One-minute heart rate recovery and clinical outcomes in transthyretin cardiac amyloidosis: incremental model fit beyond conventional CPET indices
Abstract
Aims: To assess the association of 1-min heart rate recovery (HRR1) with clinical outcomes and its incremental contribution to model fit beyond peak VO2 and ventilatory efficiency (VE/VCO2 slope) in transthyretin cardiac amyloidosis (ATTR-CM).
Methods and results: Consecutive adults with confirmed ATTR-CM undergoing symptom-limited cardiopulmonary exercise testing (CPET) were included in this single-centre observational study. During standardized active recovery at 24 W, HRR1 was defined as peak heart rate minus heart rate exactly 60 s after exercise. Cox proportional-hazards models evaluated all-cause mortality and the composite of mortality or first heart-failure hospitalization. Principal models adjusted for age, sex, peak VO2 and VE/VCO2 slope; NT-proBNP and National Amyloidosis Centre (NAC) stage were examined separately. Of 161 baseline patients, 11 with unverifiable heart-rate measurements were excluded, and exact HRR1 was available in 110. Mortality analysis included 105 patients with 33 deaths; composite-outcome analysis included 107 patients with 51 events. Median HRR1 was 15.5 bpm. In conventional CPET-adjusted models, each 10-bpm greater HRR1 was associated with lower hazards of mortality [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.44–0.95; P = 0.028] and the composite outcome (HR 0.74, 95% CI 0.57–0.97; P = 0.029). Adding HRR1 improved model fit (likelihood-ratio P = 0.017 and P = 0.021, respectively); apparent C-indices increased from 0.770 to 0.795 for mortality and from 0.695 to 0.699 for the composite outcome. Associations were non-significant after separate adjustment for NT-proBNP or NAC stage.
Conclusion: HRR1 remained associated with outcomes after CPET adjustment and improved model fit. Discrimination gains were modest; value beyond biomarker staging was unproven.
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BibTeX
@article{kosters2026oneminute,
title = {{One-minute heart rate recovery and clinical outcomes in transthyretin cardiac amyloidosis: incremental model fit beyond conventional CPET indices}},
author = {Antonio Kösters and Nikita Ermolaev and Mahshid Eslami and Leonhard Lichtblau and Lisa Seilinger and Stefanie Pahr and Mariusz Grzeda and Roza Badr Eslam},
journal = {European heart journal open},
year = {2026},
month = oct,
doi = {10.1093/ehjopen/oeag181},
url = {https://europepmc.org/article/PMC/PMC13728343},
note = {CC BY},
}
RIS
TY - JOUR
TI - One-minute heart rate recovery and clinical outcomes in transthyretin cardiac amyloidosis: incremental model fit beyond conventional CPET indices
AU - Antonio Kösters
AU - Nikita Ermolaev
AU - Mahshid Eslami
AU - Leonhard Lichtblau
AU - Lisa Seilinger
AU - Stefanie Pahr
AU - Mariusz Grzeda
AU - Roza Badr Eslam
PY - 2026
DA - 2026/10/22
JO - European heart journal open
DO - 10.1093/ehjopen/oeag181
UR - https://europepmc.org/article/PMC/PMC13728343
AB - Aims: To assess the association of 1-min heart rate recovery (HRR1) with clinical outcomes and its incremental contribution to model fit beyond peak VO2 and ventilatory efficiency (VE/VCO2 slope) in transthyretin cardiac amyloidosis (ATTR-CM). Methods and results: Consecutive adults with confirmed ATTR-CM undergoing symptom-limited cardiopulmonary exercise testing (CPET) were included in this single-centre observational study. During standardized active recovery at 24 W, HRR1 was defined as peak heart rate minus heart rate exactly 60 s after exercise. Cox proportional-hazards models evaluated all-cause mortality and the composite of mortality or first heart-failure hospitalization. Principal models adjusted for age, sex, peak VO2 and VE/VCO2 slope; NT-proBNP and National Amyloidosis Centre (NAC) stage were examined separately. Of 161 baseline patients, 11 with unverifiable heart-rate measurements were excluded, and exact HRR1 was available in 110. Mortality analysis included 105 patients with 33 deaths; composite-outcome analysis included 107 patients with 51 events. Median HRR1 was 15.5 bpm. In conventional CPET-adjusted models, each 10-bpm greater HRR1 was associated with lower hazards of mortality [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.44–0.95; P = 0.028] and the composite outcome (HR 0.74, 95% CI 0.57–0.97; P = 0.029). Adding HRR1 improved model fit (likelihood-ratio P = 0.017 and P = 0.021, respectively); apparent C-indices increased from 0.770 to 0.795 for mortality and from 0.695 to 0.699 for the composite outcome. Associations were non-significant after separate adjustment for NT-proBNP or NAC stage. Conclusion: HRR1 remained associated with outcomes after CPET adjustment and improved model fit. Discrimination gains were modest; value beyond biomarker staging was unproven.
SN - 2752-4191
ER -