scholarly journals Cardiac rehabilitation and improvement of chronotropic incompetence: Is it the exercise or just the beta blockers?

2021 ◽  
Vol 40 (12) ◽  
pp. 947-953
Author(s):  
Tiago Pimenta ◽  
J. Afonso Rocha
Keyword(s):  
Cardiac Rehabilitation ◽  
Beta Blockers ◽  
Chronotropic Incompetence

Abstract 16002: Chronotropic Incompetence Limits Exercise Capacity in Patients Taking Beta-Blockers

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Maciej Tysarowski ◽  
Krzysztof Smarz ◽  
Beata Zaborska ◽  
Ewa Pilichowska-Paszkiet ◽  
Malgorzata Sikora-Frac ◽  
...  
Keyword(s):  
Exercise Capacity ◽  
Beta Blocker ◽  
Partial Correlation ◽  
Beta Blockers ◽  
Cardiopulmonary Exercise Testing ◽  
Peak Oxygen Uptake ◽  
Male Gender ◽  
Chronotropic Incompetence ◽  
Cardiopulmonary Exercise ◽  
Variance Explained

Introduction: Chronotropic incompetence in patients taking beta-blockers is associated with poor prognosis; however, its impact on exercise capacity (EC) remains unclear. Hypothesis: We assessed the hypothesis that chronotropic incompetence is associated with decreased exercise capacity in patients taking beta-blockers. Methods: We retrospectively analyzed data from consecutive patients taking beta-blockers referred for cardiopulmonary exercise testing. EC was expressed as peak oxygen uptake (VO 2 peak; mL/kg/min). Chronotropic incompetence was defined as chronotropic index (CI) ≤ 62%. CI was calculated as [(HR at peak-resting HR) / (maximum predicted HR-resting HR)] х 100%. Results: Among 140 patients all taking beta-blockers (age 61 ± 9.7 years; 73% males), there were 113 (80.7%) patients with chronotropic incompetence. EC was lower in the group with chronotropic incompetence than the group without it, VO 2 peak 18.3 ± 5.7 vs. 24.0 ± 5.3 mL/kg/min, p < 0.001. In multivariate analysis ( Table ), EC correlated positively with CI (β = 0.14, p < 0.001) and male gender (β = 5.12, p < 0.001), and negatively with age (β = –0.17, p < 0.001) and presence of heart failure (β = –3.35, p < 0.001). Beta-blocker dose was not associated with EC. Partial correlation attributable to CI (partial R 2 = 24.7%) accounted for more than one-third of the variance in EC explained by the model (adjusted R 2 = 59.8%). Conclusions: In patients taking beta-blockers, the presence of chronotropic incompetence was associated with lower EC, regardless of the beta-blocker dose. CI accounted for more than one-third of EC variance explained by our model.

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&lt;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&lt;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.

Recovery from Chronotropic Incompetence during Phase II Cardiac Rehabilitation Contributes to the Better Future Cardiovascular Prognosis

2017 ◽  
Vol 23 (10) ◽  
pp. S59
Author(s):  
Mariko Ehara ◽  
Kenichi Shibata ◽  
Masataka Kameshima ◽  
Mayumi Konaka ◽  
Hiroaki Fujiyama ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Phase Ii ◽  
Chronotropic Incompetence ◽  
Cardiovascular Prognosis

Abstract 17050: Association of Kidney Dysfunction with Chronotropic Incompetence in Heart Failure with Preserved Ejection Fraction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
David A Klein ◽  
Daniel H Katz ◽  
Lauren Beussink-Nelson ◽  
Theresa A Strzelczyk ◽  
Sanjiv J Shah
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Regression Models ◽  
Beta Blockers ◽  
Cardiopulmonary Exercise Testing ◽  
Systolic Pressure ◽  
Maximal Heart Rate ◽  
Preserved Ejection Fraction ◽  
Chronotropic Incompetence ◽  
Chronotropic Response

Introduction: Chronotropic incompetence (CI) is an important pathophysiologic factor underlying reduced exercise capacity in heart failure with preserved ejection fraction (HFpEF), but clinical factors associated with CI in HFpEF are unknown. Based on anecdotal clinical experience, we hypothesized that coronary artery disease (CAD) and chronic kidney disease (CKD) are associated with CI in HFpEF. Methods: We studied 157 consecutive HFpEF patients undergoing cardiopulmonary exercise testing, and defined CI as maximal heart rate (HR) < 80% of estimated HR reserve (< 65% if using beta-blockers). Participants who achieved inadequate exercise effort (respiratory exchange ratio [RER] ≤ 1.05) were excluded. Unadjusted and multivariable-adjusted regression models were used to determine correlates of CI. Results were re-assessed using alternative formulations of chronotropic response. Results: Of 157 participants, 73% were women, 64% used beta-blockers, 32% had CKD, and 40% had CAD. RER > 1.05 was achieved by 108 (69%) participants, including 79/108 (76%) with CI. Lower estimated GFR, higher B-type natriuretic peptide, and higher pulmonary artery systolic pressure (but not CAD) were each associated with CI. A 1-SD decrease in GFR was independently associated with CI (adjusted odds ratio = 2.4, 95% confidence interval = [1.3, 4.6]) after adjustment for smoking status, log BNP, and beta blocker usage. Linear regression models demonstrated that GFR was independently and linearly associated with %HR reserve (β=0.31, SE=0.10; P=0.002; Figure). Findings were unchanged after re-calculation of %HR reserve and CI based on alternative formulations used in the literature. Conclusions: CI is common and strongly associated with GFR in HFpEF. Our results indicate that kidney function may mark or contribute to the development of CI in HFpEF. HFpEF patients with CKD may need to be screened for CI prior to starting medications (e.g., beta blockers) that could exacerbate CI.

Attenuation of exercise training effects in patients taking beta blockers during early cardiac rehabilitation

1986 ◽  
Vol 112 (5) ◽  
pp. 1016-1025 ◽  
Author(s):  
Paul E Ciske ◽  
Rudolph H Dressendorfer ◽  
Seymour Gordon ◽  
Gerald C Timmis
Keyword(s):  
Exercise Training ◽  
Cardiac Rehabilitation ◽  
Beta Blockers ◽  
Training Effects

Adherence to guideline-directed medical therapy and its association with re-hospitalization and mortality following coronary artery bypass graft surgery

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Dankner ◽  
L Orenstein ◽  
K Laufer ◽  
L Olmer ◽  
A Ziv ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Cardiac Rehabilitation ◽  
Coronary Artery Bypass ◽  
Beta Blockers ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Funding Source ◽  
Artery Bypass Graft ◽  
Cabg Surgery

Abstract Objectives We investigated associations with re-hospitalization, and intermediate- and long-term mortality, of cardio-thoracic surgeons' adherence to pharmacological guideline-directed medical therapy (GDMT) in discharge recommendations of coronary artery bypass graft (CABG) surgery patients. Methods In this longitudinal multicenter study, 1,131 patients who underwent elective CABG surgery in seven medical centers during 2004–2007 were interviewed in the hospital before surgery. Adherence of cardio-thoracic surgeons to GDMT was considered as prescribing medications from three families: antiplatelet therapy, beta-blockers and statins; and was determined from discharge letters. Patients were interviewed one-year after hospitalization to obtain information on re-hospitalizations and current medications. Mortality information was extracted from the Ministry of Internal Affairs registry and updated until March 2018. Results GDMT adherence was evident in the discharge recommendations of 638 patients (56.4%). A propensity score (PS)-weighted multivariate logistic regression showed a 26% lower 1-year risk of re-hospitalization/mortality among patients whose discharge recommendations reflected full adherence than among patients whose recommendations reflected partial adherence (OR=0.74, 95% CI: 0.57–0.97, p=0.03). A PS-weighted Cox proportional hazard model showed 24% lower intermediate (8 year)-term mortality hazard among patients with cardio-thoracic surgeons' adherence to GDMT, compared to other patients (HR=0.76, 95% CI: 0.59–0.98, p=0.03); however the protective effect was attenuated when examining long (14 year)-term mortality. Short- and intermediate-term protective effects were also found when considering only adherence to beta-blockers or statins. Use of GDMT increased 1-year after CABG surgery only in patients who attended cardiac rehabilitation programs after surgery and not in those who did not attend cardiac rehabilitation during that year. Conclusions The reference in CABG patients' discharge recommendations to GDMT was associated with a lower 1-y re-admissions/mortality and lower intermediate-term mortality. Cardio-thoracic surgeons should adhere closely to preventive medication guidelines. Cardiac rehabilitation is associated with better post CABG surgery patients preventive treatment. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Israel National Institute for Health Policy

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