Abnormal chronotropic reserve and heart rate recovery in patients with SLE: a case–control study

Abstract

Abnormal heart-rate (HR) response during or after a graded exercise test has been recognized as a strong and an independent predictor of all-cause mortality in healthy and diseased subjects. The purpose of the present study was to evaluate the HR response during exercise in women with systemic lupus erythematosus (SLE). In this case-control study, 22 women with SLE (age 29.5 ± 1.1 years) were compared with 20 gender-, BMI-, and age-matched healthy subjects (age 26.5 ± 1.4 years). A treadmill cardiorespiratory test was performed and HR response during exercise was evaluated by the chronotropic reserve (CR). HR recovery (ΔHRR) was defined as the difference between HR at peak exercise and at both first (ΔHRR1) and second (ΔHRR2) minutes after exercising. SLE patients presented lower peak VO(2) when compared with healthy subjects (27.6 ± 0.9 vs. 36.7 ± 1.1 ml/kg/min, p = 0.001, respectively). Additionally, SLE patients demonstrated lower CR (71.8 ± 2.4 vs. 98.2 ± 2.6%, p = 0.001), ΔHRR1 (22.1 ± 2.5 vs. 32.4 ± 2.2%, p = 0.004) and ΔHRR2 (39.1 ± 2.9 vs. 50.8 ± 2.5%, p = 0.001) than their healthy peers. In conclusion, SLE patients presented abnormal HR response to exercise, characterized by chronotropic incompetence and delayed ΔHRR.

Impaired Aerobic Capacity in Systemic Lupus Erythematosus Patients: What are the Physiological Mechanisms

“…In this sense, Prado et al [6] observed abnormal chronotropic response during cardiorespiratory exercise testing in SLE women. Moreover, prior evidence [21,25] has demonstrated lower oxygen pulse during cardiorespiratory exercise tests in SLE woman suggesting blunted inotropic response.…”

“…A growing number of investigations have shown cardiorespiratory abnormalities during exercise in SLE patients [6,8,17,20]. In this sense, Prado et al [6] observed abnormal chronotropic response during cardiorespiratory exercise testing in SLE women.…”

“…There is a growing body of evidence indicating impaired aerobic capacity in SLE patients [4][5][6][7]. For instance, Keyser et al [5] Additionally, Robb-Nicholson et al [18] showed that SLE patients performed at 45% of expected VO 2max , while Tench et al [19] concluded that SLE women exhibited poor exercise capacity, having a VO 2max 62% of the average expected value in healthy females of the same age (normality>85% VO 2max predicted) ( Furthermore, in a more recent study on childhood-onset SLE, Prado et al [22] observed both lower exercise tolerance and aerobic capacity when compared with healthy control children.…”

“…Although its pathogenesis is believed to lie in the dysregulation of the immune system, the involvement of various organ systems often leads to secondary comorbidities resulting from renal failure, hypertension, and central nervous system disorders [2]. Furthermore, SLE patients can present limitations in exercise capacity and reduced quality of life due to various clinical conditions such as fatigue, cardiorespiratory disease and muscle involvement [3][4][5][6]. In this sense, the ability to sustain daily physical activities is inextricably linked to the integrity of the oxygen (O 2 ) transport pathway, which in turn depends on several multi-organ interactions involving the heart and vessels, lungs, respiratory/peripheral muscles and autonomic nervous systems [7].…”

“…In this sense, the ability to sustain daily physical activities is inextricably linked to the integrity of the oxygen (O 2 ) transport pathway, which in turn depends on several multi-organ interactions involving the heart and vessels, lungs, respiratory/peripheral muscles and autonomic nervous systems [7]. In fact, impaired tissue O 2 transport due to altered perfusive and/or diffusive processes during exercise are pathophysiological factors that may be associated with poor exercise capacity in SLE patients [6,8].…”