What is the clinical evidence from this study?

Study design: Observational. Population: Cardiovascular disease (n=282). Intervention: Hyperventilation vs. Healthy controls aged ≥55 years. Primary outcome: Heart rate response to hyperventilation (HRRHV) (p=<0.001).

What does this research mean for the field?

Hyperventilation induces a significantly attenuated heart rate response in patients with cardiovascular disease compared to healthy controls aged 55 years and older, suggesting its potential as a simple marker of cardiovascular health. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

November 29, 2019Open Access

Hyperventilation-induced heart rate response as a potential marker for cardiovascular disease

Q: What are the key findings of this study?

Hyperventilation induced a significantly attenuated heart rate response in patients with cardiovascular disease (7 bpm) compared to healthy controls aged 55 years and older (15 bpm).

Q: What does this research mean for the field?

Hyperventilation induces a significantly attenuated heart rate response in patients with cardiovascular disease compared to healthy controls aged 55 years and older, suggesting its potential as a simple marker of cardiovascular health. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Hyperventilation induced a significantly attenuated heart rate response in patients with cardiovascular disease (7 bpm) compared to healthy controls aged 55 years and older (15 bpm).

Study Design

Type

Observational (n=282)

Multicenter

Yes

Structured PICO

Does 60 seconds of hyperventilation induce a different heart rate response in patients with cardiovascular disease compared to healthy controls?

Population

282 participants including 161 healthy controls and 121 patients with cardiovascular disease (CAD n=54, HF n=34, CAD+/HF+ n=18, CAD-/HF- n=15). Mean age varied by group (Controls 41.0, Controls 55+ 59.8, CAD 63.0, HF 61.5). Patients with implantable cardioverter defibrillators or pacemakers were excluded.

Intervention

60 seconds of hyperventilation at a pace of at least 30 breaths per minute

Comparator

Healthy controls (specifically a subgroup aged 55 years and older, n=30, used as an age-matched reference) who also performed the 60-second hyperventilation maneuver

Outcome

Heart rate response to hyperventilation (HRRHV), calculated as the relative difference between post-hyperventilation heart rate and resting heart ratesurrogate

The heart rate response to 60 seconds of hyperventilation is significantly attenuated in patients with cardiovascular disease compared to healthy controls, suggesting its potential as a simple, non-invasive screening marker.

Main Result

Absolute Event Rate: 7% vs 15%

p-value: p=<0.001

Limitations

Categorical classification of patient groups precluded a statistical assessment of disease severity
Limited sample size required grouping of a variety of different disease profiles
Retrospective pooled analysis did not account for potential bias between studies and sites
Standardization of the hyperventilation protocol between sites was not controlled
Potential confounding effects of comorbidities and cardiovascular medications

Abstract

Abstract An increase of heart rate to physical or mental stress reflects the ability of the autonomous nervous system and the heart to respond adequately. Hyperventilation is a user-controlled breathing maneuver that has a significant impact on coronary function and hemodynamics. Thus, we aimed to investigate if the heart rate response to hyperventilation (HRR HV ) can provide clinically useful information. A pooled analysis of the HRR HV after 60 s of hyperventilation was conducted in 282 participants including healthy controls; patients with heart failure (HF); coronary artery disease (CAD); a combination of both; or patients suspected of CAD but with a normal angiogram. Hyperventilation significantly increased heart rate in all groups, although healthy controls aged 55 years and older (15 ± 9 bpm) had a larger HRR HV than each of the disease groups (HF: 6 ± 6, CAD: 8 ± 8, CAD+/HF+: 6 ± 4, and CAD−/HF−: 8 ± 6 bpm, p < 0.001). No significant differences were found between disease groups. The HRR HV may serve as an easily measurable additional marker of cardiovascular health. Future studies should test its diagnostic potential as a simple, inexpensive pre-screening test to improve patient selection for other diagnostic exams.

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