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Cozgarea A, Cozma D, Teodoru M, Lazăr-Höcher AI, Cirin L, Faur-Grigori AA, Lazăr MA, Crișan S, Gaiță D, Luca CT, Văcărescu C. Heart Rate Recovery: Up to Date in Heart Failure-A Literature Review. J Clin Med 2024; 13:3328. [PMID: 38893039 PMCID: PMC11173322 DOI: 10.3390/jcm13113328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/15/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
The rising prevalence of cardiovascular disease underscores the growing significance of heart failure (HF). Pathophysiological insights into HF highlight the dysregulation of the autonomic nervous system (ANS), characterized by sympathetic overactivity and diminished vagal tone, impacting cardiovascular function. Heart rate recovery (HRR), a metric measuring the heart's ability to return to its baseline rate post-exertion, plays a crucial role in assessing cardiovascular health. Widely applied across various cardiovascular conditions including HF, coronary artery disease (CAD), and arterial hypertension (HTN), HRR quantifies the difference between peak and recovery heart rates. Given its association with elevated sympathetic tone and exercise, HRR provides valuable insights into the perspective of HF, beyond effort tolerance, reaching toward prognostic and mortality indicators. Incorporating HRR into cardiovascular evaluations enhances our understanding of autonomic regulation in HF, offering potential implications for prognostication and patient management. This review addresses the significance of HRR in HF assessment, analyzing recently conducted studies, and providing a foundation for further research and clinical application.
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Affiliation(s)
- Andreea Cozgarea
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (A.C.); (A.-I.L.-H.); (A.-A.F.-G.); (M.-A.L.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Dragoș Cozma
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (A.C.); (A.-I.L.-H.); (A.-A.F.-G.); (M.-A.L.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Minodora Teodoru
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania
- Medical Clinical Department, Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania
| | - Alexandra-Iulia Lazăr-Höcher
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (A.C.); (A.-I.L.-H.); (A.-A.F.-G.); (M.-A.L.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Liviu Cirin
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Adelina-Andreea Faur-Grigori
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (A.C.); (A.-I.L.-H.); (A.-A.F.-G.); (M.-A.L.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
| | - Mihai-Andrei Lazăr
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (A.C.); (A.-I.L.-H.); (A.-A.F.-G.); (M.-A.L.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Simina Crișan
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (A.C.); (A.-I.L.-H.); (A.-A.F.-G.); (M.-A.L.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Dan Gaiță
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (A.C.); (A.-I.L.-H.); (A.-A.F.-G.); (M.-A.L.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Constantin-Tudor Luca
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (A.C.); (A.-I.L.-H.); (A.-A.F.-G.); (M.-A.L.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
| | - Cristina Văcărescu
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (A.C.); (A.-I.L.-H.); (A.-A.F.-G.); (M.-A.L.); (S.C.); (D.G.); (C.-T.L.); (C.V.)
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Research Center of the Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania
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Panassollo TRB, Lord S, Rashid U, Taylor D, Mawston G. The effect of chronotropic incompetence on physiologic responses during progressive exercise in people with Parkinson's disease. Eur J Appl Physiol 2024:10.1007/s00421-024-05492-5. [PMID: 38683403 DOI: 10.1007/s00421-024-05492-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Heart rate (HR) response is likely to vary in people with Parkinson's disease (PD), particularly for those with chronotropic incompetence (CI). This study explores the impact of CI on HR and metabolic responses during cardiopulmonary exercise test (CPET) in people with PD, and its implications for exercise intensity prescription. METHODS Twenty-eight participants with mild PD and seventeen healthy controls underwent CPET to identify the presence or absence of CI. HR and metabolic responses were measured at submaximal (first (VT1) and second (VT2) ventilatory thresholds), and at peak exercise. Main outcome measures were HR, oxygen consumption (VO2), and changes in HR responses (HR/WR slope) to an increase in exercise demand. RESULTS CI was present in 13 (46%) PD participants (PDCI), who during CPET, exhibited blunted HR responses compared to controls and PD non-CI beyond 60% of maximal workload (p ≤ 0.05). PDCI presented a significantly lower HR at VT2, and peak exercise compared to PD non-CI and controls (p ≤ 0.001). VO2 was significantly lower in PDCI than PD non-CI and controls at VT2 (p = 0.003 and p = 0.036, respectively) and at peak exercise (p = 0.001 and p = 0.023, respectively). CONCLUSION Although poorly understood, the presence of CI in PD and its effect on HR and metabolic responses during incremental exercise is significant and important to consider when programming aerobic exercises.
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Affiliation(s)
| | - Sue Lord
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, 0627, Auckland, New Zealand
| | - Usman Rashid
- Centre for Chiropractic Research, New Zealand College of Chiropractic, 6 Harrison Road, Mount Wellington, 1060, Auckland, New Zealand
| | - Denise Taylor
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, 0627, Auckland, New Zealand
| | - Grant Mawston
- School of Clinical Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, 0627, Auckland, New Zealand
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Wheeler MT, Jacoby D, Elliott PM, Saberi S, Hegde SM, Lakdawala NK, Myers J, Sehnert AJ, Edelberg JM, Li W, Olivotto I. Effect of beta-blocker therapy on the response to mavacamten in patients with symptomatic obstructive hypertrophic cardiomyopathy. Eur J Heart Fail 2023; 25:260-270. [PMID: 36404399 DOI: 10.1002/ejhf.2737] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/28/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
AIMS In the EXPLORER-HCM trial, mavacamten improved exercise capacity and symptoms in patients with obstructive hypertrophic cardiomyopathy (oHCM). Mavacamten effects on the primary endpoint, a composite of peak oxygen consumption (VO2 ) and New York Heart Association (NYHA) class, were greater in patients not receiving background beta-blockers than in those receiving beta-blockers. We sought to determine if the effect of background treatment was consistent across other clinically meaningful parameters. METHODS AND RESULTS Subgroup analyses by beta-blocker use were performed in patients with oHCM from the EXPLORER-HCM and mavacamten long-term extension (MAVA-LTE) studies. In EXPLORER-HCM, 189 patients (75.3%) were receiving beta-blockers, and 62 (24.7%) were receiving non-dihydropyridine calcium channel blockers or no background HCM medication; 170 patients (90.4%) receiving beta-blockers had chronotropic incompetence. Improvements in peak VO2 at week 30 with mavacamten versus placebo were lower with beta-blockers (mean difference [95% confidence interval (CI)]: 1.04 [0.12, 1.95] ml/kg/min) than without beta-blockers (mean difference [95% CI]: 2.69 [1.29, 4.09] ml/kg/min); improvements in non-heart rate-dependent parameters (VE /VCO2 slope) appeared unaffected by beta-blockers. Improvements in functional capacity parameters at week 30 with mavacamten versus placebo were independent of beta-blockade for post-exercise left ventricular outflow tract gradient (mean difference [95% CI]: -37.9 [-48.0, -27.9] mmHg with beta-blockers; -33.5 [-53.6, -13.3] mmHg without beta-blockers), proportion of patients with reduction of ≥1 NYHA class, Kansas City Cardiomyopathy Questionnaire clinical summary scores and N-terminal pro-B-type natriuretic peptide. Mavacamten benefits were reproduced and maintained in MAVA-LTE regardless of beta-blockade. CONCLUSION Mavacamten improved measures of functional capacity, left ventricular outflow tract obstruction, symptom burden and biomarkers in patients with HCM regardless of beta-blocker use. Beta-blocker use was often associated with chronotropic incompetence, affecting peak VO2 and other heart rate-dependent measures, but had minimal impact on heart rate-independent measures.
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Affiliation(s)
- Matthew T Wheeler
- Division of Cardiovascular Medicine, Center for Inherited Cardiovascular Disease, Stanford University, Stanford, CA, USA
| | - Daniel Jacoby
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - Perry M Elliott
- University College London & St. Bartholomew's Hospital, London, UK
| | - Sara Saberi
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sheila M Hegde
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Neal K Lakdawala
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Myers
- Division of Cardiology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, USA
- Stanford University, Palo Alto, CA, USA
| | - Amy J Sehnert
- MyoKardia, Inc., a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Jay M Edelberg
- MyoKardia, Inc., a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Wanying Li
- MyoKardia, Inc., a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, CA, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unity, Azienda Ospedaliera Universitaria Careggi and University of Florence, Florence, Italy
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Świerżyńska E, Oręziak A, Główczyńska R, Rossillo A, Grabowski M, Szumowski Ł, Caprioglio F, Sterliński M. Rate-Responsive Cardiac Pacing: Technological Solutions and Their Applications. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23031427. [PMID: 36772467 PMCID: PMC9920425 DOI: 10.3390/s23031427] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 05/12/2023]
Abstract
Modern cardiac pacemakers are equipped with a function that allows the heart rate to adapt to the current needs of the patient in situations of increased demand related to exercise and stress ("rate-response" function). This function may be based on a variety of mechanisms, such as a built-in accelerometer responding to increased chest movement or algorithms sensing metabolic demand for oxygen, analysis of intrathoracic impedance, and analysis of the heart rhythm (Q-T interval). The latest technologies in the field of rate-response functionality relate to the use of an accelerometer in leadless endocavitary pacemakers; in these devices, the accelerometer enables mapping of the mechanical wave of the heart's work cycle, enabling the pacemaker to correctly sense native impulses and stimulate the ventricles in synchrony with the cycles of atria and heart valves. Another modern system for synchronizing pacing rate with the patient's real-time needs requires a closed-loop system that continuously monitors changes in the dynamics of heart contractions. This article discusses the technical details of various solutions for detecting and responding to situations related to increased oxygen demand (e.g., exercise or stress) in implantable pacemakers, and reviews the results of clinical trials regarding the use of these algorithms.
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Affiliation(s)
- Ewa Świerżyńska
- Department of Arrhythmia, The Cardinal Stefan Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
- Correspondence:
| | - Artur Oręziak
- Department of Arrhythmia, The Cardinal Stefan Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Renata Główczyńska
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Antonio Rossillo
- Department of Cardiology, San Bortolo Hospital, 36100 Vicenza, Italy
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Łukasz Szumowski
- Department of Arrhythmia, The Cardinal Stefan Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
| | | | - Maciej Sterliński
- Department of Arrhythmia, The Cardinal Stefan Wyszynski National Institute of Cardiology, 04-628 Warsaw, Poland
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Smarz K, Jaxa-Chamiec T, Zaborska B, Tysarowski M, Budaj A. Combined use of stress echocardiography and cardiopulmonary exercise testing to assess exercise intolerance in patients treated for acute myocardial infarction. PLoS One 2021; 16:e0255682. [PMID: 34351993 PMCID: PMC8341484 DOI: 10.1371/journal.pone.0255682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/21/2021] [Indexed: 12/28/2022] Open
Abstract
Exercise intolerance after acute myocardial infarction (AMI) is a predictor of worse prognosis, but its causes are complex and poorly studied. This study assessed the determinants of exercise intolerance using combined stress echocardiography and cardiopulmonary exercise testing (CPET-SE) in patients treated for AMI. We prospectively enrolled patients with left ventricular ejection fraction (LV EF) ≥40% for more than 4 weeks after the first AMI. Stroke volume, heart rate, and arteriovenous oxygen difference (A-VO2Diff) were assessed during symptom-limited CPET-SE. Patients were divided into four groups according to the percentage of predicted oxygen uptake (VO2) (Group 1, <50%; Group 2, 50-74%; Group 3, 75-99%; and Group 4, ≥100%). Among 81 patients (70% male, mean age 58 ± 11 years, 47% ST-segment elevation AMI) mean peak VO2 was 19.5 ± 5.4 mL/kg/min. A better exercise capacity was related to a higher percent predicted heart rate (Group 2 vs. Group 4, p <0.01), higher peak A-VO2Diff (Group 1 vs. Group 3, p <0.01) but without differences in stroke volume. Peak VO2 and percent predicted VO2 had a significant positive correlation with percent predicted heart rate at peak exercise (r = 0.28, p = 0.01 and r = 0.46, p < 0.001) and peak A-VO2Diff (r = 0.68, p <0.001 and r = 0.36, p = 0.001) but not with peak stroke volume. Exercise capacity in patients treated for AMI with LV EF ≥40% is related to heart rate response during exercise and peak peripheral oxygen extraction. CPET-SE enables non-invasive assessment of the mechanisms of exercise intolerance.
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Affiliation(s)
- Krzysztof Smarz
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Tomasz Jaxa-Chamiec
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Beata Zaborska
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Maciej Tysarowski
- Department of Cardiovascular Medicine, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT, United States of America
| | - Andrzej Budaj
- Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
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