Effects of chronotropic incompetence on exercise capacity in people with heart failure versus age-matched controls
- 19 April 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Heart Failure Reviews
- Vol. 27 (3), 795-809
- https://doi.org/10.1007/s10741-021-10081-1
Abstract
Chronotropic incompetence (CI) is an inability to adequately raise heart rate during physiological stress. We established CI prevalence and exercise capacity in heart failure versus healthy age-matched controls. We conducted a systematic search (1966–July 1, 2020) and meta-analysis of studies reporting peak VO2 in people with heart failure with reduced (HFrEF) and preserved (HFpEF) left ventricular ejection fraction and controls. Seventeen studies of 4410 participants were included, 4167 with heart failure and 243 age-matched controls. In both heart failure phenotypes, CI was more prevalent in HFrEF (51.7%) and HFpEF (55.8%) than in healthy controls (9%). Mortality was 24% higher in people with HFrEF and CI versus those with HFrEF and without CI; OR −1.24 (95% CI −2.20 to −0.28; p = 0.01). People with heart failure and CI had lower peak VO2 than those without CI (MD) −3.30 ml kg−1 min−1 (95% CI −4.25 to −2.35, p < 0.01), and this was primarily driven by the HFrEF sub-population (MD) −3.86 ml kg−1 min−1 (95% CI −4.83 to −2.89, p < 0.01). Maximum heart rate MD −37.51 beats min−1 (95% CI −41.99 to −33.03, p < 0.01) and maximum-resting heart rate were lower MD −29.44 beats min−1 (95% CI −34.55 to −24.33, p < 0.01) in people with heart failure with CI vs without CI. People with heart failure and CI demonstrated similar respiratory exchange ratios (RER) to people with heart failure but without CI; (MD) −0.02 (95% CI −0.03 to −0.01), p < 0.01, suggesting that poor effort was unlikely to explain CI. CI is more prevalent in heart failure than in age-matched controls and although it is associated with lower peak VO2 in HFrEF, it is unrelated to the lower peak VO2 in HFpEF. RER values suggest poor effort is unlikely to explain these findings.Keywords
This publication has 36 references indexed in Scilit:
- Chronotropic Incompentence and Functional Capacity in Chronic Heart Failure: No Role of β‐Blockers and β‐Blocker DoseCardiovascular Therapeutics, 2012
- Chronotropic IncompetenceCirculation, 2011
- Cardiopulmonary Exercise Testing in Patients with Chronic Heart Failure: Prognostic Comparison from Peak VO2 and VE/VCO2 Slope~!2010-04-07~!2010-04-26~!2010-05-26~!The Open Cardiovascular Medicine Journal, 2010
- Exercise training in systolic and diastolic dysfunction: Effects on cardiac function, functional capacity, and quality of lifeAmerican Heart Journal, 2007
- The Incremental Benefit of Rate-Adaptive Pacing on Exercise Performance During Cardiac Resynchronization TherapyJournal of Invasive Cardiology, 2005
- Determinants of functional capacity in patients with chronic heart failure: Role of filling pressure and systolic and diastolic functionAmerican Heart Journal, 2005
- Measuring inconsistency in meta-analysesBMJ, 2003
- Cardiac and peripheral responses to exercise in patients with chronic heart failureEuropean Heart Journal, 1999
- Decreased Heart Rate Variability in Patients with Congestive Heart Failure and Chronotropic IncompetencePacing and Clinical Electrophysiology, 1996
- Chronotropic incompetence in chronic heart failureInternational Journal of Cardiology, 1995