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Di Bello M, Chang C, McIntosh R. Dynamic vagal-mediated connectivity of cortical and subcortical central autonomic hubs predicts chronotropic response to submaximal exercise in healthy adults. Brain Cogn 2024; 175:106134. [PMID: 38266398 DOI: 10.1016/j.bandc.2024.106134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/27/2023] [Accepted: 01/06/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Despite accumulation of a substantial body of literature supporting the role of exercise on frontal lobe functioning, relatively less is understood of the interconnectivity of ventromedial prefrontal cortical (vmPFC) regions that underpin cardio-autonomic regulation predict cardiac chronotropic competence (CC) in response to sub-maximal exercise. METHODS Eligibility of 161 adults (mean age = 48.6, SD = 18.3, 68% female) was based upon completion of resting state brain scan and sub-maximal bike test. Sliding window analysis of the resting state signal was conducted over 45-s windows, with 50% overlap, to assess how changes in photoplethysmography-derived HRV relate to vmPFC functional connectivity with the whole brain. CC was assessed based upon heart rate (HR) changes during submaximal exercise (HR change /HRmax (206-0.88 × age) - HRrest). RESULTS During states of elevated HRV the vmPFC showed greater rsFC with an 83-voxel region of the hypothalamus (p < 0.001, uncorrected). Beta estimates of vmPFC connectivity extracted from a 6-mm sphere around this region emerged as the strongest predictor of CC (b = 0.283, p <.001) than age, BMI, and resting HRV F(8,144) = 6.30, p <.001. CONCLUSION Extensive glutamatergic innervation of the hypothalamus by the vmPFC allows for top-down control of the hypothalamus and its various autonomic efferents which facilitate chronotropic response during sub-maximal exercise.
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Affiliation(s)
- Maria Di Bello
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Catie Chang
- Department of Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Roger McIntosh
- Department of Psychology, University of Miami, Coral Gables, FL 33124, USA.
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Magrì D, Gallo G, Piepoli M, Salvioni E, Mapelli M, Vignati C, Fiori E, Muthukkattil ML, Corrà U, Metra M, Paolillo S, Maruotti A, Di Loro PA, Senni M, Lagioia R, Scrutinio D, Emdin M, Passino C, Parati G, Sinagra G, Correale M, Badagliacca R, Sciomer S, Di Lenarda A, Agostoni P, Filardi PP. What about chronotropic incompetence in heart failure with mildly reduced ejection fraction? Clinical and prognostic implications from the Metabolic Exercise combined with Cardiac and Kidney Indexes score dataset. Eur J Prev Cardiol 2024; 31:263-271. [PMID: 37890033 DOI: 10.1093/eurjpc/zwad338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/29/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023]
Abstract
AIMS Chronotropic incompetence (CI) is a strong predictor of outcome in heart failure with reduced ejection fraction, however no data on its clinical and prognostic impacts in heart failure with mildly reduced ejection fraction (HFmrEF) are available. Therefore, the study aims to investigate, in a large multicentre HFmrEF cohort, the prevalence of CI as well as its relationship with exercise capacity and its prognostic role over the cardiopulmonary exercise testing (CPET) parameters. METHODS AND RESULTS Within the Metabolic Exercise combined with Cardiac and Kidney Indexes (MECKI) database, we analysed data of 864 HFmrEF out of 1164 stable outpatients who performed a maximal CPET at the cycle ergometer and who had no significant rhythm disorders or comorbidities. The primary study endpoint was cardiovascular (CV) death. All-cause death was also explored. Chronotropic incompetence prevalence differed depending on the method (peak heart rate, pHR% vs. pHR reserve, pHRR%) and the cut-off adopted (pHR% from ≤75% to ≤60% and pHRR% ≤ 65% to ≤50%), ranging from 11% to 62%. A total of 84 (9.7%) CV deaths were collected, with 39 (4.5%) occurring within 5 years. At multivariate analysis, both pHR% [hazard ratio 0.97 (0.95-0.99), P < 0.05] and pHRR% [hazard ratio 0.977 (0.961-0.993), P < 0.01] were associated with the primary endpoint. A pHR% ≤ 75% and a pHRR% ≤ 50% represented the most accurate cut-off values in predicting the outcome. CONCLUSION The study suggests an association between blunted exercise-HR response, functional capacity, and CV death risk among patients with HFmrEF. Whether the CI presence might be adopted in daily HFmrEF management needs to be addressed in larger prospective studies.
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Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
| | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
| | - Massimo Piepoli
- Department of Biomedical Science for Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy, and Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | | | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, 20138 Milano, Italy
| | - Carlo Vignati
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, 20138 Milano, Italy
| | - Emiliano Fiori
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
| | - Melwyn Luis Muthukkattil
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' Università degli Studi di Roma, Via di Grottarossa 1035-1039, 00189 Roma, Italy
| | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, Via Revislate 13, 28010 Veruno, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazza del Mercato 15, 25121 Brescia, Italy
| | - Stefania Paolillo
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Via Leonardo Bianchi, 80131 Napoli, Italy
| | - Antonello Maruotti
- Dipartimento di Giurisprudenza, Economia, Politica e Lingue Moderne, Libera Università Maria Ss Assunta, Via della Traspontina 21, 00193 Roma, Italy
| | - Pierfrancesco Alaimo Di Loro
- Dipartimento di Giurisprudenza, Economia, Politica e Lingue Moderne, Libera Università Maria Ss Assunta, Via della Traspontina 21, 00193 Roma, Italy
| | - Michele Senni
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo, Italy
| | - Rocco Lagioia
- Division of Cardiology, 'S. Maugeri' Foundation, IRCCS, Institute of Cassano Murge, Via Generale Bellomo 73-75, 70124 Bari, Italy
| | - Domenico Scrutinio
- Division of Cardiology, 'S. Maugeri' Foundation, IRCCS, Institute of Cassano Murge, Via Generale Bellomo 73-75, 70124 Bari, Italy
| | - Michele Emdin
- Life Science Institute, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - Claudio Passino
- Life Science Institute, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Piazzale Brescia 20, 20149 Milano, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Via della Pietà 19, 34129 Trieste, Italy
| | - Michele Correale
- Department of Cardiology, University of Foggia, Via Antonio Gramsci 89, 71122 Foggia, Italy
| | - Roberto Badagliacca
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, 'Sapienza', Rome University, Via del Policlinico 155, 00161 Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, 'Sapienza', Rome University, Via del Policlinico 155, 00161 Rome, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority n°1 and University of Trieste, Via Slataper 9, 34134 Trieste, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Carlo Parea 4, 20138 Milano, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Via Festa del Perdono 7, 20122 Milano, Italy
| | - Pasquale Perrone Filardi
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Via Leonardo Bianchi, 80131 Napoli, Italy
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Dorey TW, McRae MD, Belke DD, Rose RA. PDE4D mediates impaired β-adrenergic receptor signalling in the sinoatrial node in mice with hypertensive heart disease. Cardiovasc Res 2023; 119:2697-2711. [PMID: 37643895 PMCID: PMC10757582 DOI: 10.1093/cvr/cvad138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 06/06/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023] Open
Abstract
AIMS The sympathetic nervous system increases HR by activating β-adrenergic receptors (β-ARs) and increasing cAMP in sinoatrial node (SAN) myocytes while phosphodiesterases (PDEs) degrade cAMP. Chronotropic incompetence, the inability to regulate heart rate (HR) in response to sympathetic nervous system activation, is common in hypertensive heart disease; however, the basis for this is poorly understood. The objective of this study was to determine the mechanisms leading to chronotropic incompetence in mice with angiotensin II (AngII)-induced hypertensive heart disease. METHODS AND RESULTS C57BL/6 mice were infused with saline or AngII (2.5 mg/kg/day for 3 weeks) to induce hypertensive heart disease. HR and SAN function in response to the β-AR agonist isoproterenol (ISO) were studied in vivo using telemetry and electrocardiography, in isolated atrial preparations using optical mapping, in isolated SAN myocytes using patch-clamping, and using molecular biology. AngII-infused mice had smaller increases in HR in response to physical activity and during acute ISO injection. Optical mapping of the SAN in AngII-infused mice demonstrated impaired increases in conduction velocity and altered conduction patterns in response to ISO. Spontaneous AP firing responses to ISO in isolated SAN myocytes from AngII-infused mice were impaired due to smaller increases in diastolic depolarization (DD) slope, hyperpolarization-activated current (If), and L-type Ca2+ current (ICa,L). These changes were due to increased localization of PDE4D surrounding β1- and β2-ARs in the SAN, increased SAN PDE4 activity, and reduced cAMP generation in response to ISO. Knockdown of PDE4D using a virus-delivered shRNA or inhibition of PDE4 with rolipram normalized SAN sensitivity to β-AR stimulation in AngII-infused mice. CONCLUSIONS AngII-induced hypertensive heart disease results in impaired HR responses to β-AR stimulation due to up-regulation of PDE4D and reduced effects of cAMP on spontaneous AP firing in SAN myocytes.
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Affiliation(s)
- Tristan W Dorey
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Megan D McRae
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Darrell D Belke
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Robert A Rose
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
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Chua SK, Chen WL, Chen LC, Shyu KG, Hung HF, Lee SH, Wang TL, Lai WT, Chen KJ, Liao ZY, Chuang CY, Chou CY. Enhancement of bicycle exercise capacity in patients with chronotropic incompetence through closed-loop stimulation: a randomized crossover trial. Europace 2023; 25:euad358. [PMID: 38042981 PMCID: PMC10751807 DOI: 10.1093/europace/euad358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/22/2023] [Indexed: 12/04/2023] Open
Abstract
AIMS This study aimed to investigate the effectiveness of closed-loop stimulation (CLS) pacing compared with the traditional DDD mode in patients with chronotropic incompetence (CI) using bicycle-based cardiopulmonary exercise testing (CPET). METHODS AND RESULTS This single-centre, randomized crossover trial involved 40 patients with CI. Patients were randomized to receive either DDD-CLS or DDD mode pacing for 2 months, followed by a crossover to the alternative mode for an additional 2 months. Bicycling-based CPET was conducted at the 3- and 5-month follow-up visits to assess exercise capacity. Other cardiopulmonary exercise outcome measures and health-related quality of life (QoL) were also assessed. DDD-CLS mode pacing significantly improved exercise capacity, resulting in a peak oxygen uptake (14.8 ± 4.0 vs. 12.0 ± 3.6 mL/kg/min, P < 0.001) and oxygen uptake at the ventilatory threshold (10.0 ± 2.2 vs. 8.7 ± 1.8 mL/kg/min, P < 0.001) higher than those of the DDD mode. However, there were no significant differences in other cardiopulmonary exercise outcome measures such as ventilatory efficiency of carbon dioxide production slope, oxygen uptake efficiency slope, and end-tidal carbon dioxide between the two modes. Patients in the DDD-CLS group reported a better QoL, and 97.5% expressed a preference for the DDD-CLS mode. CONCLUSION DDD-CLS mode pacing demonstrated improved exercise capacity and QoL in patients with CI, highlighting its potential as an effective pacing strategy for this patient population.
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Affiliation(s)
- Su-Kiat Chua
- School of Medicine, College of Medicine, Fu Jen Catholic University, 510 Zhongzheng Road, Xinzhuang District, New Taipei City 24205, Taiwan
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Wen-Ling Chen
- School of Medicine, College of Medicine, Fu Jen Catholic University, 510 Zhongzheng Road, Xinzhuang District, New Taipei City 24205, Taiwan
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Lung-Ching Chen
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Kou-Gi Shyu
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Huei-Fong Hung
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Shih-Huang Lee
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Tzu-Lin Wang
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Wei-Ting Lai
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Kuan-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Zhen-Yu Liao
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Cheng-Yen Chuang
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
| | - Ching-Yao Chou
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Road, Shih-Lin District, Taipei 11101, Taiwan
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van Campen C(LM, Verheugt FW, Rowe PC, Visser FC. Orthostatic chronotropic incompetence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). IBRO Neurosci Rep 2023; 15:1-10. [PMID: 37303862 PMCID: PMC10250802 DOI: 10.1016/j.ibneur.2023.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/25/2023] [Accepted: 04/30/2023] [Indexed: 06/13/2023] Open
Abstract
Background Orthostatic intolerance (OI) is a core diagnostic criterion in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The majority of ME/CFS patients have no evidence of hypotension or postural orthostatic tachycardia syndrome (POTS) during head-up tilt, but do show a significantly larger reduction in stroke volume index (SVI) when upright compared to controls. Theoretically a reduction in SVI should be accompanied by a compensatory increase in heart rate (HR). When there is an incomplete compensatory increase in HR, this is considered chronotropic incompetence. This study explored the relationship between HR and SVI to determine whether chronotropic incompetence was present during tilt testing in ME/CFS patients. Methods From a database of individuals who had undergone tilt testing with Doppler measurements for SVI both supine and end-tilt, we selected ME/CFS patients and healthy controls (HC) who had no evidence of POTS or hypotension during the test. To determine the relation between the HR increase and SVI decrease during the tilt test in patients, we calculated the 95% prediction intervals of this relation in HC. Chronotropic incompetence in patients was defined as a HR increase below the lower limit of the 95th % prediction interval of the HR increase in HC. Results We compared 362 ME/CFS patients with 52 HC. At end-tilt, tilt lasting for 15 (4) min, ME/CFS patients had a significantly lower SVI (22 (4) vs. 27 (4) ml/m2; p < 0.0001) and a higher HR (87 (11) vs. 78 (15) bpm; p < 0.0001) compared to HC. There was a similar relationship between HR and SVI between ME/CFS patients and HC in the supine position. During tilt ME/CFS patients had a lower HR for a given SVI; 37% had an inadequate HR increase. Chronotropic incompetence was more common in more severely affected ME/CFS patients. Conclusion These novel findings represent the first description of orthostatic chronotropic incompetence during tilt testing in ME/CFS patients.
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Affiliation(s)
| | | | - Peter C. Rowe
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Frans C. Visser
- Stichting CardioZorg, Planetenweg 5, 2132 HN Hoofddorp, The Netherlands
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Kaptein YE, Mortada ME. First reported dual-chamber leadless pacemaker in a patient with orthotopic heart transplant. HeartRhythm Case Rep 2023; 9:914-918. [PMID: 38204843 PMCID: PMC10774526 DOI: 10.1016/j.hrcr.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Yvonne E. Kaptein
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
| | - M. Eyman Mortada
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin
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Miwa K. Orthostatic Intolerance and Chronotropic Incompetence in Patients With Myalgic Encephalomyelitis or Chronic Fatigue Syndrome. Circ Rep 2023; 5:55-61. [PMID: 36818521 PMCID: PMC9908528 DOI: 10.1253/circrep.cr-22-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/23/2022] [Accepted: 12/29/2022] [Indexed: 01/25/2023] Open
Abstract
Background: Orthostatic intolerance markedly affects the day-to-day activities of patients with myalgic encephalomyelitis (ME) or chronic fatigue syndrome. Chronotropic incompetence (CI), defined as an impaired chronotropic response or reduced increases in heart rate during exercise and resulting in lower exercise capacity, may also be observed during orthostasis in patients with ME. Methods and Results: In this study, the recordings of 101 adult patients with ME (36 men, 65 women; mean [±SD] age 37±12 years) who underwent conventional active 10-min standing tests at least 3 times to determine the presence of CI were analyzed. Recordings were selected for 13 patients who experienced tests both with and without exhibiting postural orthostatic tachycardia syndrome (POTS; an increase in heart rate of ≥30 beats/min or an actual heart rate of ≥120 beats/min) while also both successfully completing and failing to complete 10-min standing on different occasions. Subjects in whom failure without POTS was observed in any test(s) while success was associated with POTS on other occasions were considered positive for CI during orthostasis. Of the 13 patients, 12 (92%) were CI positive, 5 (38%) of whom exclusively failed the tests without experiencing POTS. Conclusions: Some patients with ME were CI positive during standing tests, suggesting impaired sympathetic activation. The presence of POTS appears to be essential for maintaining orthostasis in these patients.
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Clark HI, Pearson MJ, Smart NA. Rate adaptive pacing in people with chronic heart failure increases peak heart rate but not peak exercise capacity: a systematic review. Heart Fail Rev 2023; 28:21-34. [PMID: 35138522 PMCID: PMC9902309 DOI: 10.1007/s10741-022-10217-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 02/07/2023]
Abstract
Rate adaptive cardiac pacing (RAP) allows increased heart rate (HR) in response to metabolic demand in people with implantable electronic cardiac devices (IECD). The aim of this work was to conduct a systematic review to determine if RAP increases peak exercise capacity (peak VO2) in line with peak HR in people with chronic heart failure. We conducted a systematic literature search from 1980, when IECD and RAP were first introduced, until 31 July 2021. Databases searched include PubMed, Medline, EMBASE, EBSCO, and the Clinical Trials Register. A comprehensive search of the literature produced a total of 246 possible studies; of these, 14 studies were included. Studies and subsequent analyses were segregated according to comparison, specifically standard RAP (RAPON) vs fixed rate pacing (RAPOFF), and tailored RAP (TLD RAPON) vs standard RAP (RAPON). Pooled analyses were conducted for peak VO2 and peak HR for RAPON vs RAPOFF. Peak HR significantly increased by 15 bpm with RAPON compared to RAPOFF (95%CI, 7.98-21.97, P < 0.0001). There was no significant difference between pacing mode for peak VO2 0.45 ml kg-1 min-1 (95%CI, - 0.55-1.47, P = 0.38). This systematic review revealed RAP increased peak HR in people with CHF; however, there was no concomitant improvement in peak VO2. Rather RAP may provide benefits at submaximal intensities by controlling the rise in HR to optimise cardiac output at lower workloads. HR may be an important outcome of CHF management, reflecting myocardial efficiency.
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Affiliation(s)
- H. I. Clark
- grid.1020.30000 0004 1936 7371School of Science & Technology, Exercise & Sports Science, University of New England, Armidale, NSW Australia
| | - M. J. Pearson
- grid.1020.30000 0004 1936 7371School of Science & Technology, Exercise & Sports Science, University of New England, Armidale, NSW Australia
| | - N. A. Smart
- grid.1020.30000 0004 1936 7371School of Science & Technology, Exercise & Sports Science, University of New England, Armidale, NSW Australia
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9
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Magrì D, Piepoli M, Gallo G, Corrà U, Metra M, Paolillo S, Filardi PP, Maruotti A, Salvioni E, Mapelli M, Vignati C, Senni M, Limongelli G, Lagioia R, Scrutinio D, Emdin M, Passino C, Parati G, Sinagra G, Correale M, Badagliacca R, Sciomer S, Di Lenarda A, Agostoni P. Old and new equations for maximal heart rate prediction in patients with heart failure and reduced ejection fraction on beta-blockers treatment: results from the MECKI score data set. Eur J Prev Cardiol 2022; 29:1680-1688. [PMID: 35578814 DOI: 10.1093/eurjpc/zwac099] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022]
Abstract
AIMS Predicting maximal heart rate (MHR) in heart failure with reduced ejection fraction (HFrEF) still remains a major concern. In such a context, the Keteyian equation is the only one derived in a HFrEF cohort on optimized β-blockers treatment. Therefore, using the Metabolic Exercise combined with Cardiac and Kidney Indexes (MECKI) data set, we looked for a possible MHR equation, for an external validation of Keteyien formula and, contextually, for accuracy of the historical MHR formulas and their relationship with the HR measured at the anaerobic threshold (AT). METHODS AND RESULTS Data from 3487 HFrEF outpatients on optimized β-blockers treatment from the MECKI data set were analyzed. Besides excluding all possible confounders, the new equation was derived by using HR data coming from maximal cardiopulmonary exercise test. The simplified derived equation was [109-(0.5*age) + (0.5*HR rest) + (0.2*LVEF)-(5 if haemoglobin <11 g/dL)]. The R2 and the standard error of the estimate were 0.24 and 17.5 beats min-1 with a mean absolute percentage error (MAPE) = 11.9%. The Keteyian equation had a slightly higher MAPE = 12.3%. Conversely, the Fox and Tanaka equations showed extremely higher MAPE values. The range 75-80% of MHR according to the new and the Keteyian equations was the most accurate in identifying the HR at the AT (MAPEs = 11.3-11.6%). CONCLUSION The derived equation to estimate the MHR in HFrEF patients, by accounting also for the systolic dysfunction degree and anaemia, improved slightly the Keteyian formula. Both formulas might be helpful in identifying the true maximal effort during an exercise test and the intensity domain during a rehabilitation programme.
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Affiliation(s)
- Damiano Magrì
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | | | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | - Ugo Corrà
- Cardiology Department, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno Institute, Veruno, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stefania Paolillo
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - Pasquale Perrone Filardi
- Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy
| | - Antonello Maruotti
- Dipartimento di Giurisprudenza, Economia, Politica e Lingue Moderne-Libera Università Maria Ss Assunta
- Department of Mathematics, University of Bergen, Bergen, Norway
- School of Computing, University of Portsmouth, Portsmouth, UK
| | | | - Massimo Mapelli
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milano, Italy
| | - Carlo Vignati
- Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy
| | - Michele Senni
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Limongelli
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Napoli, Italy
| | - Rocco Lagioia
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Domenico Scrutinio
- Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy
| | - Michele Emdin
- Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy.11 Cardiology Division, Santo Spirito Hospital, Roma, Italy
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy
| | - Claudio Passino
- Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy.11 Cardiology Division, Santo Spirito Hospital, Roma, Italy
- Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | | | - Roberto Badagliacca
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy
| | - Susanna Sciomer
- Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Health Authority n°1 and University of, Trieste, Trieste, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milano, Italy
- Dept. Of Clinical sciences and Community health, Cardiovascular Section, University of Milano, Milano, Italy
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Pimenta T, Rocha JA. Cardiac rehabilitation and improvement of chronotropic incompetence: Is it the exercise or just the beta blockers? Rev Port Cardiol 2021; 40:947-953. [PMID: 34922702 DOI: 10.1016/j.repce.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/11/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Clinical use of chronotropic response has been limited due to lack of consensus on the appropriate formula for chronotropic index (Ci) calculation and the definition of chronotropic incompetence. OBJECTIVES To assess the effects of cardiac rehabilitation programs (CRP) on Ci, irrespective of betablockers (BB) use and dosage. Assess the relative contribution of change in Ci on improvement in functional capacity. METHODS Retrospective analysis of a sample of patients admitted to a CRP after acute coronary syndrome, with at least 12 months of follow-up. Ci was calculated using the conventional (CCi) and the Brawner formula (BCi) for age-predicted maximum heart rate. Ci and functional capacity were estimated at three time points: T1 and T2, before and at the end of the CRP, and T3, at 12 months. The sample was categorized according to BB dosage modification between T1 and T3: G1 - reduced; G2 - no change; G3 - increased. RESULTS In G1, CCi increased from 63.5% in T1 to 77.9% in T3; in G2, from 67.3% to 77.9%; in G3, from 71.2% to 75.4%. In G1, BCi increased from 110.4% to 140.0%; in G2, from 122.8% to 140.1%; in G3, from 133.3% to 139.2%. An average increase in 1.0% in CCi was associated with an average increase in functional capacity of 0.37 METS. CONCLUSIONS Chronotropic index significantly improves with CRP, irrespective of BB dose changes. CCi is more closely related with improvement in functional capacity than BCi. Improvement of Ci is an important predictor of functional capacity and prognosis in cardiovascular disease patients.
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Affiliation(s)
- Tiago Pimenta
- Department of Physical Medicine & Rehabilitation, Centro Hospitalar e Universitário de São João, Porto, Portugal.
| | - J Afonso Rocha
- Department of Physical Medicine & Rehabilitation, Centro Hospitalar e Universitário de São João, Porto, Portugal
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11
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Lin SI, Liao FC, Chiou WR, Lin PL, Kuo JY, Tsai CT, Lee YH. Closed loop stimulation helps with weaning from chronotropic incompetence-related ventilator dependence. J Interv Card Electrophysiol 2021; 63:229-230. [PMID: 34792693 PMCID: PMC8600097 DOI: 10.1007/s10840-021-01074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/04/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Shu-I Lin
- Cardiovascular Center, MacKay Memorial Hospital, 92, Zhongshan N. Rd. Sec 2, Taipei, Taiwan, 10449.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Feng-Ching Liao
- Cardiovascular Center, MacKay Memorial Hospital, 92, Zhongshan N. Rd. Sec 2, Taipei, Taiwan, 10449.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Wei-Ru Chiou
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,Division of Cardiology, Taitung MacKay Memorial Hospital, Taitung, Taiwan
| | - Po-Lin Lin
- Division of Cardiology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Jen-Yuan Kuo
- Cardiovascular Center, MacKay Memorial Hospital, 92, Zhongshan N. Rd. Sec 2, Taipei, Taiwan, 10449.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan
| | - Cheng-Ting Tsai
- Cardiovascular Center, MacKay Memorial Hospital, 92, Zhongshan N. Rd. Sec 2, Taipei, Taiwan, 10449.,Department of Medicine, MacKay Medical College, New Taipei, Taiwan.,Department of Artificial Intelligence and Medical Application, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Ying-Hsiang Lee
- Cardiovascular Center, MacKay Memorial Hospital, 92, Zhongshan N. Rd. Sec 2, Taipei, Taiwan, 10449. .,Department of Medicine, MacKay Medical College, New Taipei, Taiwan. .,Department of Artificial Intelligence and Medical Application, MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.
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12
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Yoshida K, Takano K, Tani H, Nobuhara S, Maruyama Y, Marumoto K. ΔHR/ΔWR derived from CPET; A novel predictor of 'off' symptom in Parkinson's disease. Parkinsonism Relat Disord 2021; 92:101-104. [PMID: 34739978 DOI: 10.1016/j.parkreldis.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/28/2021] [Accepted: 10/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Chronotropic incompetence (CI) is broadly defined as the inability of the heart to increase its rate commensurate with increased activity. In this study, we tried to clarify the link between CI and UPDRS part II (off-on), which was calculated by subtracting part II (on) from part II (off), in patients with Parkinson's disease (PD). METHODS Thirty-six hospitalized patients were examined by using cardiopulmonary exercise testing (CPET) for exercise tolerance (ΔVO2/ΔWR and peak VO2/W) and the presence of CI (ΔHR/ΔWR), and using electrocardiogram for heart rate variability. RESULTS We originally divided the patients into three groups; Group I (ΔHR/ΔWR x100 <15) (N = 3), Group II (15≥, <60) (N = 28), Group III (>60) (N = 5). Since Group I and III were significantly smaller and older than Group II, we focused and divided into two groups; Group II CI (+), the PD patients with CI (15≤ ΔHR/ΔWR x100 <35), and Group II CI (-), those patients without that (35≤ ΔHR/ΔWR x100 <60). ΔVO2/ΔWR and peak VO2/W in CI (+) patients was lower than CI (-) (P = 0.022 and P = 0.096, respectively). HF power (parasympathetic activity) tends to be decreased, whereas LF/HF ratio (sympathetic activity) was increased in CI (+) patients as compared with CI (-). The UPDRS part II (off-on) of CI (+) patients was significantly higher than CI (-) (P = 0.023). CONCLUSIONS In PD patients, the difference between 'on' and 'off' in activities of daily living might be predicted by using ΔHR/ΔWR x100 obtained from CPET as an index.
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Affiliation(s)
- Kohsuke Yoshida
- Department of Clinical Laboratory, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan; Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2, Tomogaoka, Suma-ku, Kobe, Hyogo, 654-0142, Japan.
| | - Kazuki Takano
- Department of Clinical Laboratory, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Hiromi Tani
- Department of Clinical Laboratory, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Sae Nobuhara
- Department of Clinical Laboratory, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Yuki Maruyama
- Department of Pharmacy, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
| | - Kohei Marumoto
- Department of Physical Medicine and Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto, Shingu-cho, Tatsuno, Hyogo, 679-5165, Japan
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Sharma AD, Richards M, Olshansky B, Wold N, Jones P, Perschbacher D, Wilkoff BL. Heart rate score, a measure related to chronotropic incompetence in pacemaker patients. Heart Rhythm O2 2021; 2:124-131. [PMID: 34113914 PMCID: PMC8183967 DOI: 10.1016/j.hroo.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Heart rate score (HrSc) ≥70% in cardiac resynchronization therapy defibrillator and implantable cardioverter-defibrillator subjects predicts 5-year mortality risk. A high HrSc suggests few sensed cardiac cycles above the programmed lower rate. OBJECTIVE To determine if HrSc is related to chronotropic incompetence (CI) in pacemaker (PM) subjects. METHODS HrSc is the percentage of all atrial-paced and sensed events in the single tallest 10 beats/min histogram bin programmed to DDD 60/min. The prospective LIFE study of PM subjects examined multiple treadmill-based measures of CI. The 1-month postimplant DDD 60/min PM rate histogram prior to treadmill was retrospectively analyzed for HrSc. Measures of CI were applied to submaximal treadmill data in the DDD mode. HrSc was compared to these CI measures and to clinical indications for PM. RESULTS The 1-month histogram demonstrated HrSc ≥70% in 43% of subjects. HrSc ≥70% correlated with a clinical diagnosis of sick sinus syndrome (P < .001). CI was present in 34%-88% of subjects by treadmill-based measures. Agreement between treadmill-based measures for CI was poor and varied from 39% to 83%. HrSc ≥70%, as a measure of CI, was most highly correlated with unpaced heart rate <70% of age-predicted maximum heart rate (67%) (odds ratio 3.7, P < .001). CONCLUSIONS HrSc ≥70% correlates with treadmill measures of CI and clinical sick sinus syndrome. HrSc ≥70% is a measure of CI in PM subjects that is inexpensive, repeatable, and quantitative.
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14
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Wolsk E, Kaye DM, Komtebedde J, Shah SJ, Borlaug BA, Burkhoff D, Kitzman DW, Cleland JG, Hasenfuß G, Hassager C, Møller JE, Gustafsson F. Determinants and consequences of heart rate and stroke volume response to exercise in patients with heart failure and preserved ejection fraction. Eur J Heart Fail 2021; 23:754-764. [PMID: 33686716 DOI: 10.1002/ejhf.2146] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS A hallmark of heart failure with preserved ejection fraction (HFpEF) is impaired exercise capacity of varying severity. The main determinant of exercise capacity is cardiac output (CO), however little information is available about the relation between the constituents of CO - heart rate and stroke volume - and exercise capacity in HFpEF. We sought to determine if a heterogeneity in heart rate and stroke volume response to exercise exists in patients with HFpEF and describe possible clinical phenotypes associated with differences in these responses. METHODS AND RESULTS Data from two prospective trials of HFpEF (n = 108) and a study of healthy participants (n = 42) with invasive haemodynamic measurements during exercise were utilized. Differences in central haemodynamic responses were analysed with regression models. Chronotropic incompetence was present in 39-56% of patients with HFpEF and 3-56% of healthy participants depending on the definition used, but some (n = 47, 44%) had an increase in heart rate similar to that of healthy controls. Patients with HFpEF had a smaller increase in their stroke volume index (SVI) (HFpEF: +4 ± 10 mL/m2 , healthy participants: +24 ± 12 mL/m2 , P < 0.0001), indeed, SVI fell in 28% of patients at peak exercise. Higher body mass index and lower SVI at rest were associated with smaller increases in heart rate during exercise, whereas higher resting heart rate, and angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use were associated with a greater increase in SVI in patients with HFpEF. CONCLUSION The haemodynamic response to exercise was very heterogeneous among patients with HFpEF, with chronotropic incompetence observed in up to 56%, and 28% had impaired increase in SVI. This suggests that haemodynamic exercise testing may be useful to identify which HFpEF patients may benefit from interventions targeting stroke volume and chronotropic response.
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Affiliation(s)
- Emil Wolsk
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - David M Kaye
- Department of Cardiology, Alfred Hospital, Baker IDI Heart and Diabetes Research Institute, Melbourne, Australia
| | | | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Barry A Borlaug
- Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN, USA
| | | | - Dalane W Kitzman
- Department of Internal Medicine, School of Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John G Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow and National Heart & Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | | | - Jacob E Møller
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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15
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Cherneva RV, Youroukova VM, Cherneva ZV. Dynamic hyperinflation, chronotropic intolerance and abnormal heart rate recovery in non-severe chronic obstructive pulmonary disease patients-reflections in the mirror. Pulmonology 2021; 28:440-448. [PMID: 33419715 DOI: 10.1016/j.pulmoe.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The presence of abnormal heart rate recovery (HRR) and chronotropic incompetence (CI) suggests autonomic dysfunction (AD) and is associated with diminished physical activity and increased cardio-vascular (CV) risk. AIM Our aim is to analyse the correlation between AD and airflow obstruction - forced expiratory volume in 1s (FEV1), dynamic hyperinflation (DH) and disease prognosis - the BODE - index (BMI; Obstruction - FEV1;Dyspnea - mMRC;E - exercise capacity) in non-severe COPD patients without overt CV comorbidities. METHODS We used cardio-pulmonary exercise testing (CPET) with 67 subjects. Inspiratory capacity (IC) manouevres were performed for DH assessment. Echocardiography was executed before CPET and 1-2min after peak exercise. Stress left ventricular diastolic dysfunction (LVDD) was assumed if stress E/e'>15.Wilkoff method calculated the metabolic-chronotropic relationship (MCR). Chronotropic incompetence (CI) and abnormal HR recovery (HRR) were determined. MAIN RESULTS CI was detected in 44% of the mild and 65% of the moderate COPD patients. Abnormal HRR was present in 75% of the mild and 78% of the moderate COPD subjects. Multivariate regression analysis showed no association between FEV1, CPET parameters, BODE index, stress LVDD and AD. DH was the only independent predictor for both abnormal HRR and CI. CONCLUSION Evaluation of AD during incremental CPET unravels lung hyperinflation as a potential mechanism of attenuated HR response and diminished physical activity in non-severe COPD free of overt CV comorbidities. This multifaceted approach to dyspnea may facilitate the discrimination of its pathogenesis and improve its proper clinical management.
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Affiliation(s)
- R V Cherneva
- Medical University Sofia, Department of Respiratory Diseases, University Hospital for Respiratory Diseases "St. Sophia'', Sofia, bul. "Ivan Geshov 17", Bulgaria
| | - V M Youroukova
- Medical University Sofia, Department of Respiratory Diseases, University Hospital for Respiratory Diseases "St. Sophia'', Sofia, bul. "Ivan Geshov 19", Bulgaria
| | - Zh Vl Cherneva
- Department of Cardiology, Medical Institute of the Ministry of Internal Affairs, Sofia, Bulgaria.
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Hsu JC, Darden D, Alegre M, Birgersdotter-Green U, Feld GK, Hoffmayer KS, Han F, Krummen D, Raissi F, Ho G, Taub PR, Urey MA, Adler E. Effect of closed loop stimulation versus accelerometer on outcomes with cardiac resynchronization therapy: the CLASS trial. J Interv Card Electrophysiol 2021; 61:479-85. [PMID: 32757086 DOI: 10.1007/s10840-020-00829-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Chronotropic incompetence (CI) in patients with heart failure is common and associated with impaired exercise intolerance and adverse outcomes. This study sought to determine the effects of closed loop stimulation (CLS) rate-adaptive pacing on functional capacity in patients with heart failure with reduced ejection fraction (HFrEF) and CI implanted with cardiac resynchronization therapy (CRT) devices. METHODS A randomized, blinded, cross-over designed trial enrolled patients with HFrEF and CI implanted with a Biotronik CRT-D to complete a quality of life questionnaire, 6-min walk distance (6MWD), and cardiopulmonary exercise testing after two programmed periods: 1-week period of CLS and 1-week period of standard accelerometer (DDDR). RESULTS Nine patients (6 males, mean age 71.4 years, 7 with New York Heart Association Class III, mean ejection fraction 39 ± 8%) were enrolled. Quality of life trended higher in CLS as compared to DDDR (550.8 ± 123.9 vs 489.3 ± 164.9, p = 0.06). There were no differences between CLS and DDDR in 6MWD (293.1 ± 90.2 m vs 315.1 ± 95.5 m, p = 0.52), peak heart rate (HR) 110.7 ± 14.7 bpm vs 109.7 bpm ± 14.1, p = 0.67), or peak VO2 (12.3 ± 4.9 ml/kg/min vs 12.9 ± 5.9, p = 0.47). As tests were submaximal as indicated by low respiratory exchange ratios (0.98 ± 0.11 vs 1.0 ± 0.8, p = 0.35), VE/VCO2 slope also showed no difference between CLS and DDDR (35.8 ± 5.6 vs 35.4 ± 5.7, p = 0.65). Five patients (56%) preferred CLS programming (p = 1.0). CONCLUSIONS In patients with HFrEF and CI implanted with a CRT-D, peak HR, peak VO2, and 6MWD were equivalent, while there was a trend toward improved quality of life in CLS as compared to DDDR. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT02693262.
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Nakai T, Ikeya Y, Tsuchiya N, Mano H, Kurokawa S, Nagashima K, Ohkubo K, Watanabe I, Okumura Y. Benefit of Rate Response with Closed-Loop Stimulation in Patients with Difficult Hemodialysis. Int Heart J 2020; 61:611-615. [PMID: 32418964 DOI: 10.1536/ihj.19-545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rate-responsive pacing is known to improve quality of life (QOL) in patients with sick sinus syndrome and chronotropic incompetence. However, the sensors for rate response include accelerometers, closed-loop stimulation (CLS), and minute ventilation sensors (MV sensors), each of which has a different mode of action. For this reason, it is important to select appropriate sensors that match the daily habits and behavioral patterns of the patient. For example, young and active patients are expected to have a rate increase when an accelerometer is used, while elderly patients and patients with a physical disability who are only able to move slowly often have a poor response to the accelerometer. MV sensors are therefore better suited to these patients. Furthermore, CLS is considered effective for patients who require an increase in heart rate when at rest, for example, patients undergoing maintenance dialysis.We describe a representative case, demonstrating the effectiveness of closed-loop stimulation in a patient with hypotension during dialysis.
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Affiliation(s)
- Toshiko Nakai
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yukitoshi Ikeya
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Naotoshi Tsuchiya
- Department of Clinical Medical Engineering, Nihon University School of Medicine
| | - Hiroaki Mano
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Sayaka Kurokawa
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Koichi Nagashima
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Kimie Ohkubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Ichiro Watanabe
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
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Iriart X, Le Quellenec S, Pillois X, Jaussaud J, Jalal Z, Roubertie F, Douard H, Cochet H, Thambo JB. Heart rate response during exercise predicts exercise tolerance in adults with transposition of the great arteries and atrial switch operation. Int J Cardiol 2020; 299:116-122. [PMID: 31405586 DOI: 10.1016/j.ijcard.2019.07.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/11/2019] [Accepted: 07/15/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND To assess the relationship between heart rate response and exercise tolerance in adults with systemic right ventricle (sRV) after atrial switch repair for Transposition of the Great Artery (TGA) in addition to other physiological parameters. METHODS All patients with a sRV after atrial switch repair for TGA followed in our institution between June 2015 and April 2018 who underwent cardiopulmonary exercise testing (CPET) were analyzed. Cardiac imaging performed within a six-month time period of the CPET were also collected. Chronotropic incompetence was defined as the inability to achieve 80% of age-predicted maximal heart rate reserve (HRR) and <62% on a beta-blocker regimen. Patient characteristics were assessed according to tertiles of the percentage of predicted pVO2 (%ppVO2). RESULTS We studied 70 patients (mean of age 32.4 ± 7.6 years old, 51 males). Mean peak oxygen uptake was 21.5 ± 5.8 mL/kg/min, corresponding to a %ppVO2 of 57 ± 14.1% while mean VE/VCO2 slope was 37.1 ± 8.2. There was a trend toward more exaggerated hyperventilation in patient with lower pVO2. Mean age-adjusted HRR was 68.5 ± 19%. Chronotropic incompetence was observed in 65.7% and was correlated with %ppVO2 (r = 0.482; p < 0.001) as physical training evaluated with Ventilatory Anaerobic threshold (r = 0.571; p < 0.001), while no difference was found based on respiratory parameters. No echocardiographic or Magnetic Resonance Imaging parameters assessing sRV systolic function at rest were correlated with %ppVO2. CONCLUSIONS Exercise limitation is related to the inability to increase cardiac output during exercise and is notably due to the degree of chronotropic incompetence.
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Affiliation(s)
- Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, 33604 Pessac, France.
| | - Soazig Le Quellenec
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, 33604 Pessac, France
| | - Xavier Pillois
- LIRYC, L'institut de rythmologie et de modélisation cardiaque, Bordeaux University, France
| | | | - Zakaria Jalal
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, 33604 Pessac, France; LIRYC, L'institut de rythmologie et de modélisation cardiaque, Bordeaux University, France
| | - François Roubertie
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, 33604 Pessac, France; LIRYC, L'institut de rythmologie et de modélisation cardiaque, Bordeaux University, France
| | - Hervé Douard
- Cardiac Rehabilitation Department, Bordeaux University Hospital, 33604 Pessac, France
| | - Hubert Cochet
- Department of Cardiovascular imaging, Bordeaux University Hospital, 33604 Pessac, France; LIRYC, L'institut de rythmologie et de modélisation cardiaque, Bordeaux University, France
| | - Jean-Benoît Thambo
- Department of Pediatric and Adult Congenital Cardiology, Bordeaux University Hospital, 33604 Pessac, France; Clinique du sport, Mérignac, France
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Hayashi T, Mizukami A, Kuroda S, Matsumura A, Goya M, Sasano T. Sinus node dysfunction characterized by reduction only in maximum heart rate during exercise after superior vena cava isolation in atrial fibrillation catheter ablation-A potential complication. HeartRhythm Case Rep 2020; 6:206-9. [PMID: 32322498 DOI: 10.1016/j.hrcr.2019.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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20
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Paolillo S, Agostoni P, De Martino F, Ferrazzano F, Marsico F, Gargiulo P, Pirozzi E, Marciano C, Dellegrottaglie S, Perrone Filardi P. Heart rate during exercise: mechanisms, behavior, and therapeutic and prognostic implications in heart failure patients with reduced ejection fraction. Heart Fail Rev 2019; 23:537-545. [PMID: 29926282 DOI: 10.1007/s10741-018-9712-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Exercise intolerance is a typical manifestation of patients affected by heart failure with reduced ejection fraction (HFrEF); however, the relationship among functional capacity, mortality, and exercise-induced heart rate response during exercise remains unclear in either sinus rhythm or atrial fibrillation subjects. Heart rate increase during incremental load exercise has a typical pattern in normal subjects, whereas it is commonly compromised in HFrEF patients, mainly due to the imbalance of the autonomic nervous system. In the present review, we aim to describe the behavior of heart rate during exercise in normal subjects and in HFrEF patients in sinus rhythm and atrial fibrillation, understanding and explaining the mechanism leading to a different exercise performance and functional limitation. Moreover, the role of chronotropic incompetence and the need of standardizing the cutoff criteria are also discussed in order to clarify the clinical importance, the prognostic relevance, and the potential therapeutic implications of this condition. Looking into the relative contribution and interaction of heart rate response during exercise might represent an important issue to guide individualized therapeutic interventions and prognostic assessment in HFrEF patients.
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Affiliation(s)
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Dipartimento di Scienze Cliniche e di Comunità, Sezione Cardiovascolare, Università di Milano, Milan, Italy
| | - Fabiana De Martino
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Naples, Italy
| | - Francesca Ferrazzano
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Naples, Italy
| | - Fabio Marsico
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Naples, Italy
| | | | - Elisabetta Pirozzi
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Naples, Italy
| | | | - Santo Dellegrottaglie
- Division of Cardiology, Ospedale Accreditato Villa dei Fiori, Naples, Acerra, Italy.,Mount Sinai Medical School, New York City, NY, USA
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University of Naples, Naples, Italy
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21
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Magri D, Agostoni P, Sinagra G, Re F, Correale M, Limongelli G, Zachara E, Mastromarino V, Santolamazza C, Casenghi M, Pacileo G, Valente F, Morosin M, Musumeci B, Pagannone E, Maruotti A, Uguccioni M, Volpe M, Autore C. Clinical and prognostic impact of chronotropic incompetence in patients with hypertrophic cardiomyopathy. Int J Cardiol 2018; 271:125-131. [PMID: 30087038 DOI: 10.1016/j.ijcard.2018.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/23/2018] [Accepted: 04/05/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND A blunted heart rate (HR) response is associated with an impaired peak oxygen uptake (pVO2), a powerful outcome predictor in hypertrophic cardiomyopathy (HCM). The present multicenter study sought to determine the prognostic role for exercise-induced HR response in HCM. METHODS A total of 681 consecutive HCM outpatients on optimized treatment were recruited. The heart failure (HF) end-point was death due to HF, cardiac transplantation, NYHA III-IV class progression, HF worsening leading to hospitalization and severe functional deterioration leading to septal reduction. The sudden cardiac death (SCD) end-point included SCD, aborted SCD and appropriate implantable cardioverter defibrillator discharges. RESULTS During a median follow-up of 4.2 years (25-75th centile: 3.9-5.2), 81 patients reached the HF and 23 the SCD end-point. Covariates with independent effects on the HF end-point were left atrial diameter, left ventricular ejection fraction, maximal left ventricular outflow tract gradient and exercise cardiac power (ECP = pVO2∗systolic blood pressure) (C-Index = 0.807) whereas the HCM Risk-SCD score and the ECP remained associated with the SCD end-point (C-Index = 0.674). When the VO2-derived variables were not pursued, peak HR (pHR) re-entered in the multivariate HF model (C-Index = 0.777) and, marginally, in the SCD model (C-index = 0.656). A pHR = 70% of the maximum predicted resulted as the best cut-off value in predicting the HF-related events. CONCLUSIONS The cardiopulmonary exercise test is pivotal in the HCM management, however the pHR remains a meaningful alternative parameter. A pHR < 70% identified a HCM population at high risk of HF-related events, thus calling for a reappraisal of the chronotropic incompetence threshold in HCM.
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Affiliation(s)
- Damiano Magri
- Dpt Clinical and Molecular Medicine, Sapienza University, Rome, Italy.
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milano, Italy; Dpt of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianfranco Sinagra
- Cardiovascular Dpt "Ospedali Riuniti" Trieste and Postgraduate School Cardiovascular Sciences, University of Trieste Cardiology Division, Italy
| | - Federica Re
- Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy
| | | | | | - Elisabetta Zachara
- Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy
| | | | | | - Matteo Casenghi
- Dpt Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Giuseppe Pacileo
- Cardiologia SUN, Monaldi Hospital, II University of Naples, Naples, Italy
| | - Fabio Valente
- Cardiologia SUN, Monaldi Hospital, II University of Naples, Naples, Italy
| | - Marco Morosin
- Cardiovascular Dpt "Ospedali Riuniti" Trieste and Postgraduate School Cardiovascular Sciences, University of Trieste Cardiology Division, Italy
| | - Beatrice Musumeci
- Dpt Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Erika Pagannone
- Dpt Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Antonello Maruotti
- Dpt of Scienze economiche, politiche e delle lingue moderne - Libera Università SS Maria Assunta, Rome, Italy; Centre for innovation and leadership in health sciences, University of Southampton, Southampton, UK
| | - Massimo Uguccioni
- Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy
| | - Massimo Volpe
- Dpt Clinical and Molecular Medicine, Sapienza University, Rome, Italy; IRCCS - Neuromed, Pozzilli, IS, Italy
| | - Camillo Autore
- Dpt Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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22
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Herbsleb M, Schumann A, Malchow B, Puta C, Schulze PC, Gabriel HW, Bär KJ. Chronotropic incompetence of the heart is associated with exercise intolerance in patients with schizophrenia. Schizophr Res 2018. [PMID: 29526454 DOI: 10.1016/j.schres.2018.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The elevated cardiovascular risk of patients with schizophrenia contributes to a reduced life expectancy of 15-20years. This study investigated whether cardiac autonomic dysfunction (CADF) in schizophrenia is related to chronotropic incompetence, an established cardiovascular risk marker. We investigated thirty-two patients suffering from paranoid schizophrenia and thirty-two control subjects matched for age, sex, body mass index and fat free mass. A cardiopulmonary exercise test (CPET) was performed to study heart rate responses to exercise as well as submaximal (ventilatory threshold 1, VT1) and maximal endurance capacities (peak oxygen consumption, VO2peak; peak power output, Ppeak). In addition, epinephrine and norepinephrine levels were assessed in a subset of patients. Fitness parameters were significantly reduced in all patients. Most investigated physiological parameters were significantly different at rest as well as during peak exercise being in line with previously described CADF in schizophrenia. In particular, 14 out of 32 patients were classified as chronotropically incompetent whereas no control subject was below the cut-off value. In addition, a positive correlation of a slope reflecting chronotropic incompetence with peak oxygen uptake (p<0.001) was observed in patients only indicating a close correlation to the lack of physical fitness. The catecholamine increase was reduced in patients after exercise. This study identified a novel cardiac risk factor in patients with schizophrenia. Moreover, it seems to be associated with reduced physical fitness and indicates targets for exercise intervention studies. Future studies are warranted to elucidate pathophysiological mechanisms of this cardiac condition.
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Affiliation(s)
- Marco Herbsleb
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University of Jena, Germany
| | - Andy Schumann
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany
| | - Berend Malchow
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany
| | - Christian Puta
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University of Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Holger W Gabriel
- Department of Sports Medicine and Health Promotion, Friedrich-Schiller-University of Jena, Germany
| | - Karl-Jürgen Bär
- Psychiatric Brain and Body Research Group, Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany.
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23
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Rib Y, Zhussupova G, Igimbayeva G, Abdrakhmanov A, Jalali SF. Can chronotropic incompetence predict life-threatening ventricular arrhythmias in patients with stable ischemic heart disease? Caspian J Intern Med 2018; 9:164-170. [PMID: 29732035 PMCID: PMC5912225 DOI: 10.22088/cjim.9.2.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 01/09/2018] [Accepted: 01/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronotropic incompetence has prognostic value of all-cause and cardiovascular mortality in both patients with asymptomatic and symptomatic ischemic heart disease (IHD), regardless of traditional risk factors. The aim of this study was to investigate the relationship between chronotropic response during exercise test and the development of ventricular arrhythmias. METHODS 153 patients with stable ischemic heart disease were screened and observed during the 24 months since October 2014 in a university hospital in Astana Kazakhstan. They underwent bedside electrocardiography, 24h heart rate Holter monitoring, echocardiography, exercise stress test (treadmill) for assessment of chronotropic index calculating at first contact. Holter- electrocardiography was repeated three times (at 3, 6, 12 months of follow-up period) to reveal life-threatening ventricular arrhythmias. RESULTS The quantity of the ventricular extrasystoles was higher in the group with low chronotropic index. Low chronotropic index increased the risk of high grade ventricular extrasystoles more than two times (P=0.015); episodes of non-sustained VT more than three times (p<0.001); and episodes of sustained VT more than nine times (p<0.001). CONCLUSIONS Chronotropic index less than 35.6 increases the risk for life-threatening ventricular arrhythmias in patients with stable chronicle ischemic heart disease irrespectively of severe left ventricle systolic dysfunction.
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Affiliation(s)
- Yelena Rib
- Astana Medical University, Astana, Kazakhstan
| | - Gulnar Zhussupova
- Department of Internal Diseases, Astana Medical University, Astana, Kazakhstan
| | | | - Ayan Abdrakhmanov
- Depatment of Interventional Arrhythmology National Research Center for Cardiac Surgery, Astana, Kazakhstan
| | - Seyed Farzad Jalali
- Social Determinant of Health Research Center, Health Resarch Institute, Babol University of Medical Sciences, Babol, Iran
- Department of Cardiology, Babol University of Medical Sciences, Babol, Iran
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24
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Sanges S, Giovannelli J, Sobanski V, Morell-Dubois S, Maillard H, Lambert M, Podevin C, Lamblin N, De Groote P, Bervar JF, Perez T, Matran R, Rémy-Jardin M, Hatron PY, Hachulla É, Launay D. Factors associated with the 6-minute walk distance in patients with systemic sclerosis. Arthritis Res Ther 2017; 19:279. [PMID: 29246248 PMCID: PMC5732461 DOI: 10.1186/s13075-017-1489-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022] Open
Abstract
Background There is an ongoing debate regarding the relevance of the 6-minute walking distance (6MWD) in systemic sclerosis (SSc) assessment, widely used as a usual test in these patients as well as an outcome measure in clinical trials. In this work, we aimed to assess the associations between the 6MWD and various disease parameters in patients with SSc. Methods Consecutive patients followed in our SSc National Reference Centre were included in this cross-sectional study if they fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism criteria for SSc. Data were systematically collected during a comprehensive standardized evaluation that included a 6-minute walk test, clinical assessment, biological results, pulmonary function tests, transthoracic echocardiography, composite scores (European Scleroderma Study Group Activity Index, Medsger severity score, Health Assessment Questionnaire–Disability Index (HAQ-DI)) and treatments. Associations of the 6MWD with various disease parameters were assessed by linear regression in univariate and multivariate analyses. Results The study population comprised 298 patients (females 81%; mean age 58.2 ± 13.3 years; limited cutaneous SSc 82%; interstitial lung disease (ILD) 42%; pulmonary arterial hypertension (PAH) 6%). The 6MWD was significantly and independently associated with gender, age, body mass index, baseline heart rate (HR), HR variation during the test, PAH, history of arterial thrombosis and C-reactive protein levels, as well as with the HAQ-DI score in a sensitivity analysis. Muscle involvement, joint involvement and ILD were not independently associated with the 6MWD. Conclusions During SSc, the 6MWD is independently associated with initial HR and HR variation; with PAH but not ILD, suggesting that pulmonary vasculopathy may have a greater impact than parenchymal involvement on functional limitation; and with global markers of disease activity and patient disability. These results give clinicians further insight into how to interpret the 6MWD in the context of SSc. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1489-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sébastien Sanges
- University of Lille, INSERM U995, LIRIC-Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - Jonathan Giovannelli
- University of Lille, INSERM U995, LIRIC-Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - Vincent Sobanski
- University of Lille, INSERM U995, LIRIC-Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - Sandrine Morell-Dubois
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - Hélène Maillard
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - Marc Lambert
- University of Lille, INSERM U995, LIRIC-Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - Céline Podevin
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France
| | | | | | | | - Thierry Perez
- CHU Lille, Service d'Explorations Fonctionnelles Respiratoires, F-59000, Lille, France
| | - Régis Matran
- CHU Lille, Service d'Explorations Fonctionnelles Respiratoires, F-59000, Lille, France
| | | | - Pierre-Yves Hatron
- University of Lille, INSERM U995, LIRIC-Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - Éric Hachulla
- University of Lille, INSERM U995, LIRIC-Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - David Launay
- University of Lille, INSERM U995, LIRIC-Lille Inflammation Research International Center, F-59000, Lille, France. .,INSERM U995, F-59000, Lille, France. .,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France. .,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France. .,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France.
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25
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Shen H, Zhao J, Zhou X, Li J, Wan Q, Huang J, Li H, Wu L, Yang S, Wang P. Impaired chronotropic response to physical activities in heart failure patients. BMC Cardiovasc Disord 2017; 17:136. [PMID: 28545575 PMCID: PMC5445286 DOI: 10.1186/s12872-017-0571-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/15/2017] [Indexed: 12/26/2022] Open
Abstract
Background While exercise-based cardiac rehabilitation has a beneficial effect on heart failure hospitalization and mortality, it is limited by the presence of chronotropic incompetence (CI) in some patients. This study explored the feasibility of using wearable devices to assess impaired chronotropic response in heart failure patients. Methods Forty patients with heart failure (left ventricular ejection fraction, LVEF: 44.6 ± 5.8; age: 54.4 ± 11.7) received ECG Holter and accelerometer to monitor heart rate (HR) and physical activities during symptom-limited treadmill exercise testing, 6-min hall walk (6MHW), and 24-h daily living. CI was defined as maximal HR during peak exercise testing failing to reach 70% of age-predicted maximal HR (APMHR, 220 – age). The correlation between HR and physical activities in Holter-accelerometer recording was analyzed. Results Of 40 enrolled patients, 26 were able to perform treadmill exercise testing. Based on exercise test reports, 13 (50%) of 26 patients did not achieve at least 70% of APMHR (CI patients). CI patients achieved a lower % APMHR (62.0 ± 6.3%) than non-CI patients who achieved 72.0 ± 1.2% of APMHR (P < 0.0001). When Holter-accelerometer recording was used to assess chronotropic response, the percent APMHR achieved during 6MHW and physical activities was significantly lower in CI patients than in non-CI patients. CI patients had a significantly shorter 6MHW distance and less physical activity intensity than non-CI patients. Conclusion The study found impaired chronotropic response in 50% of heart failure patients who took treadmill exercise testing. The wearable Holter-accelerometer recording could help to identify impaired chronotropic response to physical activities in heart failure patients. Trial registration ClinicalTrials.gov ID NCT02358603. Registered 16 May 2014.
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Affiliation(s)
- Hong Shen
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jianrong Zhao
- Department of Cardiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohong Zhou
- Cardiac Rhythm and Heart Failure, Research and Technology, Medtronic plc, Mounds View, MN, USA
| | - Jingbo Li
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Qing Wan
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Huang
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Li
- Department of Cardiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liqun Wu
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shungang Yang
- Cardiac Rhythm and Heart Failure, Research and Technology, Medtronic plc, Mounds View, MN, USA.,Medtronic Shanghai Innovation Center, Medtronic (Shanghai) Ltd., Shanghai, China
| | - Ping Wang
- Cardiac Rhythm and Heart Failure, Research and Technology, Medtronic plc, Mounds View, MN, USA.,Medtronic Shanghai Innovation Center, Medtronic (Shanghai) Ltd., Shanghai, China
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26
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Liu HJ, Guo J, Zhao QH, Wang L, Yang WL, He J, Gong SG, Liu JM. Chronotropic Incompetence and its Relation to Exercise Intolerance in Chronic Obstructive Pulmonary Disease. Am J Med Sci 2016; 353:216-223. [PMID: 28262206 DOI: 10.1016/j.amjms.2016.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND To study the relationship between chronotropic incompetence (CI) and disease severity and to assess the effect of CI on exercise capacity in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS Arterial blood gas analysis, pulmonary function test and cardiopulmonary exercise testing were conducted in 60 patients with stable COPD and 45 healthy volunteers. CI was defined using the chronotropic response index (CRI = (peak heart rate-resting heart rate) / (220-age-resting heart rate). Based on CRI, patients with COPD were divided into the normal chronotropic group (n = 23) and CI group (n = 37). RESULTS CI was present in 61.7% of the patients with COPD. Exercise capacity (peak oxygen uptake as percentage of predicted value, peak VO2%pred), peak heart rate and CRI were significantly lower in patients with COPD than in controls. However, resting heart rate was significantly higher than in controls. FEV1%pred and exercise capacity were significantly decreased in the CI group when compared with those in the normotropic group. There was significant association between CRI with FEV1%pred and peak VO2%pred. Multivariate regression analysis showed that CRI and FEV1%pred were independent predictors of exercise capacity in patients with COPD. A cutoff of 0.74 for the CRI showed a specificity of 94.1% in predicting patients with a peak VO2%pred < 60%. CONCLUSIONS CRI was associated with disease severity in patients with COPD. CI may be an important parameter to reflect exercise capacity in patients with COPD.
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Affiliation(s)
- Hai-Jian Liu
- Department of Respiratory Medicine, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
| | - Jian Guo
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qin-Hua Zhao
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lan Wang
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wen-Lan Yang
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing He
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Su-Gang Gong
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jin-Ming Liu
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China; Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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27
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Westover AN, Nakonezny PA, Barlow CE, Vongpatanasin W, Adinoff B, Brown ES, Mortensen EM, Halm EA, DeFina LF. Exercise outcomes in prevalent users of stimulant medications. J Psychiatr Res 2015; 64:32-9. [PMID: 25840827 PMCID: PMC4437621 DOI: 10.1016/j.jpsychires.2015.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/24/2015] [Accepted: 03/12/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND To compare users of stimulant medications with matched nonusers on exercise outcomes during a maximal treadmill exercise test. METHODS A cross-sectional study of a community-based cohort comparing propensity-score-matched stimulant medication users (n = 245) and nonusers (n = 735) who underwent a maximal treadmill exercise test in the Cooper Center Longitudinal Study cohort from January 1, 1995 to December 31, 2013. Main Outcomes were peak systolic blood pressure (SBP), average rise in SBP, peak heart rate (HR), and estimated VO2max during exercise. A linear mixed model analysis was used to evaluate the effect of stimulant exposure on each of the exercise outcomes. In a sensitivity analysis, users were compared against nonusers for risk of chronotropic incompetence. Analyses were adjusted for relevant covariates and multiple testing. RESULTS Peak HR during exercise was significantly lower in stimulant medication users (least square mean estimate 170.2 beats/minute) compared to nonusers (174.4 beats/minute; p < 0.0001). Moreover, stimulant medication users had an increased risk of chronotropic incompetence compared to nonusers (adjusted odds ratio 3.28, 95% confidence interval 1.70 to 6.34, p = 0.0008). No significant differences were observed in the outcomes of peak SBP, average SBP rise, and estimated VO2max between matched groups. CONCLUSIONS Stimulant medication use was associated with a significant decrease in peak HR and an increased risk of chronotropic incompetence. Further investigation is required to understand the clinical significance of chronotropic incompetence in stimulant medication users. Concerns that stimulant medication use may increase peak SBP and average SBP during exercise were not supported by this study.
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Affiliation(s)
- Arthur N. Westover
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390,Department of Clinical Sciences, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390
| | - Paul A. Nakonezny
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390,Department of Clinical Sciences, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390
| | | | - Wanpen Vongpatanasin
- Hypertension Section, Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390
| | - Bryon Adinoff
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390,VA North Texas Health Care System, Dallas VAMC, 4500 South Lancaster Road, Dallas, TX 75216
| | - E. Sherwood Brown
- Department of Psychiatry, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390
| | - Eric M. Mortensen
- VA North Texas Health Care System, Dallas VAMC, 4500 South Lancaster Road, Dallas, TX 75216,Division of General Internal Medicine, Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390
| | - Ethan A. Halm
- Division of General Internal Medicine, Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390
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Armstrong HF, Gonzalez-Costello J, Thirapatarapong W, Jorde UP, Bartels MN. Effect of lung transplantation on heart rate response to exercise. Heart Lung 2015; 44:246-50. [PMID: 25869526 DOI: 10.1016/j.hrtlng.2015.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 01/23/2015] [Accepted: 01/29/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate if patients have a change in percent of predicted heart rate reserve used at peak exercise (%HRR) after lung transplantation, even at matching workloads. BACKGROUND Lung disease of obstructive, restrictive, and mixed types may be associated with an autonomic imbalance. Lung transplantation may improve the effects of pulmonary disease on cardiac function. However, the effect of lung transplantation on heart rate responses during exercise has not been investigated in detail. METHODS Retrospective review of patients who underwent lung transplantation. Pre and post transplant cardiopulmonary exercise tests were reviewed. RESULTS The %HRR significantly improved by a median of 37% (p < 0.001) following lung transplantation. When matching workloads were analyzed, the %HRR also decreased from a median of 36% to 24% (p < 0.001). CONCLUSIONS Corresponding to an increase in peak exercise capacity, percentage of heart rate reserve used improves significantly after lung transplantation, even at matching workloads, indicating a likely improvement in autonomic modulation.
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Affiliation(s)
- Hilary F Armstrong
- Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Jose Gonzalez-Costello
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Wilawan Thirapatarapong
- Department of Rehabilitation Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand
| | - Ulrich P Jorde
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Matthew N Bartels
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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Leti T, Guinot M, Favre-Juvin A, Bricout VA. Difference of catecholamine responses to exercise in men with trisomy 21, with or without chronotropic incompetence. Physiol Behav 2015; 142:97-103. [PMID: 25660758 DOI: 10.1016/j.physbeh.2015.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 01/30/2015] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Our purpose was to analyse if catecholamine responses to exercise would be different in Down syndrome (DS) with or without chronotropic incompetence. RESEARCH DESIGN AND METHODS Twenty five men with DS (mean age 22.2 ± 3.2) and twenty six controls (CONT, mean age 22.5 ± 1.4) participated in the study, and are divided into 3 groups: CONT, DS with chronotropic incompetence (DS+) and DS without chronotropic incompetence (DS-). During two treadmill incremental tests, blood samples were collected for the determination of hormonal and metabolic variables. RESULTS Ten out of 25 DS had chronotropic incompetence whereas no CONT. At rest, compared to CONT, despite similar physical activity, DS with chronotropic incompetence had significantly higher subcutaneous fat mass (p<0.001), lower epinephrine concentration (p<0.01), and higher leptin (p<0.01) and insulin concentrations (p<0.05). At peak exercise, all DS had lower heart rate, oxygen uptake and blood lactate concentrations than controls (p<0.001). During a 'Submaximal incremental test', DS with chronotropic incompetence had lower HR and lactate values (p<0.001) compared to CONT and DS without chronotropic incompetence (p<0.01). They also had blunted epinephrine and impaired norepinephrine responses to exercise compared to DS without chronotropic incompetence and CONT (p<0.01 and p<0.05 respectively). CONCLUSIONS Our results indicate that catecholamine adaptations to exercise are not adequate in DS+ and are associated with exercise intolerance. Thus, this endocrine profile at rest and during exercise may limit endurance performance of DS.
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Affiliation(s)
- T Leti
- Univ. Grenoble Alpes, HP2, F-38000 Grenoble, France; INSERM U1042, HP2, F-38000 Grenoble, France
| | - M Guinot
- INSERM U1042, HP2, F-38000 Grenoble, France; CHU de Grenoble, Cardiovascular & Thoracic Unit; Sports & Pathologies, F-38000 Grenoble, France
| | - A Favre-Juvin
- CHU de Grenoble, Cardiovascular & Thoracic Unit; Sports & Pathologies, F-38000 Grenoble, France
| | - V-A Bricout
- Univ. Grenoble Alpes, HP2, F-38000 Grenoble, France; INSERM U1042, HP2, F-38000 Grenoble, France; CHU de Grenoble, Cardiovascular & Thoracic Unit; Sports & Pathologies, F-38000 Grenoble, France.
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Takano N, Takano H, Fukuda T, Kikuchi H, Oguri G, Fukumura K, Iwasawa K, Nakajima T. Relationship between chronotropic incompetence and β-blockers based on changes in chronotropic response during cardiopulmonary exercise testing. Int J Cardiol Heart Vasc 2014; 6:12-18. [PMID: 28785620 PMCID: PMC5497155 DOI: 10.1016/j.ijcha.2014.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 11/11/2014] [Accepted: 11/25/2014] [Indexed: 11/22/2022]
Abstract
Background Chronotropic incompetence (CI), an attenuated heart rate (HR) response to exercise, is common in patients with cardiovascular disease. The aim of this study was to assess changes in the chronotropic response (CR) during cardiopulmonary exercise testing (CPET) in patients undergoing cardiac rehabilitation and investigate the effects of β-blockers. Methods Patients undergoing cardiac rehabilitation performed CPET. Failure to achieve 80% of the age-predicted maximal HR (APMHR) defined CI. Values of the metabolic chronotropic relationship (MCR) were calculated from the ratio of the HR reserve to metabolic reserve at 4 stages, warm-up (MCR-Wu), anaerobic threshold (MCR-AT), respiratory compensation (MCR-Rc), and peak point (MCR-Pk), using the Wilkoff model. In patients who showed an increase in MCR at ≥ 3 of the 4 exercise stages, CR was considered to have improved. Results Patients with high BNP levels (≥ 80 pg/ml) had a lower MCR at all stages compared with those with low BNP levels (< 80 pg/ml). Of the 80 patients, 47 showed an increase in both peak VO2 and AT, and of these 31 (66.0%) were taking β-blockers. Improvement in CR was observed in 30 of 47 patients with CI, and 70% of these were taking β-blockers. In patients not taking β-blockers, MCR-AT was lower than MCR-Rc, whereas in those taking β-blockers MCR-AT was higher than MCR-Rc. Conclusions An attenuated HR response may occur during the early stages of exercise. The HR response according to the presence or absence of β-blockers is clearly identifiable by comparing MCR-AT and MCR-Rc using the Wilkoff model. We have standardized definitions of CI objectively based on the Wilkoff model. An attenuated HR response may occur during the early stages of exercise. MCR values without β-blockers decreased from warm-up to AT and increased after AT. MCR values with β-blockers decreased from warm-up to Rc and increased after Rc. Cardiac rehabilitation increased peak VO2 with an improvement in HR response.
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Affiliation(s)
- Nami Takano
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Haruhito Takano
- Takano Clinic, 4-6-38 Kamisaginomiya, Nakanoku, Tokyo 165-0031, Japan
| | - Taira Fukuda
- Health Center, Hitotsubashi University, 2-1 Naka, Kunitachishi, Tokyo 186-8601, Japan
| | - Hironobu Kikuchi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Gaku Oguri
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Kazuya Fukumura
- Department of Ischemia Circulatory Physiology, The University of Tokyo Hospital, 7-3-1Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Kuniaki Iwasawa
- Division of Health Service Promotion, University of Tokyo, 7-3-1Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | - Toshiaki Nakajima
- Department of Ischemia Circulatory Physiology, The University of Tokyo Hospital, 7-3-1Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
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Dobre D, Zannad F, Keteyian SJ, Stevens SR, Rossignol P, Kitzman DW, Landzberg J, Howlett J, Kraus WE, Ellis SJ. Association between resting heart rate, chronotropic index, and long-term outcomes in patients with heart failure receiving β-blocker therapy: data from the HF-ACTION trial. Eur Heart J 2013; 34:2271-80. [PMID: 23315907 PMCID: PMC3858021 DOI: 10.1093/eurheartj/ehs433] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/18/2012] [Accepted: 11/21/2012] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of this study was to assess the association between resting heart rate (HR), chronotropic index (CI), and clinical outcomes in optimally treated chronic heart failure (HF) patients on β-blocker therapy. METHODS AND RESULTS We performed a sub-study in 1118 patients with HF and reduced ejection fraction (EF < 35%) included in the HF-ACTION trial. Patients in sinus rhythm who received a β-blocker and who performed with maximal effort on the exercise test were included. Chronotropic index was calculated as an index of HR reserve achieved, by using the equation (220-age) for estimating maximum HR. A sensitivity analysis using an equation developed for HF patients on β-blockers was also performed. Cox proportional hazards models were fit to assess the association between CI and clinical outcomes. Median (25th, 75th percentiles) follow-up was 32 (21, 44) months. In a multivariable model including resting HR and CI as continuous variables, neither was associated with the primary outcome of all-cause mortality or hospitalization. However, each 0.1 unit decrease in CI <0.6 was associated with 17% increased risk of all-cause mortality (hazard ratio 1.17, 95% confidence interval 1.01-1.36; P = 0.036), and 13% increased risk of cardiovascular mortality or HF hospitalization (hazard ratio 1.13, 1.02-1.26; P = 0.025). Overall, 666 of 1118 (60%) patients had a CI <0.6. Chronotropic index did not retain statistical significance when dichotomized at a value of ≤ 0.62. CONCLUSION In HF patients receiving optimal medical therapy, a decrease in CI <0.6 was associated with adverse clinical outcomes. Obtaining an optimal HR response to exercise, even in patients receiving optimal β-blocker therapy, may be a therapeutic target in the HF population.
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Affiliation(s)
- Daniela Dobre
- INSERM, Center of Clinical Investigation-9501, University Hospital Nancy, Lorrain Institute of Heart and Vessels Louis Mathieu, 4, rue du Morvan, 54500 Vandoeuvre-Les-Nancy, France.
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González-Costello J, Armstrong HF, Jorde UP, Bevelaqua AC, Letarte L, Thomashow BM, Bartels MN. Chronotropic incompetence predicts mortality in severe obstructive pulmonary disease. Respir Physiol Neurobiol 2013; 188:113-8. [PMID: 23669496 DOI: 10.1016/j.resp.2013.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 05/01/2013] [Accepted: 05/06/2013] [Indexed: 11/26/2022]
Abstract
We evaluated the prevalence of chronotropic incompetence (CI), a marker of autonomic dysfunction, and its prognostic value in patients with chronic obstructive pulmonary disease (COPD). We performed a retrospective analysis of 449 patients with severe COPD who underwent a cardiopulmonary exercise test, after excluding patients with lung volume reduction surgery, left ventricular dysfunction and those not in sinus rhythm. CI was defined as percent predicted heart rate reserve (%HRR). Events were defined as death or lung transplant during a median follow-up of 68 months. Median age was 61 years; median percent predicted forced expiratory volume in one second (%FEV1) of 25% and median %HRR of 33%. The hazard ratio for an event in the lowest quartile of %HRR, taking the highest quartile as reference, was of 3.2 (95% confidence interval: 2.1-4.8; p<0.001). In a multivariate regression model, %HRR was an independent predictor of events. In conclusion, CI was an independent and powerful outcome predictor in patients with severe COPD.
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Affiliation(s)
- José González-Costello
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA
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Pasquali D, Arcopinto M, Renzullo A, Rotondi M, Accardo G, Salzano A, Esposito D, Saldamarco L, Isidori AM, Marra AM, Ruvolo A, Napoli R, Bossone E, Lenzi A, Baliga RR, Saccà L, Cittadini A. Cardiovascular abnormalities in Klinefelter syndrome. Int J Cardiol 2012; 168:754-9. [PMID: 23092857 DOI: 10.1016/j.ijcard.2012.09.215] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/18/2012] [Accepted: 09/29/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several epidemiological studies have demonstrated an increased mortality from cardiovascular causes in patients with Klinefelter Syndrome (KS). Little information is available about the nature of the underlying cardiovascular abnormalities. Aim of the study was to investigate exercise performance, left ventricular architecture and function, vascular reactivity, and carotid intima-media thickness in a group of patients with KS. MATERIALS AND METHODS Sixty-nine patients with KS and 48 age-matched controls participated in our population-controlled study. Forty-eight Klinefelter subjects were on testosterone treatment at the time of the investigation while 21 were naive and underwent a complete Doppler echocardiographic examination, a cardiopulmonary exercise test as well as a vascular study including measures of carotid intima-media thickness and endothelial function with flow-mediated dilation of the brachial artery. Patients with KS on testosterone therapy (n=48) were also matched against a population of men with treated secondary hypogonadism (n=21). RESULTS Patients with KS exhibited a wide array of cardiovascular abnormalities including left ventricular diastolic dysfunction, reduced maximal oxygen consumption (p<0.01), increased intima-media thickness (p<0.05) (-34% and +42% vs. controls, respectively) and a high prevalence of chronotropic incompetence (55% of patients, p<0.01). No significant difference was found between treated and untreated KS in variance with men treated for secondary hypogonadism. CONCLUSION Left ventricular diastolic dysfunction, impaired cardiopulmonary performance, chronotropic incompetence, and increased intima-media thickness suggest that cardiovascular abnormalities are a common finding in KS that is not reversed by testosterone replacement therapy and may represent the pathophysiological underpinnings of the increased risk of dying from heart disease.
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Affiliation(s)
- Daniela Pasquali
- Department of Cardiothoracic and Respiratory Science, Endocrinology Unit, Second University of Naples, Italy
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Thompson MA, Patel H. Posttransplant pacemaker placement: case series and review. Ochsner J 2010; 10:236-240. [PMID: 21603390 PMCID: PMC3096229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION Sinus node dysfunction (SND) following orthotopic heart transplantation may lead to bradycardia, atrioventricular block, sick sinus syndrome, syncope, and death, with 6%-23% of patients requiring pacemakers. METHODS Permanent pacemakers were placed in 5% of orthotopic heart transplants conducted at our institution from January 2002 to October 2008. RESULTS THREE DIFFERENT IMPLANT TECHNIQUES WERE USED OVER THIS TIME: (1) dual-chamber pacing in the donor atrium and ventricle (A(D)-V(D)) (62.5%); (2) single lead in the donor atrium (A(D)) (12.5%); and (3) dual leads placed in both donor and recipient atrium (A(R)-A(D)) (25%). Using the percentage of paced histograms recorded in the device, heart rate variability for the types of lead placements were 14% for A(D)-V(D), 35% for A(D), and 97% for A(R)-A(D). DISCUSSION The transplanted heart is characterized physiologically by autonomic denervation and chronotropic incompetence. Restoration of chronotropic competence by atrial pacing increases exercise duration and peak VO(2). Rate responsiveness can be achieved in this patient population with the placement of one lead in the remnant right atrium and one lead in the transplanted donor right atrium.
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Affiliation(s)
| | - Hamang Patel
- Address correspondence to: Hamang Patel, MD, Ochsner Heart and Vascular Institute, Atrium 3rd Floor – Cardiology, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, (504) 842-3925, (504) 842-4184, e-mail:
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