AbstractBackgroundPrevious research has demonstrated the prognostic value of echocardiography with tissue Doppler imaging (TDI) in the heart failure (HF) population. Heart rate recovery (HRR) has also recently shown promise as a prognostic marker.HypothesisWe hypothesize echocardiography with TDI and HRR will be significantly correlated and both will provide prognostic information.MethodsA total of 243 subjects underwent echocardiography with TDI and maximal exercise testing to determine: (1) the ratio between mitral early (E) to mitral annular (E′) and E to mitral late (A) velocity; (2) left ventricular ejection fraction (LVEF); (3) left ventricular (LV) mass; (4) LV end‐systolic volume (LVESV); and (5) HRR at 1 minute postexercise (HRR1).ResultsHRR1 was significantly correlated with LVEF (r = 0.14, P = .03), LV mass (r = − 0.30, P <.001), E/A (r = − 0.22, P = .001), and E/E′ (r = − 0.49, P <.001). Multivariate Cox regression analysis revealed HRR1 was the strongest predictor of cardiac mortality (χ2: 55.5, P <.001); LV mass (residual χ2: 13.1, P <.001), E/E′ (residual χ2: 11.2, P = .001), and LVESV (residual χ2: 5.9, P = .015) all added significant prognostic value and were retained in the regression while LVEF was removed (residual χ2: 0.008, P = .93).ConclusionsTo our knowledge, this is the first investigation demonstrating an association between HRR and variables obtained from echocardiography with TDI in subjects with HF. The combination of both assessment techniques provides improved prognostic discrimination. Copyright © 2010 Wiley Periodicals, Inc.