Document Detail

Impaired heart rate recovery and chronotropic incompetence in patients with heart failure with preserved ejection fraction.
MedLine Citation:
PMID:  19917649     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: This study assessed the chronotropic response to exercise and heart rate (HR) recovery after exercise in a carefully phenotyped group of patients with heart failure with preserved left ventricular ejection fraction (HfpEF) and a control group of similar age and gender distribution. METHODS AND RESULTS: We studied 41 patients with HfpEF, 41 healthy controls, and 16 hypertensive controls. None were taking HR-limiting medications. All study participants had clinical examination, 12-lead ECG, pulmonary function test, echocardiogram, and metabolic exercise test with HR monitoring throughout exercise. Chronotropic response was measured by the percentage of the HR reserve used during maximal exercise and the peak exercise HR as a percentage of predicted maximal HR. Patients with HfpEF were generally women (70%), overweight, aged 69+/-8 years. Controls were of similar gender (63%) and age (67+/-6 years). Patients with HfpEF had significantly reduced peak VO(2) compared with controls (20+/-4 mL kg(-1) min(-1) versus 31+/-6 mL kg(-1) min(-1), P<0.001) and greater minute ventilation-carbon dioxide production relationship (V(E)/V(CO2)) slope) (33+/-6 versus 29+/-4, P<0.001). Chronotropic incompetence was significantly more common in patients with HfpEF compared with matched healthy controls as measured by the percentage of the HR reserve used during maximal exercise (63% versus 2%, <0.001) and percentage of predicted maximal HR (34% versus 2%, <0.001). In addition, abnormal HR recovery 1-minute after exercise (defined as the reduction in the HR from peak exercise 1-minute after exercise) was also significantly more common in patients with HfpEF compared with controls (23% versus 2%, P=0.01). Hypertensive controls showed similar chronotropic response to peak exercise and HR recovery after exercise as healthy controls. CONCLUSIONS: Patients with HfpEF have impaired chronotropic incompetence during maximal exercise and abnormal HR recovery after exercise.
Thanh Trung Phan; Ganesh Nallur Shivu; Khalid Abozguia; Chris Davies; Mohammad Nassimizadeh; Donie Jimenez; Rebekah Weaver; Ibrar Ahmed; Michael Frenneaux
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-11-16
Journal Detail:
Title:  Circulation. Heart failure     Volume:  3     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-20     Completed Date:  2010-02-16     Revised Date:  2010-03-23    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  29-34     Citation Subset:  IM    
Department of Cardiovascular Medicine, University of Birmingham, Birmingham, United Kingdom.
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MeSH Terms
Case-Control Studies
Exercise Test
Exercise Tolerance*
Heart Failure / physiopathology*
Heart Rate*
Middle Aged
Stroke Volume*
Grant Support
//British Heart Foundation
Comment In:
Circ Heart Fail. 2010 Mar;3(2):e1; author reply e2   [PMID:  20233984 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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