Chronotropic incompetence predicts impaired response to exercise training in heart failure patients with sinus rhythm

Schmid, Jean‐Paul; Zurek, Marzena; Saner, Hugo

doi:10.1177/2047487312444368

Cited by 49 publications

(44 citation statements)

References 29 publications

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“…Several studies suggested that a poor exercise‐induced HR response is an independent predictor of worse outcomes in several cardiovascular diseases , as well as in an apparently healthy population . Although the specific underlying mechanisms are far from being elucidated, this clinical feature has been attributed—in systolic HF patients—to a reduced myocardial sensitivity to sympathetic modulation together with a beta‐receptor down‐regulation, as well as to the anatomical and electrophysiological changes in the properties of the sinus node .…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular mortality and chronotropic incompetence in systolic heart failure: the importance of a reappraisal of current cut‐off criteria

Magrì

Corrà

Lenarda

et al. 2013

European J of Heart Fail

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Aims An independent role for the exercise‐induced heart rate (HR) response—and specifically the chronotropic incompetence (CI)—in the prognosis of heart failure (HF) is still debated. The multicentre study reported here sought to investigate the prognostic values of HR and CI variables on cardiovascular mortality in a large cohort of systolic HF patients. Methods and results A total of 1045 HF patients were recruited and prospectively followed in three Italian HF centres. The study endpoint was cardiovascular mortality. Besides a full clinical examination, each patient underwent a maximal cardiopulmonary exercise test at study enrolment. The age‐predicted peak HR (%pHR) and the peak HR reserve (%pHRR) according to different cut‐off values (60–80% of the maximum predicted) were adopted to identify the presence of CI. The median follow‐up was 876 days (interquartile range 386–1590 days). Cardiovascular death occurred in 145 cases (13.8%). Besides LVEF, peak oxygen uptake, ventilation vs. carbon dioxide production slope, and beta‐blocker therapy, the multivariate analysis showed that both %pHR and %pHRR were able to predict prognosis when considered as continuous variables. Conversely, the presence of CI was associated with the study endpoint only when the 70% (%pHR <70%, hazard ratio 1.80, confidence interval 1.24–2.61, P = 0.002; %pHRR <70%, hazard ratio 1.77, confidence interval 1.09–2.86, P = 0.020) or the 65% cut‐off values (%pHR <65%, hazard ratio 2.04, confidence interval 1.34–3.10, P = 0.001; %pHRR <65%, hazard ratio 1.54, confidence interval 1.03–2.32, P = 0.038) were adopted. Conclusions Our findings demonstrated an additive role of CI in stratifying cardiovascular mortality. Both the 65% and the 70% cut‐off values, regardless of the method (%pHR and %pHRR), allow identification of HF patients with the worst prognosis, thus supporting such definitions of CI in HF.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular mortality and chronotropic incompetence in systolic heart failure: the importance of a reappraisal of current cut‐off criteria

Magrì

Corrà

Lenarda

et al. 2013

European J of Heart Fail

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“…The poor response to rehabilitation in a subgroup of patients does not seem to be COPD-specific and/or rehabilitation-specific. Indeed, also subgroups of patients with chronic neurological diseases [35], chronic cardiac diseases [36], or chronic musculoskeletal diseases [37] respond poorly to specialised rehabilitative interventions. Moreover, response to pharmacological therapy [38,39], ambulatory oxygen therapy [40], bronchoscopic interventions [41] and lung volume reduction surgery [42] is also poor in subgroups of patients with COPD.…”

Section: Poor Response To Pulmonary Rehabilitationmentioning

confidence: 99%

Differential response to pulmonary rehabilitation in COPD: multidimensional profiling

et al. 2015

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The aim of the present study was to profile a multidimensional response to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD).Dyspnoea, exercise performance, health status, mood status and problematic activities of daily life were assessed before and after a 40-session pulmonary rehabilitation programme in 2068 patients with COPD (mean forced expiratory volume in 1 s of 49% predicted). Patients were ordered by their overall similarity concerning their multidimensional response profile, which comprises the overall response on MRC dyspnoea grade, 6MWD, cycle endurance time, Canadian Occupational Performance Measure performance and satisfaction scores, Hospital Anxiety and Depression Scale anxiety and depression, and St George's Respiratory Questionnaire total score, using a novel non-parametric regression technique.Patients were clustered into four groups with distinct multidimensional response profiles: n=378 (18.3%; "very good responder"), n=742 (35.9%; "good responder"), n=731 (35.4%; "moderate responder"), and n=217 (10.5%; "poor responder"). Patients in the "very good responder" cluster had higher symptoms of dyspnoea, number of hospitalisations <12 months, worse exercise performance, worse performance and satisfaction scores for problematic activities of daily life, more symptoms of anxiety and depression, worse health status, and a higher proportion of patients following an inpatient PR programme compared to the other three clusters.A multidimensional response outcome needs to be considered to study the efficacy of pulmonary rehabilitation services in patients with COPD, as responses to regular outcomes are differential within patients with COPD. @ERSpublications Efficacy of pulmonary rehabilitation in patients with COPD needs to be assessed using a multidimensional response http://ow.ly/RsfYK

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“…The contribution of stroke volume to cardiac output at high altitude is therefore limited and it is the heart rate reserve which plays a pivotal role in the haemodynamic adaptation to physical effort. This mechanism becomes particularly important in patients with reduced systolic function because, in addition to the reduced myocardial contractility, stroke volume in HF patients may be further impaired due to significant mitral regurgitation, decreased ventricular compliance, or pericardial constraint. Unfortunately, these patients often present a reduced heart rate reserve, which might limit their ability to adapt to high altitude.…”

Section: Discussionmentioning

confidence: 99%

Short‐term high altitude exposure at 3454 m is well tolerated in patients with stable heart failure

Schmid

Nobel

Brugger

et al. 2015

European J of Heart Fail

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AimsHigh altitude exposure for the purpose of tourism is very popular in mountainous regions and is considered to be safe for patients with stable CAD and preserved LV function. The purpose of this study was to evaluate the haemodynamic response to exercise and electrical stability by Holter monitoring in patients with chronic heart failure (HF) Methods and resultsWe studied 29 HF patients with a peak VO 2 >50% of the predicted (25 men, age 60.0 ± 8.9 years, EF 28.8 ± 5.4%) at 540 and 3454 m after an ascent using public transport. Assessments of exercise capacity (cardiopulmonary exercise test), haemodynamic response (inert gas rebreathing system), and susceptibility to arrhythmias (Holter ECG recording) were performed. None of the patients (19 with ischaemic heart disease, 11 with an implantable cardioverter defibrillator) had to return prematurely to the lowland site. Two patients presented symptoms of mild mountain sickness, and one patient developed a self-limited ventricular tachycardia during maximal exercise at high altitude. Mean peak VO 2 at the lowland site was 18.5 ± 3.6 mL/min/kg and decreased by 22.2% (P < 0.001) at high altitude. Mean resting heart rate increased from 74.3 ± 12.3 to 83.3 ± 13.4 b.p.m., P < 0.001. No statistically significant difference in premature ventricular contractions (92 ± 150/h at 540 m vs. 111 ± 196/h at 3454 m, P = 0.284) was noted.

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Chronotropic incompetence predicts impaired response to exercise training in heart failure patients with sinus rhythm

Abstract: The presence of impaired chronotropic competence is a major predictor of poor training response in CHF patients with sinus rhythm.

Cited by 49 publications

References 29 publications

Cardiovascular mortality and chronotropic incompetence in systolic heart failure: the importance of a reappraisal of current cut‐off criteria

Cardiovascular mortality and chronotropic incompetence in systolic heart failure: the importance of a reappraisal of current cut‐off criteria

Differential response to pulmonary rehabilitation in COPD: multidimensional profiling

Short‐term high altitude exposure at 3454 m is well tolerated in patients with stable heart failure

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