Key result
Faster heart rate recovery linked to ~35% lower mortality per 10 bpm in ATTR-CM.
Why the study?
The association of one-minute heart rate recovery (HRR1) with clinical outcomes and its incremental prognostic value beyond conventional CPET indices like peak VO2 and VE/VCO2 slope in transthyretin cardiac amyloidosis (ATTR-CM) required assessment.
Does one-minute heart rate recovery (HRR1) improve prognostic model fit for all-cause mortality and heart failure hospitalisation beyond conventional CPET indices in adults with transthyretin cardiac amyloidosis?
Observational (n=110)
No
Does one-minute heart rate recovery (HRR1) improve prognostic model fit for all-cause mortality and heart failure hospitalisation beyond conventional CPET indices in adults with transthyretin cardiac amyloidosis?
Hazard Ratio: 0.65 (95% CI 0.44–0.95)
p-value: p=0.028
In patients with ATTR-CM, a greater 1-minute heart rate recovery during CPET is independently associated with lower mortality and heart failure hospitalization beyond peak VO2 and VE/VCO2 slope, though its incremental value is attenuated when accounting for biomarker staging.
HRR1 was associated with outcomes in ATTR-CM; leaves open incremental value beyond peak VO2 and VE/VCO2 slope.
Aims To assess the association of one-minute heart rate recovery (HRR1) with clinical outcomes and its incremental contribution to model fit beyond peak VO2 and ventilatory efficiency (VE/VCO2 slope) in transthyretin cardiac amyloidosis (ATTR-CM). Methods Consecutive adults with confirmed ATTR-CM undergoing symptom-limited cardiopulmonary exercise testing (CPET) were included in this single-centre observational study. During standardised active recovery at 24 W, HRR1 was defined as peak heart rate minus heart rate exactly 60 seconds after exercise. Cox proportional-hazards models evaluated all-cause mortality and the composite of mortality or first heart-failure hospitalisation. Principal models adjusted for age, sex, peak VO2 and VE/VCO2 slope; NT-proBNP and National Amyloidosis Centre (NAC) stage were examined separately. Results Of 161 baseline patients, 11 with unverifiable heart-rate measurements were excluded, and exact HRR1 was available in 110. Mortality analysis included 105 patients with 33 deaths; composite-outcome analysis included 107 patients with 51 events. Median HRR1 was 15.5 bpm. In conventional CPET-adjusted models, each 10-bpm greater HRR1 was associated with lower hazards of mortality (hazard ratio [HR] 0.65, 95% confidence interval [CI] 0.44–0.95; P = 0.028) and the composite outcome (HR 0.74, 95% CI 0.57–0.97; P = 0.029). Adding HRR1 improved model fit (likelihood-ratio P = 0.017 and P = 0.021, respectively); apparent C-indices increased from 0.770 to 0.795 for mortality and from 0.695 to 0.699 for the composite outcome. Associations were non-significant after separate adjustment for NT-proBNP or NAC stage. Conclusion HRR1 remained associated with outcomes after CPET adjustment and improved model fit. Discrimination gains were modest; value beyond biomarker staging was unproven.
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Kösters et al. (2026) conducted an observational in Transthyretin cardiac amyloidosis (ATTR-CM) (n=110). One-minute heart rate recovery (HRR1, per 10-bpm increase) vs. Lower HRR1 (continuous exposure) was evaluated on All-cause mortality (co-evaluated with composite of mortality or first heart-failure hospitalisation) (HR 0.65, 95% CI 0.44-0.95, p=0.028). Each 10-bpm greater one-minute heart rate recovery was associated with lower all-cause mortality (HR 0.65; 95% CI 0.44-0.95; P=0.028) and composite events (HR 0.74; P=0.029) in ATTR-CM.
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