Decreased heart rate recovery may predict a high SYNTAX score in patients with stable coronary artery disease

Association between arterial stiffness and autonomic dysfunction in participants underwent treadmill exercise testing: a cross-sectional analysis

Data on the impact of arterial stiffness on autonomic function are limited. We sought to investigate whether heart rate recovery (HRR), a predictor of autonomic function, is impaired in patients with increased arterial stiffness. A total of 475 participants (mean age 55.8 ± 11.1 years, 34.3% women) who underwent a treadmill exercise test (TET) for the evaluation of chest pain were retrospectively analyzed. All patients underwent brachial-ankle pulse wave velocity (baPWV) measurement on the same day. HRR was defined as the difference in heart rate from maximal exercise to 1 min of recovery. Participants with the lowest HRR tertile were older and had more cardiovascular risk factors than those with the highest HRR tertile. Simple correlation analysis showed that baPWV was negatively correlated with HRR (r =  - 0.327, P < 0.001). In multiple linear regression analysis, there was a significant association between baPWV and HRR, even after adjusting for potential confounders (β =  - 0.181, P < 0.001). In participants who underwent TET, baPWV was negatively correlated with HRR. The results of our study indicate a potential relationship between arterial stiffness and the autonomic nervous system.

[Heart rate recovery and presence of coronary lesions in case of ischemic heart disease at the Abidjan Cardiology Institute in Côte d'Ivoire]

Introduction

Heart rate recovery (HRR) measured during stress tests, assesses the vago-sympathetic balance. It is a known prognostic and predictive parameter of cardiovascular mortality that is believed to be correlated with the presence and severity of coronary artery disease. The aim of this work was to assess the predictive value of heart rate recovery in the diagnostic and severity of coronary lesions in a major metropolis of sub-Saharan Africa where access to specialist care is unevenly distributed.

Patients and method

We conducted a retrospective observational study from January 2010 to February 2020 at the Abidjan Cardiology Institute, including patients who performed a diagnostic coronary angiography after a positive exercise test. Clinical, angiographic and exercise parameters were analyzed and compared in patients with abnormal heart rate recovery (HRR) and those with normal one.

Results

The main study limitation is small sampling due to the cost of the angiographic procedure which limits its realization. We recorded 41 subjects whose mean age was 53.4 ± 9.6 years with a male predominance (sex ratio of 3.6). The predominant age group was between 50 and 60 years. Males were older than females with no significant difference. The predominant cardiovascular risk factors were overweight/obesity (68.29%) and hypertension (61%). Eight patients (19.5%) presenting an abnormal HRR (≤12 bpm) had more significant coronary disease (p=0.02) and more severe ones (p=0.003). Patients with abnormal HRR tended to be older without statistical significance (p=0.081), and had lower chronotropic reserve and maximum heart rate (p=0.008 and p=0.042, respectively). The positive predictive value of HHR was 87.5% and its negative predictive value was 60.6%.

Conclusion

Abnormal HRR can predict the presence of coronary artery disease and its severity. Evaluating HRR during stress tests could help in the detection, evaluation, and monitoring of ischemic heart disease in our resource-limited countries.