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Griffith G, Lamotte G, Mehta N, Fan P, Nikolich J, Springman V, Suttman E, Joslin E, Balfany K, Dunlap M, Kohrt WM, Christiansen CL, Melanson EL, Josbeno D, Chahine LM, Patterson CG, Corcos DM. Chronotropic Incompetence During Exercise Testing as a Marker of Autonomic Dysfunction in Individuals with Early Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:121-133. [PMID: 38189712 PMCID: PMC10836543 DOI: 10.3233/jpd-230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND An attenuated heart rate response to exercise, termed chronotropic incompetence, has been reported in Parkinson's disease (PD). Chronotropic incompetence may be a marker of autonomic dysfunction and a cause of exercise intolerance in early stages of PD. OBJECTIVE To investigate the relationship between chronotropic incompetence, orthostatic blood pressure change (supine - standing), and exercise performance (maximal oxygen consumption, VO2peak) in individuals with early PD within 5 years of diagnosis not on dopaminergic medications. METHODS We performed secondary analyses of heart rate and blood pressure data from the Study in Parkinson's Disease of Exercise (SPARX). RESULTS 128 individuals were enrolled into SPARX (63.7±9.3 years; 57.0% male, 0.4 years since diagnosis [median]). 103 individuals were not taking chronotropic medications, of which 90 had a normal maximal heart rate response to exercise testing (155.3±14.0 bpm; PDnon-chrono) and 13 showed evidence of chronotropic incompetence (121.3±11.3 bpm; PDchrono, p < 0.05). PDchrono had decreased VO2peak compared to PDnon-chrono (19.7±4.5 mL/kg/min and 24.3±5.8 mL/kg/min, respectively, p = 0.027). There was a positive correlation between peak heart rate during exercise and the change in systolic blood pressure from supine to standing (r = 0.365, p < 0.001). CONCLUSIONS A subgroup of individuals with early PD not on dopaminergic medication had chronotropic incompetence and decreased VO2peak, which may be related to autonomic dysfunction. Evaluation of both heart rate responses to incremental exercise and orthostatic vital signs may serve as biomarkers of early autonomic impairment and guide treatment. Further studies should investigate whether cardiovascular autonomic dysfunction affects the ability to exercise and whether exercise training improves autonomic dysfunction.
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Affiliation(s)
- Garett Griffith
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Guillaume Lamotte
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Niyati Mehta
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Peng Fan
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Juliana Nikolich
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Victoria Springman
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Erin Suttman
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Elizabeth Joslin
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Katherine Balfany
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Wendy M. Kohrt
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado Veterans Affairs Geriatric Research, Education, and Clinical Center, Denver, CO, USA
| | - Cory L. Christiansen
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado Veterans Affairs Geriatric Research, Education, and Clinical Center, Denver, CO, USA
| | - Edward L. Melanson
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Eastern Colorado Veterans Affairs Geriatric Research, Education, and Clinical Center, Denver, CO, USA
| | - Deborah Josbeno
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lana M. Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
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Chronotropic incompetence: rediscovering phenotypes in heart failure with preserved ejection fraction. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023:S1885-5857(23)00043-9. [PMID: 36746230 DOI: 10.1016/j.rec.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/14/2022] [Indexed: 02/05/2023]
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Relationships among norepinephrine levels, exercise capacity, and chronotropic responses in heart failure patients. Heart Fail Rev 2023; 28:35-45. [PMID: 35325323 DOI: 10.1007/s10741-022-10232-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 02/07/2023]
Abstract
In heart failure (HF) patients, the pathophysiological mechanisms of severe exercise intolerance and impaired exercise capacity are related to both central and peripheral abnormalities. The central abnormalities in HF patients include impaired cardiac function and chronotropic incompetence (CI). Indeed, CI, the inability to adequately increase heart rate (HR) from rest to exercise often exhibited by HF patients, is related to activation of the sympathetic nervous system (SNS) yielding a rise in circulating norepinephrine (NE). CI may result from downregulation of β-adrenergic receptors, β-blocker usage, high baseline HR, or due to a combination of factors. This paper discusses the role of elevated NE in altering chronotropic responses in HF patients and consequently resulting in impaired exercise capacity. We suggest that future research should focus on the potential treatment of CI with rate-adaptive pacing, using a sensor to measure physical activity, without inducing deleterious hormonal activation of the sympathetic system.
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Forton K, Lamotte M, Gillet A, Chaumont M, van de Borne P, Faoro V. Beta-Adrenergic Receptor Blockade Effects on Cardio-Pulmonary Exercise Testing in Healthy Young Adults: A Randomized, Placebo-Controlled Trial. SPORTS MEDICINE - OPEN 2022; 8:150. [PMID: 36538192 PMCID: PMC9768047 DOI: 10.1186/s40798-022-00537-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 11/17/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Beta-blockers are increasingly prescribed while the effects of beta-adrenergic receptor blockade on cardio-pulmonary exercise test (CPET)-derived parameters remain under-studied. METHODS Twenty-one young healthy adults repeated three CPET at the same time with an interval of 7 days between each test. The tests were performed 3 h after a random, double-blind, cross-over single-dose intake of placebo, 2.5 mg or 5.0 mg bisoprolol, a cardio-selective beta1-adrenoreceptor antagonist. Gas exchange, heart rate (HR) and blood pressure (BP) were measured at rest and during cyclo-ergometric incremental CPET. RESULTS Maximal workload and VO2max were unaffected by the treatment, with maximal respiratory exchange ratio > 1.15 in all tests. A beta-blocker dose-dependent effect reduced resting and maximal BP and HR and the chronotropic response to exercise, evaluated by the HR/VO2 slope (placebo: 2.9 ± 0.4 beat/ml/kg; 2.5 mg bisoprolol: 2.4 ± 0.5 beat/ml/kg; 5.0 mg bisoprolol: 2.3 ± 0.4 beat/ml/kg, p < 0.001). Ventilation efficiency measured by the VE/VCO2 slope and the ventilatory equivalent for CO2 at the ventilatory threshold were not affected by beta1-receptor blockade. Post-exercise chronotropic recovery measured after 1 min was enhanced under beta1-blocker (placebo: 26 ± 7 bpm; 2.5 mg bisoprolol: 32 ± 6 bpm; 5.0 mg bisoprolol: 33 ± 6 bpm, p < 0.01). CONCLUSION The present results suggest that a single dose of bisoprolol does not affect metabolism, respiratory response and exercise capacity. However, beta-adrenergic blockade dose dependently reduces exercise hemodynamic response by lowering BP and the chronotropic response.
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Affiliation(s)
- Kevin Forton
- grid.4989.c0000 0001 2348 0746Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles, Erasme Campus CP 604, 808 Lennik Road, 1070 Brussels, Belgium ,grid.4989.c0000 0001 2348 0746Department of Cardiology, Erasmus University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Michel Lamotte
- grid.4989.c0000 0001 2348 0746Department of Cardiology, Erasmus University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexis Gillet
- grid.4989.c0000 0001 2348 0746Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles, Erasme Campus CP 604, 808 Lennik Road, 1070 Brussels, Belgium ,grid.4989.c0000 0001 2348 0746Department of Cardiology, Erasmus University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Martin Chaumont
- grid.4989.c0000 0001 2348 0746Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles, Erasme Campus CP 604, 808 Lennik Road, 1070 Brussels, Belgium ,grid.4989.c0000 0001 2348 0746Department of Cardiology, Erasmus University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe van de Borne
- grid.4989.c0000 0001 2348 0746Department of Cardiology, Erasmus University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Vitalie Faoro
- grid.4989.c0000 0001 2348 0746Cardio-Pulmonary Exercise Laboratory, Faculty of Motor Sciences, Université Libre de Bruxelles, Erasme Campus CP 604, 808 Lennik Road, 1070 Brussels, Belgium
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Jiménez-Marrero S, Ramos R, Comín-Colet J. Incompetencia cronotrópica: redescubriendo fenotipos en insuficiencia cardiaca con fracción de eyección conservada. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Sugita Y, Ito K, Sakurai S, Sakai S, Kuno S. Epicardial adipose tissue is tightly associated with exercise intolerance in patients with type 2 diabetes mellitus with asymptomatic left ventricular structural and functional abnormalities. J Diabetes Complications 2020; 34:107552. [PMID: 32139127 DOI: 10.1016/j.jdiacomp.2020.107552] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/24/2020] [Accepted: 01/26/2020] [Indexed: 12/12/2022]
Abstract
AIMS This study aimed to elucidate whether the volume of epicardial adipose tissue (EAT) is associated with left ventricular (LV) structural and functional abnormalities and exercise capacity in patients with type 2 diabetes mellitus (T2DM). METHODS EAT thickness and LV structural and functional abnormality components (e.g., global longitudinal strain, E/e', LV mass index, relative wall thickness) were measured using echocardiography in 176 patients with asymptomatic stage A and B heart failure (SAHF and SBHF, respectively) and 62 healthy controls (HC). Peak oxygen uptake (peakVO2) was measured by using cardiopulmonary exercise testing. RESULTS Even when matching study participants for age, sex, and body mass index, the EAT was thicker (HCs 5.5 ± 1.2 versus SAHF 6.4 ± 1.0 and SBHF 9.3 ± 1.7 mm) and peakVO2 was lower (HC 24.1 ± 3.3 versus SAHF 19.1 ± 2.0 and SBHF 16.9 ± 3.1 ml/kg/min) in the heart failure (HF) group than in the HC group (p < 0.001). EAT thickness (β = -0.189, p < 0.001) and peakVO2 were significantly associated, even after adjusting for multivariates (R2 = 0.457). CONCLUSIONS In T2DM patients with asymptomatic HF, EAT may be associated with LV structural and functional abnormalities and exercise intolerance.
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Affiliation(s)
- Yousuke Sugita
- Faculty of Health Sciences, Tsukuba University of Technology, Japan; Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan.
| | - Katsuhiko Ito
- National Hospital Organization Saitama National Hospital, Japan
| | | | - Satoshi Sakai
- Faculty of Health Sciences, Tsukuba University of Technology, Japan
| | - Shinya Kuno
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan
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Hawkins SM, Guensch DP, Friedrich MG, Vinco G, Nadeshalingham G, White M, Mongeon FP, Hillier E, Teixeira T, Flewitt JA, Eberle B, Fischer K. Hyperventilation-induced heart rate response as a potential marker for cardiovascular disease. Sci Rep 2019; 9:17887. [PMID: 31784617 PMCID: PMC6884614 DOI: 10.1038/s41598-019-54375-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/12/2019] [Indexed: 12/03/2022] Open
Abstract
An increase of heart rate to physical or mental stress reflects the ability of the autonomous nervous system and the heart to respond adequately. Hyperventilation is a user-controlled breathing maneuver that has a significant impact on coronary function and hemodynamics. Thus, we aimed to investigate if the heart rate response to hyperventilation (HRRHV) can provide clinically useful information. A pooled analysis of the HRRHV after 60 s of hyperventilation was conducted in 282 participants including healthy controls; patients with heart failure (HF); coronary artery disease (CAD); a combination of both; or patients suspected of CAD but with a normal angiogram. Hyperventilation significantly increased heart rate in all groups, although healthy controls aged 55 years and older (15 ± 9 bpm) had a larger HRRHV than each of the disease groups (HF: 6 ± 6, CAD: 8 ± 8, CAD+/HF+: 6 ± 4, and CAD-/HF-: 8 ± 6 bpm, p < 0.001). No significant differences were found between disease groups. The HRRHV may serve as an easily measurable additional marker of cardiovascular health. Future studies should test its diagnostic potential as a simple, inexpensive pre-screening test to improve patient selection for other diagnostic exams.
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Affiliation(s)
- Selwynne M Hawkins
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Dominik P Guensch
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Diagnostic, Interventional and Paediatric Radiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, McGill University, Montreal, Canada
- Departments of Cardiac Sciences and Radiology, University of Calgary, Calgary, Canada
| | - Giulia Vinco
- Departments of Medicine and Diagnostic Radiology, McGill University Health Centre, Montreal, Canada
- University of Verona, Verona, Italy
| | | | - Michel White
- Philippa and Marvin Carsley CMR Center at the Montreal Heart Institute, Montreal, Canada
| | | | - Elizabeth Hillier
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Tiago Teixeira
- Philippa and Marvin Carsley CMR Center at the Montreal Heart Institute, Montreal, Canada
- Douro e Vouga Hospital Centre, Sta Maria da Feira, Portugal
| | - Jacqueline A Flewitt
- Stephenson Cardiovascular MR Centre, Libin Cardiovascular Institute of Alberta, Calgary, Canada
| | - Balthasar Eberle
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Kady Fischer
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
- Department of Diagnostic, Interventional and Paediatric Radiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
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Marzlin KM, Webner C. Chronotropic Incompetence. AACN Adv Crit Care 2019; 30:294-300. [PMID: 31462528 DOI: 10.4037/aacnacc2019182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Karen M Marzlin
- Karen M. Marzlin is Advanced Practice Registered Nurse, Aultman Hospital; Adjunct Faculty, Malone University; and Owner/Author/Educator/Consultant, Key Choice/Cardiovascular Nursing Education Associates, 4565 Venus Rd, Uniontown, OH 44685 . Cynthia Webner is Adjunct Faculty, Acute Care Nurse Practitioner Program, Malone University, Canton, Ohio; and Partner, Key Choice/Cardiovascular Nursing Education Associates, Uniontown, Ohio
| | - Cynthia Webner
- Karen M. Marzlin is Advanced Practice Registered Nurse, Aultman Hospital; Adjunct Faculty, Malone University; and Owner/Author/Educator/Consultant, Key Choice/Cardiovascular Nursing Education Associates, 4565 Venus Rd, Uniontown, OH 44685 . Cynthia Webner is Adjunct Faculty, Acute Care Nurse Practitioner Program, Malone University, Canton, Ohio; and Partner, Key Choice/Cardiovascular Nursing Education Associates, Uniontown, Ohio
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Zweerink A, van der Lingen ALCJ, Handoko ML, van Rossum AC, Allaart CP. Chronotropic Incompetence in Chronic Heart Failure. Circ Heart Fail 2019; 11:e004969. [PMID: 30354566 DOI: 10.1161/circheartfailure.118.004969] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronotropic incompetence (CI) is generally defined as the inability to increase the heart rate (HR) adequately during exercise to match cardiac output to metabolic demands. In patients with heart failure (HF), however, this definition is unsuitable because metabolic demands are unmatched to cardiac output in both conditions. Moreover, HR dynamics in patients with HF differ from those in healthy subjects and may be affected by β-blocking medication. Nevertheless, it has been demonstrated that CI in HF is associated with reduced functional capacity and poor survival. During exercise, the normal heart increases both stroke volume and HR, whereas in the failing heart, contractility reserve is lost, thus rendering increases in cardiac output primarily dependent on cardioacceleration. Consequently, insufficient cardioacceleration because of CI may be considered a major limiting factor in the exercise capacity of patients with HF. Despite the profound effects of CI in this specific population, the issue has drawn limited attention during the past years and is often overlooked in clinical practice. This might partly be caused by a lack of standardized approach to diagnose the disease, further complicated by changes in HR dynamics in the HF population, which render reference values derived from a normal population invalid. Cardiac implantable electronic devices (implantable cardioverter defibrillator; cardiac resynchronization therapy) now offer a unique opportunity to study HR dynamics and provide treatment options for CI by rate-adaptive pacing using an incorporated sensor that measures physical activity. This review provides an overview of disease mechanisms, diagnostic strategies, clinical consequences, and state-of-the-art device therapy for CI in HF.
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Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
| | | | - M Louis Handoko
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
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Hasebe H. A Patient with Left Bundle Branch Block and Persistent Atrial Fibrillation Treated with Cardiac Catheter Ablation and Pharmacologic Cardiac Resynchronization Therapy without the Use of an Implantable Cardiac Device. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:123-127. [PMID: 29391388 PMCID: PMC5804315 DOI: 10.12659/ajcr.907268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patient: Male, 68 Final Diagnosis: Heart failure Symptoms: Short of breath Medication: — Clinical Procedure: Catheter ablation of AF Specialty: Cardiology
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Affiliation(s)
- Hideyuki Hasebe
- Division of Arrhythmology, Shizuoka Saiseikai General Hospital, Shizuoka City, Shizuoka, Japan
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Biffi M, Massaro G, Candelora A, Angeletti A, Valzania C, Martignani C, Grassini D, Diemberger I, Ziacchi M. Less is more: Can we achieve cardiac resynchronization with 2 leads only? Int J Cardiol 2017; 249:184-190. [DOI: 10.1016/j.ijcard.2017.09.189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/17/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
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Keytsman C, Dendale P, Hansen D. Chronotropic Incompetence During Exercise in Type 2 Diabetes: Aetiology, Assessment Methodology, Prognostic Impact and Therapy. Sports Med 2015; 45:985-95. [DOI: 10.1007/s40279-015-0328-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Biffi M, Melissano D, Rossi P, Kaliska G, Havli ek A, Pelargonio G, Romero R, Guastaferro C, Menichelli M, Vireca E, Frisoni J, Boriani G, Malacky T. The OPTI-MIND study: a prospective, observational study of pacemaker patients according to pacing modality and primary indications. Europace 2014; 16:689-97. [DOI: 10.1093/europace/eut387] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kociol RD. Circulation: Heart Failure
Editors’ Picks. Circ Heart Fail 2014. [DOI: 10.1161/circheartfailure.113.001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Magrì D, Corrà U, Di Lenarda A, Cattadori G, Maruotti A, Iorio A, Mezzani A, Giannuzzi P, Mantegazza V, Gondoni E, Sinagra G, Piepoli MF, Fiorentini C, Agostoni P. Cardiovascular mortality and chronotropic incompetence in systolic heart failure: the importance of a reappraisal of current cut-off criteria. Eur J Heart Fail 2013; 16:201-9. [DOI: 10.1002/ejhf.36] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/23/2013] [Accepted: 07/26/2013] [Indexed: 01/02/2023] Open
Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine; ‘Sapienza’ Università degli Studi di Roma; Roma Italy
| | - Ugo Corrà
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS; Istituto Scientifico di Veruno; Veruno Italy
| | - Andrea Di Lenarda
- Centro Cardiovascolare; Azienda per i Servizi Sanitari no. 1; Trieste Italy
| | | | - Antonello Maruotti
- Southampton Statistical Sciences Research Institute & School of Mathematics; University of Southampton; Southampton UK
- Department of Politic Sciences; Università ‘Roma Tre’; Roma Italy
| | - Annamaria Iorio
- Cardiovascular Department; Ospedali Riuniti and Università di Trieste; Trieste Italy
| | - Alessandro Mezzani
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS; Istituto Scientifico di Veruno; Veruno Italy
| | - Pantaleo Giannuzzi
- Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS; Istituto Scientifico di Veruno; Veruno Italy
| | | | | | - Gianfranco Sinagra
- Cardiovascular Department; Ospedali Riuniti and Università di Trieste; Trieste Italy
| | - Massimo F. Piepoli
- Heart Failure Unit, Cardiac Department; Guglielmo da Saliceto Hospital; Piacenza Italy
| | - Cesare Fiorentini
- Centro Cardiologico Monzino; IRCCS; Milano Italy
- Department of Clinical Sciences and Community Health; Università di Milano; Milano Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino; IRCCS; Milano Italy
- Department of Clinical Sciences and Community Health; Università di Milano; Milano Italy
- Department of Respiratory and Critical Care Medicine; University of Washington; Seattle USA
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El-Refai M, Peterson EL, Wells K, Swadia T, Sabbah HN, Spertus JA, Williams LK, Lanfear DE. Comparison of β-blocker effectiveness in heart failure patients with preserved ejection fraction versus those with reduced ejection fraction. J Card Fail 2013; 19:73-9. [PMID: 23384631 DOI: 10.1016/j.cardfail.2012.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/27/2012] [Accepted: 12/03/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND The aim of this study was to compare the benefit of beta-blockers (BB) in heart failure (HF) with preserved versus reduced ejection fraction (EF). METHODS AND RESULTS This was a retrospective study of insured patients who were hospitalized for HF from January 2000 to June 2008. Pharmacy claims were used to estimate BB exposure over 6-month rolling windows. The association between BB exposure and all-cause hospitalization or death was tested with the use of time-updated proportional hazards regression, with adjustment for baseline covariates and other HF medication exposure. The groups were compared by stratification (EF <50% vs ≥50%) and with the use of an EF-group × BB exposure interaction term. A total of 1,835 patients met the inclusion criteria, 741 (40%) with a preserved EF. Median follow-up was 2.1 years. In a fully adjusted multivariable model, BB exposure was associated with a decreased risk of death or hospitalization in both groups (EF <50%: hazard ratio [HR] 0.53 [P < .0001]; EF ≥50%: HR 0.68 [P = .009]). There was no significant difference in this protective association between groups (interaction: P = .32). CONCLUSIONS BB exposure was associated with a similar protective effect regarding time to death or hospitalization in HF patients regardless of whether EF was preserved or reduced. An adequately powered randomized trial of BB in HF with preserved EF is warranted.
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Affiliation(s)
- Mostafa El-Refai
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan 48202, USA
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