Role of Heart Rate Recovery in Chronic Heart Failure: Results From the MyoVasc Study

Background Cardiac autonomic dysfunction is associated with heart failure (HF). Reduced heart rate recovery (HRR) indicates impaired parasympathetic reactivation after physical activity. Heart rate recovery 60 seconds after peak effort (HRR 60 ) is linked to autonomic dysfunction, but data on its relevance across HF phenotypes are scarce. This study aimed to identify clinical determinants of HRR 60 in an HF cohort and assess its relationship with clinical outcomes. Methods Data from the MyoVasc study (NCT04064450; N=3289) were analyzed. Participants underwent standardized clinical phenotyping including cardiopulmonary exercise testing. HRR 60 was defined as the heart rate decline 60 seconds after exercise termination. Clinical determinants of HRR 60 were evaluated using multivariate regression, whereas Cox regression analyses assessed all‐cause death and worsening of HF. Results The analysis sample comprised 1289 individuals (median age, 66.0 [interquartile range {IQR}, 58.0–73.0] years, 30.4% women) ranging from stage B to stage C/D according to the universal definition of HF. Age, sex, smoking, obesity, peripheral artery disease, and chronic kidney disease were identified as determinants of HRR 60 . HRR 60 showed a strong association with all‐cause death (hazard ratio [HR] HRR60 [10 bpm] , 1.56 [95% CI, 1.32–1.85]; P <0.0001) and worsening of HF (HR HRR60 [10 bpm] , 1.36 [95% CI, 1.10–1.69]; P =0.0052) independent of age, sex, and clinical profile. Sensitivity analysis showed a stronger association with worsening HF in HF with preserved left ventricular ejection fraction ( P interaction =0.027). Conclusions HRR 60 was associated with clinical outcome in chronic HF. Because it showed a stronger association with outcomes in HF with preserved ejection fraction, future research should consider phenotype‐specific differences.