Jae SY, Kurl S, Laukkanen JA, Yoon ES, Choi YH, Fernhall B,
Franklin BA

Ann Med. 2017 Aug;49(5):404-410.

BACKGROUND: We examined whether slow heart rate recovery (HRR) after exercise
testing as an estimate of impaired autonomic function is related to coronary
artery calcification (CAC), an emerging marker of coronary atherosclerosis.
METHODS: We evaluated 2088 men who participated in a health-screening program
that included measures of CAC and peak or symptom-limited cardiopulmonary
exercise testing. HRR was calculated as the difference between peak heart rate
(HR) during exercise testing and the HR at 2 min of recovery after peak exercise.
We measured CAC using multidetector computed tomography to calculate the Agatston
coronary artery calcium score. Advanced CAC was defined as a mean CAC >75th
percentile for each age group.
RESULTS: HRR was negatively correlated with CAC (r = -.14, p < .01). After
adjusting for conventional risk factors, participants in the lowest quartile of
HRR (<38 bpm) were 1.59 times (95% CI: 1.17-2.18; p < .05) more likely to have
advanced CAC than their counterparts in the highest quartile of HRR (>52 bpm).
Each 1 bpm decrease in HRR was associated with 1% increase in advanced CAC after
adjusting for potential confounders.
CONCLUSIONS: An attenuated HRR after exercise testing is associated with advanced
CAC, independent of coronary risk factors and other related hemodynamic response.
KEY MESSAGES Slow heart rate recovery (HRR) after maximal exercise testing,
indicating decreased autonomic function, is associated with an increased risk of
cardiovascular event and mortality. Slow HRR has been linked with the occurrence
of malignant ventricular arrhythmias, but it remains unclear whether slow HRR is
associated with an increased risk of coronary artery calcification (CAC), an
emerging marker of coronary atherosclerosis. An attenuated HRR after exercise
testing was associated with advanced CAC, independent of coronary risk factors
and other potential hemodynamic confounder, supporting the hypothesis that slow
HRR is related to the burden of atherosclerotic coronary artery disease.