| Chronotropic incompetence, beta-blockers, and functional capacity in advanced congestive heart failure: time to pace? | |
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MedLine Citation:
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PMID: 18096432 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Chronotropic incompetence (CI) is often seen in subjects with chronic congestive heart failure (CHF). The prevalence of CI, its mechanisms and association with beta-blocker use as well as exercise capacity have not been clearly defined. METHODS AND RESULTS: Cardiopulmonary exercise tolerance testing data for 278 consecutive patients with systolic CHF was analyzed. CI, defined as the inability to reach 80% of maximally predicted heart rate was present in 128 of 278 subjects (46%). The prevalence of CI was highest in those with most impaired exercise capacity (72, 48, and 24% for subjects with a VO(2) of <14.0, 14.0-20.0, and >20.0 ml/kg/min respectively; p=0.001). While subjects with CI had lower peak exercise heart rate (114 vs. 152 bpm), and lower peak VO(2) (15.4 vs. 19.9 ml/kg/min), they were equally likely to be on chronic beta-blocker therapy (74% vs. 71%; p=0.51). Heart rate and norepinephrine (NE) levels were measured during exercise in a separate cohort of 24 subjects with CHF. There was no difference in beta-blocker dose between subjects with and without CI, however, exercise induced NE release and Chronotropic Responsiveness Index, a measure of post-synaptic beta-receptor sensitivity to NE, were lower in subjects with CI (1687+/-911 vs. 2593+/-1451 pg/ml p=0.08; CRI 12.7+/-5.7 vs. 22.1+/-4.7, p=0.002). CONCLUSIONS: CI occurs in >70% of subjects with advanced systolic CHF irrespective of beta-blocker use and is associated with a trend toward impaired NE release, post-synaptic beta-receptor desensitization and reduced exercise capacity. |
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Authors:
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Ulrich P Jorde; Timothy J Vittorio; Michael E Kasper; Emma Arezzi; Paolo C Colombo; Rochelle L Goldsmith; Kartikya Ahuja; Chi-Hong Tseng; Francois Haas; David S Hirsh |
Publication Detail:
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Type: Journal Article Date: 2007-12-21 |
Journal Detail:
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Title: European journal of heart failure Volume: 10 ISSN: 1388-9842 ISO Abbreviation: Eur. J. Heart Fail. Publication Date: 2008 Jan |
Date Detail:
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Created Date: 2008-01-08 Completed Date: 2008-06-03 Revised Date: 2011-06-08 |
Medline Journal Info:
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Nlm Unique ID: 100887595 Medline TA: Eur J Heart Fail Country: Netherlands |
Other Details:
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Languages: eng Pagination: 96-101 Citation Subset: IM |
Affiliation:
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Division of Cardiology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, United States. upj1@columbia.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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administration & dosage* Exercise / physiology* Exercise Tolerance / physiology* Female Heart Failure* / blood, drug therapy, physiopathology Heart Rate / drug effects, physiology* Humans Male Middle Aged Norepinephrine / blood Oxygen Consumption / physiology* Stimulation, Chemical Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 51-41-2/Norepinephrine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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