@article {RamosP4436, author = {Roberta Pulcheri Ramos and Jaquelina Sonoe Ota Arakaki and Priscila Barbosa and Erika Treptow and Fabricio Martins Valois and Eloara Vieira Machado Ferreira and Luiz Eduardo Nery and J. Alberto Neder}, title = {Prognostic implications of delayed heart rate recovery from maximal-incremental exercise in patients with pulmonary arterial hypertension}, volume = {40}, number = {Suppl 56}, elocation-id = {P4436}, year = {2012}, publisher = {European Respiratory Society}, abstract = {Rationale: Early recovery from exercise is characterized by a marked reduction in heart rate (HR) due to sudden reintroduction of vagal tone and progressive withdrawal of sympathetic stimulation. HR recovery (HRR) is delayed in pulmonary arterial hypertension (PAH), a disabling condition associated with autonomic imbalance. Objective: To investigate the usefulness of HRR to estimate exercise impairment and prognosis in PAH patients. Methods: We evaluated 72 patients with PAH of varied aetiology (NYHA class I to IV) and 21 age- and gender-matched controls who underwent a maximal incremental cardiopulmonary exercise test (CPET) with HR being recorded up to the 5th minute of recovery. Results: HRR was consistently lower in patients compared to controls (p\<0.05). The best cutoff for HRR in one minute (HRR1min) to discriminate patients from controls was 18 beats (AUC 0.76 [0.66-0.86], p \<0.05). {\textquotedblleft}Normal{\textquotedblright} HRR1min was associated with a range of maximal and sub-maximal variables indicative of better preserved exercise tolerance (p\<0.05). On a multiple regression analysis which considered only CPET-independent variables (6-minute walking distance, NYHA class and PAH treatment), HRR1min was the single predictor of mortality (hazard ratio (95\% confidence interval)= 1.19 (1.03-1.37); p\<0.05). Conclusions: Preserved HRR1min (\>18 beats) is associated with less impaired responses to exercise in patients with PAH. Conversely, an abnormal HRR1min response has negative prognostic implications, a finding likely to be clinically useful when more sophisticated analyses provided by a full CPET are not readily available.}, issn = {0903-1936}, URL = {https://erj.ersjournals.com/content/40/Suppl_56/P4436}, eprint = {https://erj.ersjournals.com/content/40/Suppl_56/P4436.full.pdf}, journal = {European Respiratory Journal} }