Key result
HRR1 <16 beats linked to ~3-fold higher risk of clinical worsening in CTEPH.
Why the study?
The role of heart rate recovery at 1 min (HRR1) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) remains unclear despite its known prognostic value in pulmonary arterial hypertension.
Does attenuated heart rate recovery at 1 min (HRR1 <16 beats) predict clinical worsening in patients with chronic thromboembolic pulmonary hypertension?
Cohort (n=211)
No
Does attenuated heart rate recovery at 1 min (HRR1 <16 beats) predict clinical worsening in patients with chronic thromboembolic pulmonary hypertension?
Effect estimate: approximately a 3-fold risk
Attenuated heart rate recovery at 1 minute (<16 beats) after exercise is a strong independent predictor of clinical worsening and disease severity in patients with chronic thromboembolic pulmonary hypertension.
Attenuated HRR1 signals higher clinical worsening risk in CTEPH; leaves open whether it refines risk stratification beyond established markers.
BACKGROUND: Attenuated heart rate recovery at 1 min (HRR1) was demonstrated to correlate with poor prognosis in patients with pulmonary arterial hypertension, whereas its role in patients with chronic thromboembolic pulmonary hypertension (CTEPH) remains unclear. OBJECTIVES: The aim of this study was to investigate the correlations between HRR1 and functional status, echocardiography, hemodynamics, and prognosis of CTEPH. METHODS: We retrospectively enrolled patients with CTEPH who underwent right heart catheterization and cardiopulmonary exercise test between June 2014 to October 2020 in Fuwai hospital. The primary outcome was clinical worsening. Linear regression was performed to assess the association between HRR1 and established markers of CTEPH severity. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff of HRR1. Cox regression models were used to assess the association between HRR1 and clinical worsening. RESULTS: A total of 211 patients with CTEPH were included in the study. After adjusting for confounders, HRR1 positively correlated with 6-min walk distance, mixed venous oxygen saturation, and peak oxygen consumption, and negatively correlated with NT-proBNP, pulmonary vascular resistance, and ventilatory equivalent of carbon dioxide. Compared with patients with HRR1 ≥16 beats, patients with HRR1 <16 beats had approximately a 3-fold risk of experiencing clinical worsening and the risk escalated with time. CONCLUSION: HRR1 could reflect disease severity and was independently associated with prognosis in patients with CTEPH.
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Jin et al. (2021) conducted a cohort in Chronic thromboembolic pulmonary hypertension (CTEPH) (n=211). Heart rate recovery at 1 min (HRR1) <16 beats vs. HRR1 ≥16 beats was evaluated on Clinical worsening (approximately a 3-fold risk). Heart rate recovery at 1 min <16 beats was associated with an approximately 3-fold increased risk of clinical worsening compared to ≥16 beats in patients with CTEPH.
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