Heart rate recovery: autonomic determinants, methods of assessment and association with mortality and cardiovascular diseases

Summary Cardiovascular disease (CVD) is the primary cause of mortality worldwide. Cardiac autonomic dysfunction seems to be related to the genesis of several CVDs and is also linked to the increased risk of mortality in CVD patients. The quantification of heart rate decrement after exercise – known...

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Bibliographic Details
Published in:Clinical physiology and functional imaging 2014-09, Vol.34 (5), p.327-339
Main Authors: Peçanha, Tiago, Silva-Júnior, Natan Daniel, Forjaz, Cláudia Lúcia de Moraes
Format: Article
Language:English
Subjects:
autonomic nervous system
Autonomic Nervous System - physiopathology
Cardiovascular Diseases - diagnosis
Cardiovascular Diseases - mortality
Cardiovascular Diseases - physiopathology
Electrocardiography
Exercise
Exercise Test
Health risk assessment
Heart - innervation
Heart Rate
Humans
Methods
Models, Biological
Mortality
parasympathetic nervous system
Predictive Value of Tests
Prognosis
Recovery of Function
Risk Factors
sympathetic nervous system
Time Factors
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Summary:Summary Cardiovascular disease (CVD) is the primary cause of mortality worldwide. Cardiac autonomic dysfunction seems to be related to the genesis of several CVDs and is also linked to the increased risk of mortality in CVD patients. The quantification of heart rate decrement after exercise – known as heart rate recovery (HRR) – is a simple tool for assessing cardiac autonomic activity in healthy and CVD patients. Furthermore, since The Cleveland Clinic studies, HRR has also been used as a powerful index for predicting mortality. For these reasons, in recent years, the scientific community has been interested in proposing methods and protocols to investigate HRR and understand its underlying mechanisms. The aim of this review is to discuss current knowledge about HRR, including its potential primary and secondary physiological determinants, as well as its role in predicting mortality. Published data show that HRR can be modelled by an exponential curve, with a fast and a slow decay component. HRR may be influenced by population and exercise characteristics. The fast component mainly seems to be dictated by the cardiac parasympathetic reactivation, probably promoted by the deactivation of central command and mechanoreflex inputs immediately after exercise cessation. On the other hand, the slow phase of HRR may be determined by cardiac sympathetic withdrawal, possibly via the deactivation of metaboreflex and thermoregulatory mechanisms. All these pathways seem to be impaired in CVD, helping to explain the slower HRR in such patients and the increased rate of mortality in individuals who present a slower HRR.
ISSN:1475-0961
1475-097X
DOI:10.1111/cpf.12102