Related Experiment Video
Updated: Mar 7, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Relation of heart rate recovery after exercise testing to coronary artery calcification
Sae Young Jae1, Sudhir Kurl2, Jari A Laukkanen2
1a Department of Sport Science , University of Seoul , Seoul , South Korea.
Insights
Slow heart rate recovery (HRR) after exercise indicates impaired autonomic function and is linked to coronary artery calcification (CAC). This suggests a connection between autonomic health and atherosclerosis burden.
Area of Science:
- Cardiology
- Autonomic Function
- Cardiovascular Disease
Background:
- Coronary artery calcification (CAC) is an emerging marker for coronary atherosclerosis.
- Slow heart rate recovery (HRR) after exercise is an indicator of impaired autonomic function.
- The relationship between HRR and CAC was previously unclear.
Purpose of the Study:
- To investigate the association between slow heart rate recovery (HRR) after exercise and coronary artery calcification (CAC).
- To determine if impaired autonomic function, as estimated by HRR, correlates with the presence of coronary atherosclerosis.
Main Methods:
- Evaluated 2088 men undergoing health screening with CAC measurement and cardiopulmonary exercise testing.
- Calculated HRR as the difference between peak and 2-minute recovery heart rate.
- Measured CAC using multidetector computed tomography; advanced CAC defined as >75th percentile for age.
Main Results:
- HRR was negatively correlated with CAC (r = -0.14, p < 0.01).
- Lowest HRR quartile (<38 bpm) had 1.59 times higher likelihood of advanced CAC compared to the highest quartile (>52 bpm), independent of risk factors.
- Each 1 bpm decrease in HRR was associated with a 1% increase in advanced CAC.
Conclusions:
- Attenuated HRR after exercise is associated with advanced CAC, independent of traditional coronary risk factors.
- This finding supports the hypothesis that slow HRR is related to the burden of atherosclerotic coronary artery disease.
- Slow HRR may serve as a non-invasive marker for assessing coronary atherosclerosis risk.
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.
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:20Exercise and Cardiovascular Response
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Coronary Artery Disease V: Interprofessional Care
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...