chronotropic incompetence and impaired heart rate (HR) recovery are related to mortality. Guidelines lack specific reference values for HR recovery. We defined normal values and studied blunted HR response and recovery and mortality risk. Methods and results. We included 9917 subjects (45% females) aged 18–85 years who performed a cycle exercise test. We defined normal values for peak HR, HR reserve, and HR recovery at 1 and 2 min (HRR1 and HRR2) based on individuals apparently healthy (N = 2242). Associations between blunted HR indices (<5th percentile) and mortality over a median follow-up of 8.6 years were analysed using Cox regression and competing risk analysis. All HR indices were age-dependent and... (More)

Aims. Chronotropic incompetence and impaired heart rate (HR) recovery are related to mortality. Guidelines lack specific reference values for HR recovery. We defined normal values and studied blunted HR response and recovery and mortality risk. Methods and results. We included 9917 subjects (45% females) aged 18–85 years who performed a cycle exercise test. We defined normal values for peak HR, HR reserve, and HR recovery at 1 and 2 min (HRR1 and HRR2) based on individuals apparently healthy (N = 2242). Associations between blunted HR indices (<5th percentile) and mortality over a median follow-up of 8.6 years were analysed using Cox regression and competing risk analysis. All HR indices were age-dependent and independent predictors of all-cause and cardiovascular (CV) mortality. The 5th percentiles of HR reserve, HRR1, and HRR2 correlated weakly with existing reference values. Heart rate recovery variables were the strongest predictors of all-cause mortality in both the overall population [HRR1, hazard ratio 1.70 (95% confidence interval, 1.49–1.94), and HRR2, 1.57 (1.37–1.79)] and in subjects with normal exercise capacity [HRR1, 1.96 (1.61–2.39), and HRR2, 1.76 (1.46–2.12)]. Combining HR indices appeared to increase the risk of all-cause [HRR1 and HRR2, 1.96 (1.68–2.29), and peak HR and HRR1, 1.87 (1.56–2.23)] and CV mortality, although no specific combination was superior for predicting CV mortality. Conclusion. All HR indices were age-dependent and associated with all-cause and CV mortality. Blunted HR recovery variables were the strongest predictors of all-cause mortality, even in subjects with normal exercise capacity. Combined blunted HR indices appeared to add prognostic value.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cycle exercise test, Heart rate recovery, Heart rate response, Mortality, Reference values
in
European Journal of Preventive Cardiology
volume
32
issue
1
pages
11 pages
publisher
Oxford University Press
external identifiers
  • scopus:85214854343
  • pmid:39325720
ISSN
2047-4873
DOI
10.1093/eurjpc/zwae308
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.
id
761cab5d-e469-42c5-ad36-0b811965ce34
date added to LUP
2025-03-13 12:28:47
date last changed
2025-07-17 23:46:26
@article{761cab5d-e469-42c5-ad36-0b811965ce34,
  abstract     = {{<p>Aims. Chronotropic incompetence and impaired heart rate (HR) recovery are related to mortality. Guidelines lack specific reference values for HR recovery. We defined normal values and studied blunted HR response and recovery and mortality risk. Methods and results. We included 9917 subjects (45% females) aged 18–85 years who performed a cycle exercise test. We defined normal values for peak HR, HR reserve, and HR recovery at 1 and 2 min (HRR<sub>1</sub> and HRR<sub>2</sub>) based on individuals apparently healthy (N = 2242). Associations between blunted HR indices (&lt;5th percentile) and mortality over a median follow-up of 8.6 years were analysed using Cox regression and competing risk analysis. All HR indices were age-dependent and independent predictors of all-cause and cardiovascular (CV) mortality. The 5th percentiles of HR reserve, HRR<sub>1</sub>, and HRR<sub>2</sub> correlated weakly with existing reference values. Heart rate recovery variables were the strongest predictors of all-cause mortality in both the overall population [HRR<sub>1</sub>, hazard ratio 1.70 (95% confidence interval, 1.49–1.94), and HRR<sub>2</sub>, 1.57 (1.37–1.79)] and in subjects with normal exercise capacity [HRR<sub>1</sub>, 1.96 (1.61–2.39), and HRR<sub>2</sub>, 1.76 (1.46–2.12)]. Combining HR indices appeared to increase the risk of all-cause [HRR<sub>1</sub> and HRR<sub>2</sub>, 1.96 (1.68–2.29), and peak HR and HRR<sub>1</sub>, 1.87 (1.56–2.23)] and CV mortality, although no specific combination was superior for predicting CV mortality. Conclusion. All HR indices were age-dependent and associated with all-cause and CV mortality. Blunted HR recovery variables were the strongest predictors of all-cause mortality, even in subjects with normal exercise capacity. Combined blunted HR indices appeared to add prognostic value.</p>}},
  author       = {{Jou, Jordi and Zhou, Xingwu and Lindow, Thomas and Brudin, Lars and Hedman, Kristofer and Ekström, Magnus and Malinovschi, Andrei}},
  issn         = {{2047-4873}},
  keywords     = {{Cycle exercise test; Heart rate recovery; Heart rate response; Mortality; Reference values}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  pages        = {{32--42}},
  publisher    = {{Oxford University Press}},
  series       = {{European Journal of Preventive Cardiology}},
  title        = {{Heart rate response and recovery in cycle exercise testing : normal values and association with mortality}},
  url          = {{http://dx.doi.org/10.1093/eurjpc/zwae308}},
  doi          = {{10.1093/eurjpc/zwae308}},
  volume       = {{32}},
  year         = {{2025}},
}