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Michael S Lauer - One of the best experts on this subject based on the ideXlab platform.
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Heart Rate Recovery coming back full circle to the baroreceptor reflex
Circulation Research, 2016Co-Authors: Michael S LauerAbstract:In the current issue of Circulation Research , McCrory et al1 report on the association of Heart Rate Recovery after simple orthostatic challenge—otherwise known as standing up—with all-cause mortality. The authors measured Heart Rate changes in the first 110 seconds after standing up in 4475 participants of an Irish population–based, cohort study. Immediately after standing, Heart Rate, as expected, increased but in most subjects started to fall toward resting levels within 10 seconds. The Rate of decline between 10 and 20 seconds post orthostatic challenge—or Heart Rate Recovery (HRR10–20)—was lower in older subjects and in subjects with a history of vascular disease. It was also an independent predictor of 4-year mortality: the lower the HRR10–20, the greater the mortality. Article, see p 666 To put these findings in perspective, we go back 28 years, when Schwartz et al2 published a report on a series of experiments that linked baroreceptor function with cardiac response to acute stress. The investigators produced an anterior myocardial infarction (MI) in 301 dogs and …
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association of socioeconomic status with functional capacity Heart Rate Recovery and all cause mortality
JAMA, 2006Co-Authors: Mehdi H Shishehbor, David Litaker, Claire E Pothier, Michael S LauerAbstract:ContextLower socioeconomic status (SES) confers heightened cardiovascular risk and mortality, although the mediating pathways are unclear.ObjectiveTo evaluate the extent to which exercise physiologic characteristics account for the association between lower SES and mortality.Design, Setting, and ParticipantsProspective cohort study of 30 043 consecutive patients living in 7 counties in northeast Ohio referred between 1990 and 2002 for symptom-limited stress testing for evaluation of known or suspected coronary artery disease. Follow-up for mortality continued through February 2004.Main Outcome MeasuresEstimated functional capacity in metabolic equivalents and Heart Rate Recovery, physiologic characteristics that are determined directly from exercise; testing and all-cause mortality during a median follow-up of 6.5 years.ResultsMultivariable models adjusting for demographics, insurance status, smoking status, and clinical confounders demonstRated a strong association between a composite SES score based on census block data and functional capacity (adjusted odds ratio comparing 25th with 75th percentile values, 1.72; 95% confidence interval [CI], 1.56-1.89; P<.001) as well as Heart Rate Recovery (adjusted odds ratio comparing 25th with 75th percentile values, 1.18; 95% CI, 1.07-1.30; P<.001). There were 2174 deaths, with mortality risk increasing from 5% to 10% as SES decreased by quartile (P<.001). Cox proportional hazards models that included all confounding variables except exercise physiologic characteristics demonstRated increased mortality as SES decreased (adjusted hazard ratio comparing 25th with 75th percentile values, 1.32; 95% CI, 1.22-1.42; P<.001). After further adding functional capacity and Heart Rate Recovery, the magnitude of this relationship was reduced (comparing 25th with 75th percentile values; adjusted hazard ratio, 1.17; 95% CI, 1.08-1.26; P<.001), with these variables explaining 47% of the association.ConclusionsImpaired functional capacity and abnormal Heart Rate Recovery were strongly associated with lower SES and accounted for a major proportion of the correlation between SES and mortality. Efforts to modify these clinical features among patients with low SES may narrow disparities in mortality.
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association of triglyceride to hdl cholesterol ratio with Heart Rate Recovery
Diabetes Care, 2004Co-Authors: Mehdi H Shishehbor, Byron J Hoogwerf, Michael S LauerAbstract:OBJECTIVE —Insulin resistance is associated with autonomic dysfunction. An attenuated decrease in Heart Rate after exercise (or Heart Rate Recovery [HRR]) predicts all-cause mortality and is believed to reflect decreased parasympathetic activity. Utilizing triglyceride/HDL cholesterol concentration as a marker of insulin resistance, we sought to assess the association between insulin resistance and HRR. RESEARCH DESIGN AND METHODS —Our study population included 4,963 healthy adults who participated in the Lipid Research Clinics Prevalence Study and underwent exercise testing. HRR was considered abnormal if it did not drop ≥42 bpm 2 min after completion of exercise. Fasting blood specimens were drawn. RESULTS —Individuals in the highest quartile of triglyceride/HDL cholesterol had a significantly higher prevalence of abnormal HRR (40 vs. 30%, multivariable-adjusted prevalence ratio 1.18, 95% CI 1.01–1.39; P = 0.04). As a continuous variable, an increase in 1 SD of triglyceride–to–HDL cholesterol ratio was associated with a greater likelihood of an abnormal HRR, even after adjusting for >20 covariates (adjusted OR 1.16, 95% CI 1.07–1.25; P P = 0.015). CONCLUSIONS —HRR is associated with triglyceride–to–HDL cholesterol ratio and identifies patients with insulin resistance who are at increased risk of death.
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Heart Rate Recovery after exercise is apredictor of mortality independent of the angiographic severity of coronary disease
Journal of the American College of Cardiology, 2003Co-Authors: Deepak P Vivekananthan, Eugene H Blackstone, Claire E Pothier, Michael S LauerAbstract:Abstract Objectives We sought to determine whether abnormal Heart Rate Recovery predicts mortality independent of the angiographic severity of coronary disease. Background An attenuated decrease in Heart Rate after exercise, or Heart Rate Recovery (HRR), has been shown to predict mortality. There are few data on its prognostic significance once the angiographic severity of coronary artery disease (CAD) is ascertained. Methods For six years we followed 2,935 consecutive patients who underwent symptom-limited exercise testing for suspected CAD and then had a coronary angiogram within 90 days. The HRR was abnormal if ≤12 beats/min during the first minute after exercise, except among patients undergoing stress echocardiography, in whom the cutoff was ≤18 beats/min. Angiographic CAD was considered severe if the Duke CAD Prognostic Severity Index was ≥42 (on a scale of 0 to 100), which corresponds to a level of CAD where revascularization is associated with better long-term survival. Results Severe CAD was present in 421 patients (14%), whereas abnormal HRR was noted in 838 patients (29%). There were 336 deaths (11%). Mortality was predicted by abnormal HRR (hazard ratio [HR] 2.5, 95% confidence interval [CI] 2.0 to 3.1; p Conclusions Even after taking into account the angiographic severity of CAD, left ventricular function, and exercise capacity, HRR is independently predictive of mortality.
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Heart Rate Recovery following maximal exercise testing as a predictor of cardiovascular disease and all cause mortality in men with diabetes
Diabetes Care, 2003Co-Authors: Yiling J Cheng, Michael S Lauer, Conrad P Earnest, Timothy S Church, J B Kampert, Larry W Gibbons, Steven N BlairAbstract:OBJECTIVE —Heart Rate Recovery (HRR) is an independent prognostic indicator for cardiovascular disease (CVD) and all-cause mortality in healthy men. We examined the association of HRR to CVD-related and all-cause mortality in men with diabetes. RESEARCH DESIGN AND METHODS —In this cohort study we examined 2,333 men with documented diabetes (mean age 49.4 years) that had baseline 5-min HRR measurement following maximal exercise (Heart Rate peak − Heart Rate 5 min of Recovery ) at The Cooper Clinic, Dallas, TX. We identified HRR quartiles as quartile 1 75 bpm. Hazard ratios (HRs) for cardiovascular and all-cause death were adjusted for age, cardiorespiratory fitness, resting Heart Rate, fasting blood glucose, BMI, smoking habit, alcohol consumption, total cholesterol, triglyceride, and history of CVD at baseline. RESULTS —During a median of 14.9 years follow-up, there were 142 deaths that were considered CVD related and 287 total deaths. Compared with men in the highest quartile of HRR, adjusted HRs in the first, second, and third quartiles were 2.0 (95% CI 1.1–3.8), 1.5 (0.8–2.7), and 1.5 (0.9–2.8), respectively, for cardiovascular death ( P for trend P for trend CONCLUSIONS —Among men with diabetes, a decreased HRR, even measured as long as 5 min after Recovery, was independently predictive of cardiovascular and all-cause death.
Eugene H Blackstone - One of the best experts on this subject based on the ideXlab platform.
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Heart Rate Recovery after exercise is apredictor of mortality independent of the angiographic severity of coronary disease
Journal of the American College of Cardiology, 2003Co-Authors: Deepak P Vivekananthan, Eugene H Blackstone, Claire E Pothier, Michael S LauerAbstract:Abstract Objectives We sought to determine whether abnormal Heart Rate Recovery predicts mortality independent of the angiographic severity of coronary disease. Background An attenuated decrease in Heart Rate after exercise, or Heart Rate Recovery (HRR), has been shown to predict mortality. There are few data on its prognostic significance once the angiographic severity of coronary artery disease (CAD) is ascertained. Methods For six years we followed 2,935 consecutive patients who underwent symptom-limited exercise testing for suspected CAD and then had a coronary angiogram within 90 days. The HRR was abnormal if ≤12 beats/min during the first minute after exercise, except among patients undergoing stress echocardiography, in whom the cutoff was ≤18 beats/min. Angiographic CAD was considered severe if the Duke CAD Prognostic Severity Index was ≥42 (on a scale of 0 to 100), which corresponds to a level of CAD where revascularization is associated with better long-term survival. Results Severe CAD was present in 421 patients (14%), whereas abnormal HRR was noted in 838 patients (29%). There were 336 deaths (11%). Mortality was predicted by abnormal HRR (hazard ratio [HR] 2.5, 95% confidence interval [CI] 2.0 to 3.1; p Conclusions Even after taking into account the angiographic severity of CAD, left ventricular function, and exercise capacity, HRR is independently predictive of mortality.
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association of fasting plasma glucose with Heart Rate Recovery in healthy adults a population based study
Diabetes, 2002Co-Authors: Claudia Panzer, Eugene H Blackstone, Michael S Lauer, Andreas Brieke, Byron J HoogwerfAbstract:Diabetes is associated with abnormal autonomic function and increased mortality. Abnormal Heart Rate Recovery after exercise, a measure of autonomic dysfunction, is also associated with increased mortality. The objective of this study was to determine the association of fasting plasma glucose with abnormal Heart Rate Recovery and its prognostic importance in healthy adults. We studied 5,190 healthy adults who did not have medically treated diabetes (mean age 45 years, 39% women), were enrolled in the Lipid Research Clinics’ Prevalence Study, and underwent exercise testing. Heart Rate Recovery was defined as the change from peak Heart Rate to that after 2 min of Recovery; an abnormal value was ≤42 bpm. All-cause mortality was assessed over 12 years. A total of 504 participants (10%) had impaired fasting glucose, and 131 (3%) had untreated diabetes. An abnormal Heart Rate Recovery was found in 1,699 (33%). Compared with participants who had normal fasting plasma glucose, abnormal Heart Rate Recovery was more common among those with impaired fasting glucose (42 vs. 31%; relative risk, 1.34; 95% confidence interval [CI], 1.20–1.50; P P P = 0.0003). An abnormal Heart Rate Recovery added to impaired fasting plasma glucose for the prediction of death. Fasting plasma glucose is strongly and independently associated with abnormal Heart Rate Recovery, even at nondiabetic levels.
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Heart Rate Recovery immediately after treadmill exercise and left ventricular systolic dysfunction as predictors of mortality the case of stress echocardiography
Circulation, 2001Co-Authors: Junko Watanabe, Eugene H Blackstone, Maran Thamilarasan, James D Thomas, Michael S LauerAbstract:Background An attenuated Heart Rate Recovery after exercise has been shown to be predictive of mortality. In prior studies, Recovery Heart Rates were measured while patients were exercising lightly, that is, during a cool-down period. It is not known whether Heart Rate Recovery predicts mortality when measured in the absence of a cool-down period or after accounting for left ventricular systolic function. Methods and Results We followed 5438 consecutive patients without a history of Heart failure or valvular disease referred for exercise echocardiography for 3 years. Heart Rate Recovery was defined as the difference in Heart Rate between peak exercise and 1 minute later; a value ≤18 beats per minute was considered abnormal. Patients assumed the left lateral decubitus position after exercise. An abnormal Heart Rate Recovery was present in 805 patients (15%); during follow-up, 190 died. An abnormal Heart Rate Recovery was predictive of death (9% versus 2%, hazard ratio [HR] 3.9, 95% CI 2.9 to 5.3, P<0.0001)...
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independent contribution of myocardial perfusion defects to exercise capacity and Heart Rate Recovery for prediction of all cause mortality in patients with known or suspected coronary Heart disease
Journal of the American College of Cardiology, 2001Co-Authors: Lazaro A Diaz, Eugene H Blackstone, Richard C Brunken, Claire E Snader, Michael S LauerAbstract:OBJECTIVES The goal of this study was to determine the value of thallium201single photon emission computed tomography (SPECT) imaging for prediction of all-cause mortality when considered along with functional capacity and Heart Rate Recovery. BACKGROUND Myocardial perfusion defects identified by thallium201SPECT imaging are predictive of cardiac events. Functional capacity and Heart Rate Recovery are exercise measures that also have prognostic implications. METHODS We followed 7,163 consecutive adults referred for symptom-limited exercise thallium SPECT (mean age 60 ± 10, 25% women) for 6.7 years. Using information theory, we identified a probable best model relating nuclear findings to outcome to calculate a prognostic nuclear score. RESULTS There were 855 deaths. Intermediate- and high-risk prognostic nuclear scores were noted in 28% and 10% of patients. Compared with those with low-risk scans, patients with an intermediate-risk score were at increased risk for death (14% vs. 9%, hazard ratio: 1.67, 95% confidence interval [CI]: 1.44 to 1.95, p < 0.0001), while those with high-risk scores were at greater risk (24%, hazard ratio: 2.98, 95% CI: 2.49 to 3.56, p < 0.0001). In multivariable analyses that adjusted for clinical characteristics, functional capacity and Heart Rate Recovery, an intermediate-risk nuclear score remained predictive of death (adjusted hazard ratio: 1.50, 95% CI: 1.28 to 1.76, p < 0.0001), as did a high-risk score (adjusted hazard ratio: 2.76, 95% CI: 2.13 to 2.56, p < 0.0001). Impaired functional capacity and decreased Heart Rate Recovery provided additional prognostic information. CONCLUSIONS Myocardial perfusion defects detected by thallium SPECT imaging are independently predictive of long-term all-cause death, even after accounting for exercise capacity, Heart Rate Recovery and other potential confounders.
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Heart Rate Recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ecg
JAMA, 2000Co-Authors: Erna Obenza Nishime, Christopher R Cole, Eugene H Blackstone, Fredric J Pashkow, Michael S LauerAbstract:ContextBoth attenuated Heart Rate Recovery following exercise and the Duke treadmill exercise score have been demonstRated to be independent predictors of mortality, but their prognostic value relative to each other has not been studied.ObjectiveTo assess the associations among abnormal Heart Rate Recovery, treadmill exercise score, and death in patients referred specifically for exercise electrocardiography.Design and SettingProspective cohort study conducted in an academic medical center between September 1990 and December 1997, with a median follow-up of 5.2 years.PatientsA total of 9454 consecutive patients (mean [SD] age, 53 [11] years; 78% male) who underwent symptom-limited exercise electrocardiographic testing. Exclusion criteria included age younger than 30 years, history of Heart failure or valvular disease, pacemaker implantation, and uninterpretable electrocardiograms.Main Outcome MeasuresAll-cause mortality, as predicted by abnormal Heart Rate Recovery, defined as failure of Heart Rate to decrease by more than 12/min during the first minute after peak exercise, and by treadmill exercise score, defined as (exercise time) − (5 × maximum ST-segment deviation) − (4 × treadmill angina index).ResultsThree hundred twelve deaths occurred in the cohort. Abnormal Heart Rate Recovery and intermediate- or high-risk treadmill exercise score were present in 20% (n = 1852) and 21% (n = 1996) of patients, respectively. In univariate analyses, death was predicted by both abnormal Heart Rate Recovery (8% vs 2% in patients with normal Heart Rate Recovery; hazard ratio [HR], 4.16; 95% confidence interval [CI], 3.33-5.19; χ2 = 158; P<.001) and intermediate- or high-risk treadmill exercise score (8% vs 2% in patients with low-risk scores; HR, 4.28; 95% CI, 3.43-5.35; χ2 = 164; P<.001). After adjusting for age, sex, standard cardiovascular risk factors, medication use, and other potential confounders, abnormal Heart Rate Recovery remained predictive of death (among the 8549 patients not taking β-blockers, adjusted HR, 2.13; 95% CI, 1.63-2.78; P<.001), as did intermediate- or high-risk treadmill exercise score (adjusted HR, 1.49; 95% CI, 1.15-1.92; P = .002). There was no interaction between these 2 predictors.ConclusionsIn this cohort of patients referred specifically for exercise electrocardiography, both abnormal Heart Rate Recovery and treadmill exercise score were independent predictors of mortality. Heart Rate Recovery appears to provide additional prognostic information to the established treadmill exercise score and should be considered for routine incorporation into exercise test interpretation.
Isabelle Denjoy - One of the best experts on this subject based on the ideXlab platform.
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Heart Rate Recovery After Exercise Is Associated With Arrhythmic Events in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia
Circulation. Arrhythmia and electrophysiology, 2020Co-Authors: Krystien V.v. Lieve, Veronica Dusi, Christian Van Der Werf, J Martijn Bos, Conor Lane, Mathis Korseberg Stokke, Thomas Roston, Aurora Djupsjöbacka, Yuko Wada, Isabelle DenjoyAbstract:Background: Risk stratification in catecholaminergic polymorphic ventricular tachycardia remains ill defined. Heart Rate Recovery (HRR) immediately after exercise is regulated by autonomic reflexes, particularly vagal tone, and may be associated with symptoms and ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia. Our objective was to evaluate whether HRR after maximal exercise on the exercise stress test (EST) is associated with symptoms and ventricular arrhythmias. Methods: In this retrospective observational study, we included patients ≤65 years of age with an EST without antiarrhythmic drugs who attained at least 80% of their age- and sex-predicted maximal HR. HRR in the Recovery phase was calculated as the difference in Heart Rate (HR) at maximal exercise and at 1 minute in the Recovery phase (ΔHRR1'). Results: We included 187 patients (median age, 36 years; 68 [36%] symptomatic before diagnosis). Pre-EST HR and maximal HR were equal among symptomatic and asymptomatic patients. Patients who were symptomatic before diagnosis had a greater ΔHRR1' after maximal exercise (43 [interquartile range, 25-58] versus 25 [interquartile range, 19-34] beats/min; P
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Heart Rate Recovery after exercise is associated with arrhythmic events in patients with catecholaminergic polymorphic ventricular tachycardia
Circulation-arrhythmia and Electrophysiology, 2020Co-Authors: Krystien V.v. Lieve, Veronica Dusi, Christian Van Der Werf, Mathis Korseberg Stokke, Thomas Roston, Aurora Djupsjöbacka, Yuko Wada, Martijn J Bos, Conor M Lane, Isabelle DenjoyAbstract:BACKGROUND: Risk stratification in catecholaminergic polymorphic ventricular tachycardia remains ill defined. Heart Rate Recovery (HRR) immediately after exercise is regulated by autonomic reflexes, particularly vagal tone, and may be associated with symptoms and ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia. Our objective was to evaluate whether HRR after maximal exercise on the exercise stress test (EST) is associated with symptoms and ventricular arrhythmias. METHODS: In this retrospective observational study, we included patients ≤65 years of age with an EST without antiarrhythmic drugs who attained at least 80% of their age- and sex-predicted maximal HR. HRR in the Recovery phase was calculated as the difference in Heart Rate (HR) at maximal exercise and at 1 minute in the Recovery phase (ΔHRR1'). RESULTS: We included 187 patients (median age, 36 years; 68 [36%] symptomatic before diagnosis). Pre-EST HR and maximal HR were equal among symptomatic and asymptomatic patients. Patients who were symptomatic before diagnosis had a greater ΔHRR1' after maximal exercise (43 [interquartile range, 25-58] versus 25 [interquartile range, 19-34] beats/min; P<0.001). Corrected for age, sex, and relatedness, patients in the upper tertile for ΔHRR1' had an odds ratio of 3.4 (95% CI, 1.6-7.4) of being symptomatic before diagnosis (P<0.001). In addition, ΔHRR1' was higher in patients with complex ventricular arrhythmias at EST off antiarrhythmic drugs (33 [interquartile range, 22-48] versus 27 [interquartile range, 20-36] beats/min; P=0.01). After diagnosis, patients with a ΔHRR1' in the upper tertile of its distribution had significantly more arrhythmic events as compared with patients in the other tertiles (P=0.045). CONCLUSIONS: Catecholaminergic polymorphic ventricular tachycardia patients with a larger HRR following exercise are more likely to be symptomatic and have complex ventricular arrhythmias during the first EST off antiarrhythmic drug.
Christopher R Cole - One of the best experts on this subject based on the ideXlab platform.
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Heart Rate Recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ecg
JAMA, 2000Co-Authors: Erna Obenza Nishime, Christopher R Cole, Eugene H Blackstone, Fredric J Pashkow, Michael S LauerAbstract:ContextBoth attenuated Heart Rate Recovery following exercise and the Duke treadmill exercise score have been demonstRated to be independent predictors of mortality, but their prognostic value relative to each other has not been studied.ObjectiveTo assess the associations among abnormal Heart Rate Recovery, treadmill exercise score, and death in patients referred specifically for exercise electrocardiography.Design and SettingProspective cohort study conducted in an academic medical center between September 1990 and December 1997, with a median follow-up of 5.2 years.PatientsA total of 9454 consecutive patients (mean [SD] age, 53 [11] years; 78% male) who underwent symptom-limited exercise electrocardiographic testing. Exclusion criteria included age younger than 30 years, history of Heart failure or valvular disease, pacemaker implantation, and uninterpretable electrocardiograms.Main Outcome MeasuresAll-cause mortality, as predicted by abnormal Heart Rate Recovery, defined as failure of Heart Rate to decrease by more than 12/min during the first minute after peak exercise, and by treadmill exercise score, defined as (exercise time) − (5 × maximum ST-segment deviation) − (4 × treadmill angina index).ResultsThree hundred twelve deaths occurred in the cohort. Abnormal Heart Rate Recovery and intermediate- or high-risk treadmill exercise score were present in 20% (n = 1852) and 21% (n = 1996) of patients, respectively. In univariate analyses, death was predicted by both abnormal Heart Rate Recovery (8% vs 2% in patients with normal Heart Rate Recovery; hazard ratio [HR], 4.16; 95% confidence interval [CI], 3.33-5.19; χ2 = 158; P<.001) and intermediate- or high-risk treadmill exercise score (8% vs 2% in patients with low-risk scores; HR, 4.28; 95% CI, 3.43-5.35; χ2 = 164; P<.001). After adjusting for age, sex, standard cardiovascular risk factors, medication use, and other potential confounders, abnormal Heart Rate Recovery remained predictive of death (among the 8549 patients not taking β-blockers, adjusted HR, 2.13; 95% CI, 1.63-2.78; P<.001), as did intermediate- or high-risk treadmill exercise score (adjusted HR, 1.49; 95% CI, 1.15-1.92; P = .002). There was no interaction between these 2 predictors.ConclusionsIn this cohort of patients referred specifically for exercise electrocardiography, both abnormal Heart Rate Recovery and treadmill exercise score were independent predictors of mortality. Heart Rate Recovery appears to provide additional prognostic information to the established treadmill exercise score and should be considered for routine incorporation into exercise test interpretation.
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Heart Rate Recovery after submaximal exercise testing as a predictor of mortality in a cardiovascularly healthy cohort
Annals of Internal Medicine, 2000Co-Authors: Christopher R Cole, Eugene H Blackstone, Joanne M Foody, Michael S LauerAbstract:BACKGROUND: Abnormal Heart Rate Recovery after symptom-limited exercise predicts death. It is unknown whether this is also true among patients undergoing submaximal testing. OBJECTIVE: To test the prognostic implications of Heart Rate Recovery in cardiovascularly healthy adults undergoing submaximal exercise testing. DESIGN: Population-based cohort study. SETTING: 10 primary care sites. PARTICIPANTS: 5234 adults without evidence of cardiovascular disease who were enrolled in the Lipid Research Clinics Prevalence Study. MEASUREMENTS: Heart Rate Recovery was defined as the change from peak Heart Rate to that measured 2 minutes later (Heart Rate Recovery was defined as < or =42 beats/min). RESULTS: During 12 years of follow-up, 312 participants died. Abnormal Heart Rate Recovery predicted death (relative risk, 2.58 [CI, 2.06 to 3.20]). After adjustment for standard risk factors, fitness, and resting and exercise Heart Rates, abnormal Heart Rate Recovery remained predictive (adjusted relative risk, 1.55 [CI, 1.22 to 1.98]) (P<0.001). CONCLUSION: Even after submaximal exercise, abnormal Heart Rate Recovery predicts death.
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Heart Rate Recovery after submaximal exercise testing as a predictor of mortality in a cardiovascularly healthy cohort
Annals of Internal Medicine, 2000Co-Authors: Christopher R Cole, Eugene H Blackstone, Joanne M Foody, Michael S LauerAbstract:Abnormal Heart Rate Recovery after symptom-limited exercise is an important prognostic factor. This study found that even after submaximal exercise in patients in good cardiovascular health, abnorm...
Stuart D Katz - One of the best experts on this subject based on the ideXlab platform.
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subacute pyridostigmine exposure increases Heart Rate Recovery and cardiac parasympathetic tone in rats
Clinical and Experimental Pharmacology and Physiology, 2017Co-Authors: Manushree Bharadwaj, Stuart D Katz, Michael S Davis, Christian Cook, C N Pope, Lara K MaxwellAbstract:Heart Rate Recovery (HRR) describes the rapid deceleration of Heart Rate after strenuous exercise and is an indicator of parasympathetic tone. A reduction in parasympathetic tone occurs in patients with congestive Heart failure, resulting in prolonged HRR. Acetylcholinesterase inhibitors, such as pyridostigmine, can enhance parasympathetic tone by increasing cholinergic input to the Heart. The objective of this study was to develop a rodent model of HRR to test the hypothesis that subacute pyridostigmine administration decreases cholinesterase activity and acceleRates HRR in rats. Ten days after implantation of radiotelemetry transmitters, male Sprague Dawley rats were randomized to control (CTL) or treated (PYR; 0.14 mg/mL pyridostigmine in the drinking water, 29 days) groups. Rats were exercised on a treadmill to record HRR, and blood samples were collected on days 0, 7, 14, and 28 of pyridostigmine administration. Total cholinesterase and acetylcholinesterase (AChE) activity in plasma was decreased by 32%-43% and 57%-80%, respectively, in PYR rats on days 7-28, while plasma butyrylcholinesterase activity did not significantly change. AChE activity in red blood cells was markedly reduced by 64%-66%. HRR recorded 1 minute after exercise was higher in the PYR group on days 7, 14 and 28, and on day 7 when HRR was estimated at 3 and 5 minutes. Autonomic tone was evaluated pharmacologically using sequential administration of muscarinic (atropine) and adrenergic (propranolol) blockers. Parasympathetic tone was increased in PYR rats as compared with the CTL group. These data support the study hypothesis that subacute pyridostigmine administration enhances HRR by increasing cardiac parasympathetic tone.
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subacute pyridostigmine exposure increases Heart Rate Recovery and cardiac parasympathetic tone in rats
Clinical and Experimental Pharmacology and Physiology, 2017Co-Authors: Manushree Bharadwaj, Stuart D Katz, Carey Pope, Michael S Davis, Christian Cook, Lara K MaxwellAbstract:Heart Rate Recovery (HRR) describes the rapid deceleration of Heart Rate after strenuous exercise and is an indicator of parasympathetic tone. A reduction in parasympathetic tone occurs in patients with congestive Heart failure, resulting in prolonged HRR. Acetylcholinesterase inhibitors, such as pyridostigmine, can enhance parasympathetic tone by increasing cholinergic input to the Heart. The objective of this study was to develop a rodent model of HRR to test the hypothesis that subacute pyridostigmine administration decreases cholinesterase activity and acceleRates HRR in rats. Ten days after implantation of radiotelemetry transmitters, male Sprague Dawley rats were randomized to control (CTL) or treated (PYR; 0.14 mg/ml pyridostigmine in the drinking water, 29 days) groups. Rats were exercised on a treadmill to record HRR, and blood samples were collected on days 0, 7, 14, and 28 of pyridostigmine administration. Total cholinesterase and acetylcholinesterase (AChE) activity in plasma was decreased by 32-43% and 57-80%, respectively, in PYR rats on days 7-28, while plasma butyrylcholinesterase activity did not significantly change. AChE activity in RBCs was markedly reduced by 64-66%. HRR recorded 1 min after exercise was higher in the PYR group on days 7, 14 and 28, and on day 7 when HRR was estimated at 3 and 5 min. Autonomic tone was evaluated pharmacologically using sequential administration of muscarinic (atropine) and adrenergic (propranolol) blockers. Parasympathetic tone was increased in PYR rats as compared with the CTL group. These data support the study hypothesis that subacute pyridostigmine administration enhances HRR by increasing cardiac parasympathetic tone. This article is protected by copyright. All rights reserved.
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acetylcholinesterase inhibition with pyridostigmine improves Heart Rate Recovery after maximal exercise in patients with chronic Heart failure
Heart, 2003Co-Authors: Ana Silvia Androne, Katarzyna Hryniewicz, Rochelle L Goldsmith, A Arwady, Stuart D KatzAbstract:Objective: To characterise the effects of acetylcholinesterase inhibition with pyridostigmine on parasympathetic tone in patients with chronic Heart failure (CHF). Design: Prospective randomised, double blind crossover trial. Setting: University hospital outpatient Heart failure clinic. Patients: 20 ambulatory subjects with stable CHF (mean age 55 years, mean ejection fraction 24%). Interventions: Oral administration of a single dose of pyridostigmine 30 mg and matching placebo on sepaRate days. Main outcome measures: Heart Rate Recovery at one minute and three minutes after completion of maximal exercise. Results: Heart Rate Recovery at one minute after exercise was significantly greater after administration of pyridostigmine than after administration of placebo (mean (SEM) 27.4 (3.2) beats/min v 22.4 (2.4) beats/min, p < 0.01). Heart Rate Recovery at three minutes after exercise did not differ after administration of pyridostigmine and placebo (mean (SEM) 44.4 (3.9) beats/min v 41.8 (3.6) beats/ min, NS). Peak Heart Rate, peak oxygen uptake, peak respiratory exchange ratio, plasma noradrenaline (norepinephrine) concentrations, and plasma brain natriuretic peptide concentrations did not differ after administration of pyridostigmine and placebo. Conclusions: Acetylcholinesterase inhibition with pyridostigmine increased Heart Rate Recovery at one minute but not at three minutes after exercise. A specific effect of pyridostigmine on Heart Rate one minute after exercise suggests that pyridostigmine augments parasympathetic tone in patients with CHF.
