Document Detail


Chronotropic incompentence and functional capacity in chronic heart failure: no role of β-blockers and β-blocker dose.
MedLine Citation:
PMID:  20553283     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: To assess the effect of chronotropic incompetence on functional capacity in chronic heart failure (CHF) patients, as evaluated as NYHA and peak oxygen consumption (pVO(2) ), focusing on the presence and dose of β-blocker treatment.
METHODS: Nine hundred and sixty-seven consecutive CHF patients were evaluated, 328 of whom were discarded because they failed to meet the study criteria. Of the 639 analyzed, 90 were not treated with β-blockers whereas the other 549 were. The latter were further subdivided in high (n = 184) and low (n = 365) β-blockers daily dose group in accordance with an arbitrary cut-off of 25 mg for carvedilol and of 5 mg for bisoprolol. Failure to achieve 80% of the percentage of maximum age predicted peak heart rate (%Max PHR) or of HR reserve (%HRR) constituted chronotropic incompetence.
RESULTS: No differences were found in NYHA or pVO2 between patients with and without β-blockers and, similarly, between high and low β-blocker dose groups. Twenty and sixty-nine percent of not β-blocked patients showed chronotropic incompetence according to %Max PHR and %HRR, respectively, whereas this prevalence rose to 61% and 84% in those on β-blocker therapy. Patients taking β-blockers without chronotropic incompetence, as inferable from both %Max PHR and %HRR, showed higher NYHA and pVO2 regardless of drug dose, whereas, in not β-blocked patients, only %HRR revealed a difference in functional capacity. At multivariable analysis, HR increase during exercise (ΔHR) was the variable most strongly associated to pVO2 (β: 0.572; SE: 0.008; P < 0.0001) and NYHA class (β: -0.499; SE: 0.001; P < 0.0001).
CONCLUSIONS: ΔHR is a powerful predictor of CHF severity regardless of the presence of β-blocker therapy and of β-blocker daily dose.
Authors:
Damiano Magrì; Pietro Palermo; Filippo M Cauti; Mauro Contini; Stefania Farina; Gaia Cattadori; Anna Apostolo; Elisabetta Salvioni; Alessandra Magini; Carlo Vignati; Marina Alimento; Susanna Sciomer; Maurizio Bussotti; Piergiuseppe Agostoni
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Publication Detail:
Type:  Journal Article     Date:  2010-06-11
Journal Detail:
Title:  Cardiovascular therapeutics     Volume:  30     ISSN:  1755-5922     ISO Abbreviation:  Cardiovasc Ther     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-14     Completed Date:  2012-07-03     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  101319630     Medline TA:  Cardiovasc Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  100-8     Citation Subset:  IM    
Copyright Information:
© 2010 Blackwell Publishing Ltd.
Affiliation:
U.O. Cardiologia, S. Andrea Hospital, Sapienza University, Rome, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / administration & dosage*,  diagnostic use,  therapeutic use*
Aged
Bisoprolol / administration & dosage,  therapeutic use
Carbazoles / administration & dosage,  therapeutic use
Chronic Disease
Dose-Response Relationship, Drug
Echocardiography
Exercise Test
Exercise Tolerance
Female
Heart Failure / diagnosis*,  drug therapy,  physiopathology
Heart Rate / drug effects
Humans
Linear Models
Male
Middle Aged
Oxygen Consumption / drug effects,  physiology
Propanolamines / administration & dosage,  therapeutic use
Ventricular Function, Left / drug effects
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Carbazoles; 0/Propanolamines; 0K47UL67F2/carvedilol; 66722-44-9/Bisoprolol

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