{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T12:29:45Z","timestamp":1787574585761,"version":"build-2736575974"},"reference-count":30,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babes University of Medicine and Pharmacy Timisoara"},{"id":[{"id":"https:\/\/ror.org\/00afdp487","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: The Heart Rate Recovery Index (HRRI), derived from post-exercise heart rate recovery (HRR), reflects autonomic function and cardiovascular performance. Whether HRRI reflects early myocardial dysfunction and left atrial remodelling in heart failure with preserved ejection fraction (HFpEF) has not been previously examined. The H2FPEF score, which integrates clinical and echocardiographic parameters, is used to assess the likelihood of HFpEF. This study investigates the relationship between HRRI, H2FPEF score, and echocardiographic markers of longitudinal systolic function, including mitral annular plane systolic excursion (MAPSE), as well as left atrial volume index (LAVI), in patients with preserved left ventricular ejection fraction. Methods: A prospective observational study included 241 patients referred for cardiac exercise testing at the Institute of Cardiovascular Diseases Timisoara and the Clinical County Hospital of Sibiu. HRRI was calculated as the ratio of heart rate acceleration time (AT) to deceleration time (DT) during exercise testing. A comprehensive echocardiographic assessment was performed on all patients. Statistical analysis involved univariate testing and multivariable logistic regression with stepwise selection. Results: HRRI was significantly lower in HFpEF patients compared with those without heart failure (1.97 \u00b1 0.66 vs. 2.73 \u00b1 1.08, p &lt; 0.01). HRRI correlated significantly with exercise performance, age, H2FPEF score, and echocardiographic markers of diastolic and longitudinal systolic dysfunction. ROC analysis identified an HRRI cut-off value of 2.25 for HFpEF detection (AUC = 0.748), while HRRI remained significantly associated with HFpEF after adjustment for the covariates included in the model. The combined HRRI\u2013H2FPEF score improved diagnostic discrimination compared with the H2FPEF score alone (AUC 0.897 vs. 0.858), achieving an overall classification accuracy of 82.2%. Conclusions: In our study, HRRI is significantly reduced in HFpEF and distinguishes patients with and without heart failure. It shows associations with echocardiographic markers of diastolic and longitudinal systolic dysfunction, exercise capacity, and H2FPEF score.<\/jats:p>","DOI":"10.3390\/jcm15176510","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:47:19Z","timestamp":1787572039000},"page":"6510","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Heart Rate Recovery Index as a Functional Marker in Heart Failure with Preserved Ejection Fraction: Associations with H2FPEF Score, Longitudinal Systolic Function and Left Atrial Remodelling"],"prefix":"10.3390","volume":"15","author":[{"given":"Andreea","family":"Dache","sequence":"first","affiliation":[{"name":"Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"},{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"V\u0103c\u0103rescu","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"},{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1121-3788","authenticated-orcid":false,"given":"Minodora","family":"Teodoru","sequence":"additional","affiliation":[{"name":"County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania"},{"name":"Medical Clinical Department, Faculty of Medicine, \u201cLucian Blaga\u201d University, 550024 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9384-5584","authenticated-orcid":false,"given":"Mihai Octavian","family":"Negrea","sequence":"additional","affiliation":[{"name":"Medical Clinical Department, Faculty of Medicine, \u201cLucian Blaga\u201d University, 550024 Sibiu, Romania"},{"name":"Sibiu Municipal Hospital, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7351-741X","authenticated-orcid":false,"given":"Cristina","family":"Tudoran","sequence":"additional","affiliation":[{"name":"Department VII, Internal Medicine II, Discipline of Cardiology, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Department of Cardiology, County Emergency Hospital \u201cPius Br\u00eenzeu\u201d, 300723 Timisoara, Romania"},{"name":"Centre of Molecular Research in Nephrology and Vascular Disease, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1330-8191","authenticated-orcid":false,"given":"Alexandra-Iulia","family":"Laz\u0103r-H\u00f6cher","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liviu","family":"Cirin","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelina Andreea","family":"Faur-Grigori","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"},{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2190-0337","authenticated-orcid":false,"given":"Bogdan-Simion","family":"Suciu","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"},{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7378-7787","authenticated-orcid":false,"given":"Drago\u0219","family":"Cozma","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"},{"name":"Department of Cardiology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Research Center of the Institute of Cardiovascular Diseases, 300310 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1146\/annurev-med-042220-022745","article-title":"Heart Failure with Preserved Ejection Fraction: Mechanisms and Treatment Strategies","volume":"73","author":"Omote","year":"2022","journal-title":"Annu. 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