scholarly journals HEART RATE SCORE, A MEASURE RELATED to CHRONOTROPIC INCOMPETENCE IN PACEMAKER PATIENTS

2021 ◽  
Author(s):  
Arjun D. Sharma ◽  
Mark Richards ◽  
Brian Olshansky ◽  
Nicholas Wold ◽  
Paul Jones ◽  
...  
Keyword(s):  
Heart Rate ◽  
Chronotropic Incompetence ◽  
Rate Score

Creation of physiologic rhythm by closed loop stimulation in heart failure patients with severe chronotropic incompetence: worldwide first results of a pilot study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Proff ◽  
B Merkely ◽  
R Papp ◽  
C Lenz ◽  
P.J Nordbeck ◽  
...  
Keyword(s):  
Heart Rate ◽  
Closed Loop ◽  
Funding Source ◽  
Chronotropic Incompetence ◽  
First Results ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Background The prevalence of chronotropic incompetence (CI) in heart failure (HF) population is high and negatively impacts prognosis. In HF patients with an implanted cardiac resynchronisation therapy (CRT) device and severe CI, the effect of rate adaptive pacing on patient outcomes is unclear. Closed loop stimulation (CLS) based on cardiac impedance measurement may be an optimal method of heart rate adaptation according to metabolic need in HF patients with severe CI. Purpose This is the first study evaluating the effect of CLS on the established prognostic parameters assessed by the cardio-pulmonary exercise (CPX) testing and on quality of life (QoL) of the patients. Methods A randomised, controlled, double-blind and crossover pilot study has been performed in CRT patients with severe CI defined as the inability to achieve 70% of the age-predicted maximum heart rate (APMHR). After baseline assessment, patients were randomised to either DDD-CLS pacing (group 1) or DDD pacing at 40 bpm (group 2) for a 1-month period, followed by crossover for another month. At baseline and at 1- and 2-month follow-ups, a CPX was performed and QoL was assessed using the EQ-5D-5L questionnaire. The main endpoints were the effect of CLS on ventilatory efficiency (VE) slope (evaluated by an independent CPX expert), the responder rate defined as an improvement (decrease) of the VE slope by at least 5%, percentage of maximal predicted heart rate reserve (HRR) achieved, and QoL. Results Of the 36 patients enrolled in the study, 20 fulfilled the criterion for severe CI and entered the study follow-up (mean age 68.9±7.4 years, 70% men, LVEF=41.8±9.3%, 40%/60% NYHA class II/III). Full baseline and follow-up datasets were obtained in 17 patients. The mean VE slope and HRR at baseline were 34.4±4.4 and 49.6±23.8%, respectively, in group 1 (n=7) and 34.5±12.2 and 54.2±16.1% in group 2 (n=10). After completing the 2-month CPX, the mean difference between DDD-CLS and DDD-40 modes was −2.4±8.3 (group 1) and −1.2±3.5 (group 2) for VE slope, and 17.1±15.5% (group 1) and 8.7±18.8% (group 2) for HRR. Altogether, VE slope improved by −1.8±2.95 (p=0.31) in DDD-CLS versus DDD-40, and HRR improved by 12.9±8.8% (p=0.01). The VE slope decreased by ≥5% in 47% of patients (“responders to CLS”). The mean difference in the QoL between DDD-CLS and DDD-40 was 0.16±0.25 in group 1 and −0.01±0.05 in group 2, resulting in an overall increase by 0.08±0.08 in the DDD-CLS mode (p=0.13). Conclusion First results of the evaluation of the effectiveness of CLS in CRT patients with severe CI revealed that CLS generated an overall positive effect on well-established surrogate parameters for prognosis. About one half of the patients showed CLS response in terms of improved VE slope. In addition, CLS improved quality of life. Further clinical research is needed to identify predictors that can increase the responder rate and to confirm improvement in clinical outcomes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Biotronik SE & Co. KG

Heart rate score predicts mortality independent of shocks in ICD and CRT-D patients

2019 ◽  
Vol 58 (1) ◽  
pp. 103-111
Author(s):  
Brian Olshansky ◽  
Mark Richards ◽  
Arjun D. Sharma ◽  
Paul W. Jones ◽  
Nick Wold ◽  
...  
Keyword(s):  
Heart Rate ◽  
Rate Score

scholarly journals Heart Rate Reserve in Fontan Patients: Chronotropic Incompetence or Hemodynamic Limitation?

2019 ◽  
Vol 8 (9) ◽  
Author(s):  
Guido Claessen ◽  
Andre La Gerche ◽  
Alexander Van De Bruaene ◽  
Mathias Claeys ◽  
Rik Willems ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Reserve ◽  
Chronotropic Incompetence ◽  
Fontan Patients

Heart Rate Recovery and Chronotropic Incompetence in Patients with Subclinical Hypothyroidism

2010 ◽  
Vol 33 (1) ◽  
pp. 2-5 ◽  
Author(s):  
MUSTAFA AKCAKOYUN ◽  
YUNUS EMIROGLU ◽  
SELCUK PALA ◽  
RAMAZAN KARGIN ◽  
GAMZE BABUR GULER ◽  
...  
Keyword(s):  
Heart Rate ◽  
Subclinical Hypothyroidism ◽  
Heart Rate Recovery ◽  
Chronotropic Incompetence

scholarly journals 945-622 Impaired Heart Rate Response to Graded Exercise: Prognostic Implications of Chronotropic Incompetence

1995 ◽  
Vol 25 (2) ◽  
pp. 171A
Author(s):  
Michael S. Lauer ◽  
Peter M. Okin ◽  
Martin G. Larson ◽  
Jane C. Evans ◽  
Keaven M. Anderson ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Response ◽  
Chronotropic Incompetence ◽  
Graded Exercise ◽  
Prognostic Implications

Exercise Training Improves Chronotropic Incompetence but not Heart Rate Recovery to Exercise in Heart Transplant Patients

2015 ◽  
Vol 47 ◽  
pp. 422
Author(s):  
Emmanuel Gomes Ciolac ◽  
Rafael E. Castro ◽  
Fernando Bacal ◽  
Edimar A. Bocchi ◽  
Guilherme V. Guimarães
Keyword(s):  
Heart Rate ◽  
Exercise Training ◽  
Heart Transplant ◽  
Heart Rate Recovery ◽  
Chronotropic Incompetence ◽  
Transplant Patients

scholarly journals Association of abnormal heart rate recovery and chronotropic incompetence with obesity in a healthy cohort

2003 ◽  
Vol 41 (6) ◽  
pp. 191-192
Author(s):  
Michael S. Lauer ◽  
David Yu ◽  
Claire E. Pothier ◽  
Eugene H. Blackstone
Keyword(s):  
Heart Rate ◽  
Heart Rate Recovery ◽  
Chronotropic Incompetence ◽  
Healthy Cohort

scholarly journals Functional capacity and gender-related differences in Fabry disease

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Guglielmi ◽  
A Mollo ◽  
F Bandera ◽  
A Camporeale ◽  
M Frigelli ◽  
...  
Keyword(s):  
Heart Rate ◽  
Fabry Disease ◽  
Functional Capacity ◽  
Cardiac Involvement ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Lower Percentage ◽  
Chronotropic Incompetence ◽  
Chronotropic Response ◽  
O2 Pulse

Abstract Background Fabry disease (FD) is a rare x-linked lysosomal storage disease characterized by accumulation of glicosphingolipids in several organs, including the heart. Cardiac involvement manifests as left ventricular (LV) hypertrophy, often complicated by myocardial fibrosis. The impact of disease on functional capacity is not well defined, as well as the potential gender-related differences. Aim To evaluate the functional capacity in a cohort of FD patients with different degree of cardiac involvement. Methods Seventy-two patients were prospectively enrolled from March 2015 to December 2019. Patients underwent cardiac magnetic resonance (CMR) and cardiopulmonary exercise test (CPET) with cycle ergometer. In addition to standard CPET parameters, Chronotropic Index (CI) was calculated as (HR max − HR rest) / (HR max predicted − HR rest), adjusting with HR max predicted calculated as 119 + (HR rest/2) − (age/2) in case of beta-blockers treatment. Results CMR showed left ventricle (LV) hypertrophy (LV mass greater than normal reference value) in 36.1% of patients, LGE and reduced T1 values were detected in 30.6% and 59.7% of subjects respectively. Twenty-eight patients were males (39%), the median age was 40 (28–54) [median (25th–75th)] years and only 11 (15%) subjects were on beta-blockers. All subjects performed a maximal test [RQ max = 1.21 (1.14–1.26)] using a ramp protocol of 15 (15–20) Watt. The absolute peakVO2 was 18.2 (15.75–24.08) mL/min/kg, whilst the percentage of predicted peakVO2 was 67.7 (57.3–76.6)%. The chronotropic response of the overall population was characterized by reduced peak heart rate (HRmax) [80.3 (73.8–87.6)% of predicted], and diminished chronotropic index (CI) [0.67 (0.55–0.77) normal value: 0.80], but preserved heart rate reserve (HRR) [21 (12–28) bpm]. Ventilatory efficiency was preserved [VE/VCO2 = 25.70 (23.18–28.00)]. At gender analysis, men showed higher absolute peakVO2 [men vs females: 19.95 (17.20–28.28) vs 17.80 (15.50–21.28) mL/min/kg, p=0.02] but lower percentage of predicted [64.24 (52.58–70.61) vs 70.75 (59.05–78.02)%, p<0.001] than females. No differences between genders were observed in chronotropic response [HRmax = 138 (108–154) vs 142 (135–153) bpm, p=0.38; HRR = 22 (13–36) vs 20 (11–26), p=0.097; CI: 0.67 (0.51–0.76) vs 0.67 (0.58–0.79), p=0.33], whilst females showed a lower peak O2 pulse (VO2/HR) than males [men vs females: 12.08 (10.04–13.64) vs 7.76 (6.88–9.22), p<0.001], possibly related to gender differences in LV dimensions and stroke volume. Conclusions This large cohort of FD patients with different degree of cardiac involvement showed a significantly impaired functional capacity, mainly characterized by relevant chronotropic incompetence (independent from the use of beta-blockers), consistent with systemic autonomic dysfunction. The degree of chronotropic incompetence was similar between the genders, but females showed higher predicted peakVO2 despite a lower peak O2 pulse. FUNDunding Acknowledgement Type of funding sources: None.

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