Heart rate recovery and tissue Doppler echocardiography in heart failure

Background: Previous research has demonstrated the prognostic value of echocardiography with tissue Doppler imaging (TDI) in the heart failure (HF) population. Heart rate recovery (HRR) has also recently shown promise as a prognosticmarker. Hypothesis: We hypothesize echocardiography with TDI and HRR will be significantly correlated and both will provide prognostic information. Methods: A total of 243 subjects underwent echocardiography with TDI and maximal exercise testing to determine: (1) the ratio between mitral early (E) to mitral annular (E′) and E to mitral late (A) velocity; (2) left ventricular ejection fraction (LVEF); (3) left ventricular (LV) mass; (4) LV end-systolic volume (LVESV); and (5) HRR at 1 minute postexercise (HRR1). Results: HRR1 was significantly correlated with LVEF (r = 0.14, P = .03), LV mass (r = -0.30, P <.001), E/A (r = -0.22, P = .001), and E/E′ (r = -0.49, P <.001). Multivariate Cox regression analysis revealed HRR 1 was the strongest predictor of cardiacmortality (χ2: 55.5, P <.001); LV mass (residual χ2: 13.1, P <.001), E/E′ (residualχ2: 11.2, P = .001), and LVESV (residualχ2: 5.9, P = .015) all added significant prognostic value and were retained in the regression while LVEF was removed (residual χ2: 0.008, P = .93). Conclusions: To our knowledge, this is the first investigation demonstrating an association between HRR and variables obtained from echocardiography with TDI in subjects with HF. The combination of both assessment techniques provides improved prognostic discrimination.