Cardiovascular mortality and chronotropic incompetence in systolic heart failure: The importance of a reappraisal of current cut-off criteria

Damiano Magrì, Ugo Corrà, Andrea Di Lenarda, Gaia Cattadori, Antonello Maruotti, Annamaria Iorio, Alessandro Mezzani, Pantaleo Giannuzzi, Valentina Mantegazza, Erica Gondoni, Gianfranco Sinagra, Massimo F. Piepoli, Cesare Fiorentini, Piergiuseppe Agostoni

Research output: Contribution to journalArticle

Abstract

Aims: An independent role for the exercise-induced heart rate (HR) response- and specifically the chronotropic incompetence (CI)-in the prognosis of heart failure (HF) is still debated. The multicentre study reported here sought to investigate the prognostic values of HR and CI variables on cardiovascular mortality in a large cohort of systolic HF patients. Methods A total of 1045 HF patients were recruited and prospectively followed in three Italian HF centres. The study endpoint and results: was cardiovascular mortality. Besides a full clinical examination, each patient underwent a maximal cardiopulmonary exercise test at study enrolment. The age-predicted peak HR (%pHR) and the peak HR reserve (%pHRR) according to different cut-off values (60-80% of the maximum predicted) were adopted to identify the presence of CI. The median follow-up was 876 days (interquartile range 386-1590 days). Cardiovascular death occurred in 145 cases (13.8%). Besides LVEF, peak oxygen uptake, ventilation vs. carbon dioxide production slope, and beta-blocker therapy, the multivariate analysis showed that both %pHR and %pHRR were able to predict prognosis when considered as continuous variables. Conversely, the presence of CI was associated with the study endpoint only when the 70% (%pHR

Original languageEnglish
Pages (from-to)201-209
Number of pages9
JournalEuropean Journal of Heart Failure
Volume16
Issue number2
DOIs
Publication statusPublished - 2014

Keywords

  • Cardiopulmonary exercise test
  • Chronotropic incompetence
  • Heart failure
  • Heart rate
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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