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Regarding the elegant and innovative study by Vivekananthan et al., entitled “Heart Rate Recovery After Exercise Is a Predictor of Mortality, Independent of the Angiographic Severity of Coronary Disease” recently published in JACC(1), I must object that the title of such a good report is substantially wrong. In fact, the word “exercise” should have been more precisely substituted with the words “treadmill-exercise.” This is definitely not a trivial correction, for no study has ever demonstrated that heart rate recovery (HRR) after any type of exercise other than treadmill has any relation with mortality. My group has completed a study of 1-min HRR after cycloergometer-exercise test as a predictor of mortality in a cohort of 1,420 real-life exercise-test candidates; we found substantial differences compared to the treadmill-derived parameter. I can surely state that no evidence has ever been published in the peer-reviewed medical literature linking HRR and mortality using any exercise modality other than treadmill-exercise. This should be emphasized, as many clinicians could be tempted to apply these results to other clinical exercise settings.
- American College of Cardiology Foundation