Impaired chronotropic response to physical activities in heart failure patients

Hong Shen, Jianrong Zhao, Xiaohong Zhou, Jingbo Li, Qing Wan, Jing Huang, Hui Li, Liqun Wu, Shungang Yang, Ping Wang, Hong Shen, Jianrong Zhao, Xiaohong Zhou, Jingbo Li, Qing Wan, Jing Huang, Hui Li, Liqun Wu, Shungang Yang, Ping Wang

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.

Keywords: 6 min hall walk; Chronotropic incompetence; Heart failure rehabilitation; Heart rate; Treadmill exercise testing.

Figures

Fig. 1
Fig. 1
Heart rate and Actigraph VM recording during treadmill exercise testing. a Holter heart rate (top) and Actigraph activity in VM (middle) recording during 7 levels of treadmill exercise testing (bottom) in one patient. b the correlation between Holter heart rate and levels of VM during treadmill exercise testing in all 26 patients. Each dot represents the measurement of a maximal VM value in one of 7 levels of treadmill exercise testing
Fig. 2
Fig. 2
Correlation between heart rate and physical activities during daily living. a the correlation between heart rate (bpm, the ordinate) and the percentage of each maximal daily physical activity over the greatest maximal daily physical activity (the abscissa) in one patient; b the correlation for all 40 patients; c the correlation for 13 non-CI patients; d the correlation for 13 CI patients. Dashed line in (c and d) represents the maximal HR above 100 bpm during physical activity events

References

    1. .
    1. Achttien RJ, Staal JB, van der Voort S, et al. Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline. Nath Heart J. 2015;23:6–17. doi: 10.1007/s12471-014-0612-2.
    1. Sagar VA, Davies EJ, Briscoe S, et al. Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open Heart. 2015;2:e000163. doi: 10.1136/openhrt-2014-000163.
    1. Carvalho VO, Mezzani A. Aerobic exercise training intensity in patients with chronic heart failure: principles of assessment and prescription. Eur J Cardiovasc Prev Rehabil. 2011;18:5–14.
    1. Camm AJ, Lu F. Chronotropic incompetence –clinical implications. Clin Cardiol. 1996;19:503–508. doi: 10.1002/clc.4960190612.
    1. Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001;37:153–156. doi: 10.1016/S0735-1097(00)01054-8.
    1. Brubaker PH, Kitzman DW. Prevalence and management of chronotropic incompetence in heart failure. Current Cardiol Rep. 2007;9:229–235. doi: 10.1007/BF02938355.
    1. Brubaker PH, Kitzman DW. Chronotropic incompetence: causes, consequences, and management. Circulation. 2011;123:1010–1020. doi: 10.1161/CIRCULATIONAHA.110.940577.
    1. Khan MN, Pothier CE, Lauer MS. Chronotropic incompetence as a predictor of death among patients with normal electrograms taking beta blockers (Metoprolol or Atenolol) Am J Cardiol. 2005;96:1328–1333. doi: 10.1016/j.amjcard.2005.06.082.
    1. Savonen KP, Kiviniemi V, Laukkanen JA, et al. Chronotropic incompetence and mortality in middle-aged men with known or suspected coronary heart disease. Eur Heart Journal. 2008;29:1896–1902. doi: 10.1093/eurheartj/ehn269.
    1. Dobre D, Zannad F, Keteyian SJ, et al. Association between resting heart rate, chronotropic index, and long-term outcomes in patients with heart failure receiving b-blocker therapy: data from the HF-ACTION trial. Eur Heart Journal. 2013;34:2271–2280. doi: 10.1093/eurheartj/ehs433.
    1. Magrì D, Corrà U, Lenarda AD, et al. Cardiovascular mortality and chronotropic incompetence in systolic heart failure: the importance of a reappraisal of current cut-off criteria. Eur J of Heart Failure. 2014;16:201–209. doi: 10.1002/ejhf.36.
    1. Clark AL, Coats AJS. Chronotropic incompetence in chronic heart failure. International J Cardiol. 1995;49:225–231. doi: 10.1016/0167-5273(95)02316-O.
    1. Roche F, Pichot V, Da Costa A. Chronotropic incompetence response to exercise in congestive heart failure, relationship with autonomic status. Clin Physiol. 2001;21:335–342. doi: 10.1046/j.1365-2281.2001.00328.x.
    1. Silva DA, Lima AC, Vargas FT, et al. Association between physical activity measurements and key parameters of cardiopulmonary exercise testing in patients with heart failure. J Cardiac Fail. 2013;19:635–640. doi: 10.1016/j.cardfail.2013.08.002.
    1. Garcia-Ortiz L, Recio-Rodriguez JI, Puig-Ribera A, et al. Blood pressure circadian pattern and physical exercise assessment by accelerometer and 7-day physical activity recall scale. Am J Hypertension. 2014;27:665–673. doi: 10.1093/ajh/hpt159.
    1. García-Ortiz L, Recio-Rodríguez JI, Schmidt-Trucksäss A, et al. Relationship between objectively measured physical activity and cardiovascular aging in the general population – the EVIDENT trial. Atherosclerosis. 2014;233:434–440. doi: 10.1016/j.atherosclerosis.2014.01.021.
    1. Patterson JA, Naughton J, Pietras RJ, et al. Treadmill exercise in assessment of the functional capacity of patients with cardiac disease. Am J Cardiol. 1972;30:757–762. doi: 10.1016/0002-9149(72)90151-8.
    1. Meyer TE, Day JD, Merkel S, et al. Predictors of Chronotropic incompetence in heart Failure patients. J Card Fail. 2006;12:S18. doi: 10.1016/j.cardfail.2006.06.068.
    1. Martin DO, Day JD, Murphy A, et al. Does Chronotropic incompetence limit the functional status of heart failure patients? J Card Fail. 2008;14:S67. doi: 10.1016/j.cardfail.2008.06.179.
    1. Witte KKA, Cleland JGF, Clark AL. Chronic heart failure, chronotropic incompetence, and the effects of β blockade. Heart. 2006;92:481–486. doi: 10.1136/hrt.2004.058073.
    1. Gauri AJ, Raxwal VK, Roux L, et al. Effects of chronotropic incompetence and β-blocker use on the exercise treadmill test in men. Am Heart J. 2001;142:136–141. doi: 10.1067/mhj.2001.115788.
    1. Magri D, Palermo P, Cauti FM, et al. Chronotropic Incompentence and functional capacity in chronic heart failure: no role of β-blockers and β-blocker dose. Cardiovasc Ther. 2012;30:100–108. doi: 10.1111/j.1755-5922.2010.00184.x.
    1. Packer M, Bristow MR, Cohn JN, et al. The effect of Carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med. 1996;334:1349–1355. doi: 10.1056/NEJM199605233342101.
    1. The RESOLVD Investigators Effects of Metoprolol CR in patients with ischemic and dilated Cardiomyopathy. Circulation. 2000;101:378–384. doi: 10.1161/01.CIR.101.4.378.
    1. MERIT-HF Study Group Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL randomised intervention trial in congestive heart failure (MERIT-HF) Lancet. 1999;353(9169):2001–2007. doi: 10.1016/S0140-6736(99)04440-2.
    1. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8:30–41. doi: 10.1038/nrcardio.2010.165.
    1. Tse HF, Siu CW, Lee KLF, et al. The incremental benefit of rate-adaptive pacing on exercise performance during cardiac resynchronization therapy. J Am Coll Cardiol. 2005;46:2292–2297. doi: 10.1016/j.jacc.2005.02.097.
    1. Semelka M, Gera J. Sick sinus syndrome: a review. Am Fam Physician. 2013;87(10):691–696.

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