Heart rate recovery is an important predictor of outcomes in patients with connective tissue diseaseassociated pulmonary hypertension

PVRI Member Authors: Raed A. Dweik


Reduced heart rate recovery (HRR) after exercise is associated with increased mortality in cardiac and pulmonary diseases. We sought to evaluate the association between HRR after the 6-minute walk test (6MWT) and outcomes in patients with connective tissue disease–associated pulmonary hypertension (CTD-PH). Data were obtained by review of the medical records. HRR was defined as the difference in heart rate at the end of the 6MWT and after 1 minute (HRR1), 2 minutes (HRR2), and 3 minutes (HRR3) of rest. All patients with pulmonary hypertension and a diagnosis of systemic sclerosis, systemic lupus erythematosus, or mixed connective tissue disease who underwent the 6MWT between August 1, 2009, and October 30, 2011, were included (n = 66). By Kaplan-Meier analysis, HRR1, HRR2, and HRR3 at different cutoff points were all good predictors, with HRR1 of <16 being the best predictor of time to clinical worsening (log-rank P < 0.0001), hospitalization (log-rank P = 0.0001), and survival (log-rank P < 0.003). By proportional hazards regression, patients with HRR1 of <16 were at increased risk of clinical worsening (hazard ratio [HR]: 6.4 [95% confidence interval (CI): 2.6–19.2]; P < 0.0001], hospitalization (HR: 6.6 [95% CI: 2.4–23]; P < 0.0001), and death (HR: 4.5 [95% CI: 1.6–15.7]; P= 0.003). Patients in the highest tercile (HRR1 of ≥19) were unlikely to have a clinical worsening event (HR: 0.1 [95% CI: 0.04–0.5]; P = 0.001], to be hospitalized (HR: 0.1 [95% CI: 0.02–0.5]; P = 0.001), or to die (HR: 0.3 [95% CI: 0.07–0.9]; P = 0.04]. In conclusion, in patients with CTD-PH, abnormal HRR1 (defined as HRR1 of <16) after the 6MWT is a strong predictor of clinical worsening, time to clinical worsening, survival, and hospitalization.

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Functional Ability/ Impairment/ Quality of Life/ Physical Activity/ Exercise
Pulmonary Hypertension


Omar A. Minai, Quyen Nguyen, Srinivas Mummadi, Esteban Walker, Kevin McCarthy, Raed A. Dweik

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Pulmonary Circulation Vol 5: No 3 cover image

September 2015

Pulmonary Circulation Vol 5: No 3

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