Heart rate kinetics during standard cardiopulmonary exercise testing in heart transplant recipients: a longitudinal study

AbstractBackground:Cardiopulmonary exercise testing has been used to measure functional capacity in children who have undergone a heart transplant. Cardiopulmonary exercise testing results have not been compared between children transplanted for a primary diagnosis of CHD and those with a primary diagnosis of cardiomyopathy despite differences in outcomes. This study is aimed to compare cardiopulmonary exercise testing performance between these two groups.Methods:Patients who underwent heart transplant with subsequent cardiopulmonary exercise testing at least 6 months after transplant at our institution were identified. They were then divided into two groups based on primary cardiac diagnosis: CHD or cardiomyopathy. Patient characteristics, echocardiograms, cardiac catheterisations, outcomes, and cardiopulmonary exercise test results were compared between the two groups.Results:From the total of 35 patients, 15 (43%) had CHD and 20 (57%) had cardiomyopathy. Age at transplant, kidney disease, lung disease, previous rejection, coronary vasculopathy, catheterisation, and echocardiographic data were similar between the groups. Mean time from transplant to cardiopulmonary exercise testing, exercise duration, and maximum oxygen consumption were similar in both groups. There was a difference in heart rate response with CHD heart rate response of 63 beats per minute compared to cardiomyopathy group of 78 (p = 0.028). Patients with CHD had more chronotropic incompetence than those with cardiomyopathy (p = 0.036).Conclusion:Primary diagnosis of CHD is associated with abnormal heart rate response and more chronotropic incompetence compared to those transplanted for cardiomyopathy.

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The relationship between heart rate and oxygen consumption in heart transplant recipients during a cardiopulmonary exercise test

International Journal of Cardiology ◽

10.1016/j.ijcard.2009.07.035 ◽

2010 ◽

Vol 145 (1) ◽

pp. 158-160 ◽

Cited By ~ 3

Author(s):

Vitor Oliveira Carvalho ◽

Edimar Alcides Bocchi ◽

Lucas Nóbilo Pascoalino ◽

Guilherme Veiga Guimarães

Keyword(s):

Heart Rate ◽

Oxygen Consumption ◽

Heart Transplant ◽

Exercise Test ◽

Cardiopulmonary Exercise Test ◽

Transplant Recipients ◽

Cardiopulmonary Exercise ◽

Heart Transplant Recipients ◽

The Relationship

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Parasympathetic Reinnervation Accompanied By Improved Post-Exercise Heart Rate Recovery and Quality of Life in Heart Transplant Recipients

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2015.01.847 ◽

2015 ◽

Vol 34 (4) ◽

pp. S301

Author(s):

T. Imamura ◽

K. Kinugawa ◽

T. Inaba ◽

H. Maki ◽

M. Hatano ◽

...

Keyword(s):

Quality Of Life ◽

Heart Rate ◽

Heart Transplant ◽

Heart Rate Recovery ◽

Exercise Heart Rate ◽

Transplant Recipients ◽

Post Exercise ◽

Heart Transplant Recipients

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Impairments in Blood Pressure Regulation and Cardiac Baroreceptor Sensitivity Among Patients With Heart Failure Supported With Continuous-Flow Left Ventricular Assist Devices

Circulation Heart Failure ◽

10.1161/circheartfailure.120.007448 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Christine Sailer ◽

Hannah Edelmann ◽

Cullen Buchanan ◽

Pedro Giro ◽

Matthew Babcock ◽

...

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Exercise Testing ◽

Cardiopulmonary Exercise Testing ◽

Left Ventricular ◽

Advanced Heart Failure ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Baroreceptor Sensitivity ◽

Cardiopulmonary Exercise

Background: Continuous-flow (CF) left ventricular assist devices (LVADs) improve outcomes for patients with advanced heart failure (HF). However, the lack of a physiological pulse predisposes to side-effects including uncontrolled blood pressure (BP), and there are little data regarding the impact of CF-LVADs on BP regulation. Methods: Twelve patients (10 males, 60±11 years) with advanced heart failure completed hemodynamic assessment 2.7±4.1 months before, and 4.3±1.3 months following CF-LVAD implantation. Heart rate and systolic BP via arterial catheterization were monitored during Valsalva maneuver, spontaneous breathing, and a 0.05 Hz repetitive squat-stand maneuver to characterize cardiac baroreceptor sensitivity. Plasma norepinephrine levels were assessed during head-up tilt at supine, 30 o and 60 o . Heart rate and BP were monitored during cardiopulmonary exercise testing. Results: Cardiac baroreceptor sensitivity, determined by Valsalva as well as Fourier transformation and transfer function gain of Heart rate and systolic BP during spontaneous breathing and squat-stand maneuver, was impaired before and following LVAD implantation. Norepinephrine levels were markedly elevated pre-LVAD and improved—but remained elevated post-LVAD (supine norepinephrine pre-LVAD versus post-LVAD: 654±437 versus 323±164 pg/mL). BP increased during cardiopulmonary exercise testing post-LVAD, but the magnitude of change was modest and comparable to the changes observed during the pre-LVAD cardiopulmonary exercise testing. Conclusions: Among patients with advanced heart failure with reduced ejection fraction, CF-LVAD implantation is associated with modest improvements in autonomic tone, but persistent reductions in cardiac baroreceptor sensitivity. Exercise-induced increases in BP are blunted. These findings shed new light on mechanisms for adverse events such as stroke, and persistent reductions in functional capacity, among patients supported by CF-LVADs. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03078972.

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Enhanced brain natriuretic peptide response to peak exercise in heart transplant recipients

Journal of Applied Physiology ◽

10.1152/jappl.1998.85.6.2270 ◽

1998 ◽

Vol 85 (6) ◽

pp. 2270-2276 ◽

Cited By ~ 24

Author(s):

Bernard Geny ◽

Anne Charloux ◽

Eliane Lampert ◽

Jean Lonsdorfer ◽

Pascal Haberey ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Heart Transplantation ◽

Left Ventricular Mass ◽

Heart Transplant ◽

Left Ventricular Mass Index ◽

Left Ventricular ◽

Peak Exercise ◽

Transplant Recipients ◽

Heart Transplant Recipients

We investigated the atrial (ANP) and brain natriuretic peptides (BNP), catecholamines, heart rate, and blood pressure responses to graded upright maximal cycling exercise of eight matched healthy subjects and cardiac-denervated heart transplant recipients (HTR). Baseline heart rate and diastolic blood pressure, together with ANP (15.2 ± 3.7 vs. 4.4 ± 0.8 pmol/l; P < 0.01) and BNP (14.3 ± 2.6 vs. 7.4 ± 0.6 pmol/l; P< 0.01), were elevated in HTR, but catecholamine levels were similar in both groups. Peak exercise O2uptake and heart rate were lower in HTR. Exercise-induced maximal ANP increase was similar in both groups (167 ± 34 vs. 216 ± 47%). Enhanced BNP increase was significant only in HTR (37 ± 8 vs. 16 ± 8%; P < 0.05). Similar norepinephrine but lower peak epinephrine levels were observed in HTR. ANP and heart rate changes from rest to 75% peak exercise were negatively correlated ( r = −0.76, P < 0.05), and BNP increase was correlated with left ventricular mass index ( r = 0.83, P < 0.01) after heart transplantation. Although ANP increase was not exaggerated, these data support the idea that the chronotropic limitation secondary to sinus node denervation might stimulate ANP release during early exercise in HTR. Furthermore, the BNP response to maximal exercise, which is related to the left ventricular mass index of HTR, is enhanced after heart transplantation.

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