부산대학교 도서관

Background: Heart rate recovery (HRR), most often described as the decrease of heart rate at 1 minute after cessation of exercise, has proven to be a predictor of all-cause mortality and death of coronary artery disease (CAD). However, recent research suggests the importance of HRR less than a minute after an orthostatic challenge as a predictor of all-cause mortality. A systematic analysis of the predictive value of HRR at different points in time after cessation of exercise has not been performed.Hypothesis: We hypothesised that HRR shortly after cessation of exercise is more predictive of all-cause mortality and death by CAD than after 1 minute.Method and Results: The prognostic value of HRR at 10, 30 and 50 seconds after cessation of exercise was investigated for all-cause mortality and death of CAD in 41,452 participants (mean age of 56 years, 55.8% female) free from cardiovascular disease, selected from the general population (UK Biobank). During a median follow-up period of 4.9 years 545 participants died (including 41 of CAD causes). The mean HRR at 10, 30 and 50 seconds was 18.4bpm, 28.6bpm and 34.3bpm, respectively. At all of the 3 time points HRR was predictive of all-cause mortality and death of CAD (p<0.01) in the univariable cox regression analyses. After multivariable adjustments that included aerobic exercise capacity and cardiovascular risk factors, HRR at 10 seconds remained the strongest predictor of all-cause mortality and death of CAD (HR, 0.884; 95% Cl, 0.824-0.947 per 5-bpm increase; P<0.01 & HR, 0.619; 95% Cl, 0.460-0.834; P<0.01); HRR at 30 seconds still predicted all-cause mortality (HR, 0.930; 95% Cl, 0.880-0.982, P<0.01), but not death of CAD, and HRR at 50 seconds was not predictive of either all cause mortality or death of CAD.Conclusion: Here we provide evidence that decreased HRR at 10 seconds after cessation of exercise is a superior predictor of outcome compared to the commonly used HRR at 1 minute post exercise. This observation might have important implications for the future interpretation and reporting of exercise testing in clinical practice.