Chronotropic incompetence and coronary artery disease

Anjos-Andrade, Fernando D; Sousa, Antônio Carlos Sobral; Barreto‐Filho, José Augusto; Alves, Erica O; Nascimento-Junior, Adão C.; Santana, Nathalie Oliveira de; Vasconcelos, Francis Lima; Garcez, Flávia Barreto; Araújo, Vanessa P.; Araujo, Ana Carla Pereira de; Santos, Bruno Fernandes de Oliveira; Silveira, Débora Consuelo Rocha; Amorim, Rívia Siqueira; Garcia, Diego Leonardo Cruz Lima; Filho, José Carlos Sizino Franco; Neto, Antônio Aristides de Sá; Calasans, Flávia Ricci; Melo, Enaldo Vieira de; Oliveira, Joselina Luzia Menezes

doi:10.1080/ac.65.6.2059859

Cited by 7 publications

(5 citation statements)

References 30 publications

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“…Previous studies suggested that several factors other than beta-blocker treatment could affect HR response during exercise, including age, body weight, functional capacity, cardiac function, high max CK-MB, diabetes mellitus, and heart failure after MI [22,23,24,25,26]. The present study used MCR as an indicator of HR response, because MCR allows for the assessment of HR response without the effects of age, physical fitness, or functional capacity [15,16].…”

Section: Discussionmentioning

confidence: 99%

Effects of αβ-Blocker Versus β1-Blocker Treatment on Heart Rate Response During Incremental Cardiopulmonary Exercise in Japanese Male Patients with Subacute Myocardial Infarction

Nemoto

Kasahara

Izawa

et al. 2019

IJERPH

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A simplified substitute for heart rate (HR) at the anaerobic threshold (AT), i.e., resting HR plus 30 beats per minute or a percentage of predicted maximum HR, is used as a way to determine exercise intensity without cardiopulmonary exercise testing (CPX) data. However, difficulties arise when using this method in subacute myocardial infarction (MI) patients undergoing beta-blocker therapy. This study compared the effects of αβ-blocker and β1-blocker treatment to clarify how different beta blockers affect HR response during incremental exercise. MI patients were divided into αβ-blocker (n = 67), β1-blocker (n = 17), and no-β-blocker (n = 47) groups. All patients underwent CPX one month after MI onset. The metabolic chronotropic relationship (MCR) was calculated as an indicator of HR response from the ratio of estimated HR to measured HR at AT (MCR-AT) and peak exercise (MCR-peak). MCR-AT and MCR-peak were significantly higher in the αβ-blocker group than in the β1-blocker group (p < 0.001, respectively). Multiple regression analysis revealed that β1-blocker but not αβ-blocker treatment significantly predicted lower MCR-AT and MCR-peak (β = −0.432, p < 0.001; β = −0.473, p < 0.001, respectively). Based on these results, when using the simplified method, exercise intensity should be prescribed according to the type of beta blocker used.

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Section: Discussionmentioning

confidence: 99%

Effects of αβ-Blocker Versus β1-Blocker Treatment on Heart Rate Response During Incremental Cardiopulmonary Exercise in Japanese Male Patients with Subacute Myocardial Infarction

Nemoto

Kasahara

Izawa

et al. 2019

IJERPH

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“…The slight increase in heart rate may be attributed to transient alterations in blood flow on the atrial wall 31 , progressive reductions in systolic volume or ventricular compliance alterations produced by diastolic dysfunction 32 .…”

Section: Discussionmentioning

confidence: 99%

Does the Aging Process Significantly Modify the Mean Heart Rate?

Santos¹,

Sousa²,

Reis³

et al. 2013

Arquivos Brasileiros De Cardiologia

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BackgroundThe Mean Heart Rate (MHR) tends to decrease with age. When adjusted for gender and diseases, the magnitude of this effect is unclear. ObjectiveTo analyze the MHR in a stratified sample of active and functionally independent individuals. MethodsA total of 1,172 patients aged ≥ 40 years underwent Holter monitoring and were stratified by age group: 1 = 40-49, 2 = 50-59, 3 = 60-69, 4 = 70-79, 5 = ≥ 80 years. The MHR was evaluated according to age and gender, adjusted for Hypertension (SAH), dyslipidemia and non-insulin dependent diabetes mellitus (NIDDM). Several models of ANOVA, correlation and linear regression were employed. A two-tailed p value <0.05 was considered significant (95% CI). ResultsThe MHR tended to decrease with the age range: 1 = 77.20 ± 7.10; 2 = 76.66 ± 7.07; 3 = 74.02 ± 7.46; 4 = 72.93 ± 7.35; 5 = 73.41 ± 7.98 (p < 0.001). Women showed a correlation with higher MHR (p <0.001). In the ANOVA and regression models, age and gender were predictors (p < 0.001). However, R2 and ETA2 < 0.10, as well as discrete standardized beta coefficients indicated reduced effect. Dyslipidemia, hypertension and DM did not influence the findings. ConclusionThe MHR decreased with age. Women had higher values of MHR, regardless of the age group. Correlations between MHR and age or gender, albeit significant, showed the effect magnitude had little statistical relevance. The prevalence of SAH, dyslipidemia and diabetes mellitus did not influence the results.

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“…In a follow-up analysis, limiting our observations to those with at least 2 years of follow-up did not materially change our results (data not shown). Since chronotropic incompetence is associated with prevalent coronary heart disease, 34 exclusion of participants who failed to reach 85% of age-predicted maximal heart rate not only decreased the possibility of reverse causation, but also reduced the chances for misclassifying fitness category. We also controlled for a number of potentially confounding variables in the analyses.…”

Section: Discussionmentioning

confidence: 99%

Associations among cardiorespiratory fitness, C-reactive protein, and all-cause mortality in men and women

Farrell

Léonard

Barlow

et al. 2023

Journal of Investigative Medicine

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We examined individual and joint associations among high-sensitivity C-reactive protein (CRP), cardiorespiratory fitness (fitness), and mortality in healthy men and women. Between January 1, 2000 and December 31, 2016, 30,077 adults (31.3% women) received a comprehensive physical examination. Fitness was determined from maximal treadmill exercise test duration. Participants were categorized as unfit (Quintile 1) and fit (Quintiles 2–5), and by normal (<2 mg/L) and elevated (≥2 mg/L) CRP categories. Adjusted hazard ratios (HRs) with 95% confidence interval (CI) for all-cause mortality were computed with Cox regression. During an average of 10.1 years of follow-up, 576 deaths occurred. Following adjustment for age, smoking status, sex, exam year, body mass index, systolic blood pressure, total cholesterol, triglyceride:high-density lipoprotein ratio, and fasting glucose, HR (95% CI) for all-cause mortality were 1.0 (referent) and 1.52 (1.14–2.02) for fit and unfit categories, respectively. Corresponding values for normal and elevated CRP categories were 1.0 and 1.50 (1.20–1.89), respectively. When grouped by fitness and CRP category, there was significantly greater mortality risk in the unfit than the fit category within the elevated CRP category (HR = 1.77 (1.14–2.75)), but not in the normal CRP category (HR = 1.38 (0.96–1.98)). Each 1 metabolic equivalent increment in fitness and 1 mg/L increment in CRP were associated with 10.0% (95% CI: 5.1–14.8%) decreased and 7.3% (95% CI: 2.0%–12.9%) increased mortality hazard, respectively. Compared to the unfit, fit individuals have an attenuated mortality risk within each CRP category. Thus, higher fitness appears to provide some protection against all-cause mortality, particularly among those with elevated levels of inflammation.

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Chronotropic incompetence and coronary artery disease

Abstract: Chronotropic incompetence is associated with ventricular dysfunction in peak exercise and critical right coronary artery lesions.

Cited by 7 publications

References 30 publications

Effects of αβ-Blocker Versus β1-Blocker Treatment on Heart Rate Response During Incremental Cardiopulmonary Exercise in Japanese Male Patients with Subacute Myocardial Infarction

Effects of αβ-Blocker Versus β1-Blocker Treatment on Heart Rate Response During Incremental Cardiopulmonary Exercise in Japanese Male Patients with Subacute Myocardial Infarction

Does the Aging Process Significantly Modify the Mean Heart Rate?

Associations among cardiorespiratory fitness, C-reactive protein, and all-cause mortality in men and women

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