Heart rate recovery after orthostatic challenge and cardiopulmonary exercise testing in older individuals: prospective multicentre observational cohort study
Aaron James,
David Bruce,
Nicholas Tetlow,
Amour B.U. Patel,
Ethel Black,
Nicole Whitehead,
Anna Ratcliff,
Alice Jamie Humphreys,
Neil MacDonald,
Gayle McDonnell,
Ravishankar Raobaikady,
Jeeveththaa Thirugnanasambanthar,
Jeuela I. Ravindran,
Nicole Whitehead,
Gary Minto,
Tom E.F. Abbott,
Shaman Jhanji,
Don Milliken,
Gareth L. Ackland
Affiliations
Aaron James
Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, UK
David Bruce
Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden Hospital, London, UK
Nicholas Tetlow
Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden Hospital, London, UK
Amour B.U. Patel
Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary, University of London, UK
Ethel Black
Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden Hospital, London, UK
Nicole Whitehead
Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden Hospital, London, UK
Anna Ratcliff
Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, UK
Alice Jamie Humphreys
Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, UK
Neil MacDonald
Department of Anaesthesia and Perioperative Medicine, Royal London Hospital, London, UK
Gayle McDonnell
Department of Anaesthesia and Perioperative Medicine, Royal London Hospital, London, UK
Ravishankar Raobaikady
Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary, University of London, UK
Jeeveththaa Thirugnanasambanthar
Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary, University of London, UK
Jeuela I. Ravindran
Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary, University of London, UK
Nicole Whitehead
Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden Hospital, London, UK
Gary Minto
Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, UK
Tom E.F. Abbott
Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary, University of London, UK; Department of Anaesthesia and Perioperative Medicine, Royal London Hospital, London, UK
Shaman Jhanji
Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden Hospital, London, UK
Don Milliken
Department of Anaesthesia, Perioperative Medicine and Critical Care, Royal Marsden Hospital, London, UK
Gareth L. Ackland
Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary, University of London, UK; Department of Anaesthesia and Perioperative Medicine, Royal London Hospital, London, UK; Corresponding author. Translational Medicine and Therapeutics, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.
Background: Impaired vagal function in older individuals, quantified by the ‘gold standard’ delayed heart rate recovery after maximal exercise (HRRexercise), is an independent predictor of cardiorespiratory capacity and mortality (particularly when HRR ≤12 beats min−1). Heart rate also often declines after orthostatic challenge (HRRorthostatic), but the mechanism remains unclear. We tested whether HRRorthostatic reflects similar vagal autonomic characteristics as HRRexercise. Methods: Prospective multicentre cohort study of subjects scheduled for cardiopulmonary exercise testing (CPET) as part of routine care. Before undergoing CPET, heart rate was measured with participants seated for 3 min, before standing for 3 min (HRRorthostatic). HRRexercise 1 min after the end of CPET was recorded. The primary outcome was the correlation between mean heart rate change every 10 s for 1 min after peak heart rate was attained on standing and after exercise for each participant. Secondary outcomes were HRRorthostatic and peak VO2 compared between individuals with HRRexercise 12 beats min−1 (n=60; mean difference: 3 beats min−1 [95% confidence interval 1–5 beats min−1]; P<0.0001). Slower HRRorthostatic was associated with lower peak VO2 (mean difference: 3.7 ml kg-1 min−1 [95% confidence interval 0.7–6.8 ml kg-1 min−1]; P=0.039). Conclusion: Prognostically significant heart rate recovery after exhaustive exercise is characterised by quantitative differences in heart rate recovery after orthostatic challenge. These data suggest that orthostatic challenge is a valid, simple test indicating vagal impairment. Clinical trial registration: researchregistry6550.
