Clinical Research
Pediatric Cardiology
Heart Rate Response During Exercise Predicts Survival in Adults With Congenital Heart Disease

Presented as part of the 2005 Outstanding Research Award in Pediatric Cardiology at the American Heart Association Scientific Sessions, Dallas, Texas, November 13, 2005.
https://doi.org/10.1016/j.jacc.2006.05.051Get rights and content
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Objectives

To assess the prognostic value of heart rate response to exercise in adult congenital heart disease (ACHD) patients.

Background

An abnormal heart rate response to exercise is related to autonomic dysfunction and may have prognostic implications in ACHD.

Methods

We identified 727 consecutive ACHD patients (mean age [± SD] 33 ± 13 years) with varying diagnoses and without pacemakers. Peak oxygen consumption (peak Vo2), resting heart rate, and the increase in heart rate from resting level to peak exercise (“heart rate reserve”) were measured. We also quantified the decrease in heart rate (“heart rate recovery”) after cessation of exercise.

Results

During a median follow-up of 28 months, 38 patients died. Lower values of heart rate reserve, peak heart rate, heart rate recovery, and peak Vo2(p < 0.01 for each) were associated with increased mortality in univariate analysis. Furthermore, heart rate reserve predicted mortality independently of antiarrhythmic therapy, functional class, and peak Vo2. Stratifying patients by diagnostic groups revealed that a lower heart rate reserve was also associated with a greater risk of death in patients with complex anatomy, Fontan circulation, and tetralogy of Fallot (p < 0.05 for each).

Conclusions

An abnormal heart rate response to exercise identifies ACHD patients with a higher risk of mortality in the midterm, even after accounting for antiarrhythmic medication and exercise capacity. Heart rate reserve is a simple and inexpensive way to identify ACHD patients at higher mortality risk.

Abbreviations and Acronyms

ACHD
adult congenital heart disease
AUC
area under curve
NYHA
New York Heart Association
ROC
receiver-operating characteristic

Cited by (0)

The Royal Brompton Adult Congenital Heart Programme and the Department of Clinical Cardiology have received support from the British Heart Foundation and the Clinical Research Committee, Royal Brompton Hospital, London.

1

Dr. Dimopoulos is supported by the European Society of Cardiology, Drs. Francis, Okonko, and Babu-Narayan by the British Heart Foundation, and Dr. Broberg by the Waring Trust.