Chronotropic Incompentence and Functional Capacity in Chronic Heart Failure: No Role of β-Blockers and β-Blocker Dose

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Abstract

Aim: To assess the effect of chronotropic incompetence on functional capacity in chronic heart failure (CHF) patients, as evaluated as NYHA and peak oxygen consumption (pVO 2), focusing on the presence and dose of β-blocker treatment. Methods: Nine hundred and sixty-seven consecutive CHF patients were evaluated, 328 of whom were discarded because they failed to meet the study criteria. Of the 639 analyzed, 90 were not treated with β-blockers whereas the other 549 were. The latter were further subdivided in high (n = 184) and low (n = 365) β-blockers daily dose group in accordance with an arbitrary cut-off of 25 mg for carvedilol and of 5 mg for bisoprolol. Failure to achieve 80% of the percentage of maximum age predicted peak heart rate (%Max PHR) or of HR reserve (%HRR) constituted chronotropic incompetence. Results: No differences were found in NYHA or pVO2 between patients with and without β-blockers and, similarly, between high and low β-blocker dose groups. Twenty and sixty-nine percent of not β-blocked patients showed chronotropic incompetence according to %Max PHR and %HRR, respectively, whereas this prevalence rose to 61% and 84% in those on β-blocker therapy. Patients taking β-blockers without chronotropic incompetence, as inferable from both %Max PHR and %HRR, showed higher NYHA and pVO2 regardless of drug dose, whereas, in not β-blocked patients, only %HRR revealed a difference in functional capacity. At multivariable analysis, HR increase during exercise (ΔHR) was the variable most strongly associated to pVO2 (β: 0.572; SE: 0.008; P <0.0001) and NYHA class (β: -0.499; SE: 0.001; P <0.0001). Conclusions: ΔHR is a powerful predictor of CHF severity regardless of the presence of β-blocker therapy and of β-blocker daily dose.

Original languageEnglish
Pages (from-to)100-108
Number of pages9
JournalCardiovascular Therapeutics
Volume30
Issue number2
DOIs
Publication statusPublished - Apr 2012

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Heart Failure
Bisoprolol
Oxygen Consumption
Therapeutics
Heart Rate
Exercise
Pharmaceutical Preparations

Keywords

  • β-Blocker
  • Cardiopulmonary test
  • Chronic heart failure
  • Chronotropic incompetence
  • Exercise capacity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)
  • Pharmacology

Cite this

@article{47897c7c76c6483595cfce8634f048aa,
title = "Chronotropic Incompentence and Functional Capacity in Chronic Heart Failure: No Role of β-Blockers and β-Blocker Dose",
abstract = "Aim: To assess the effect of chronotropic incompetence on functional capacity in chronic heart failure (CHF) patients, as evaluated as NYHA and peak oxygen consumption (pVO 2), focusing on the presence and dose of β-blocker treatment. Methods: Nine hundred and sixty-seven consecutive CHF patients were evaluated, 328 of whom were discarded because they failed to meet the study criteria. Of the 639 analyzed, 90 were not treated with β-blockers whereas the other 549 were. The latter were further subdivided in high (n = 184) and low (n = 365) β-blockers daily dose group in accordance with an arbitrary cut-off of 25 mg for carvedilol and of 5 mg for bisoprolol. Failure to achieve 80{\%} of the percentage of maximum age predicted peak heart rate ({\%}Max PHR) or of HR reserve ({\%}HRR) constituted chronotropic incompetence. Results: No differences were found in NYHA or pVO2 between patients with and without β-blockers and, similarly, between high and low β-blocker dose groups. Twenty and sixty-nine percent of not β-blocked patients showed chronotropic incompetence according to {\%}Max PHR and {\%}HRR, respectively, whereas this prevalence rose to 61{\%} and 84{\%} in those on β-blocker therapy. Patients taking β-blockers without chronotropic incompetence, as inferable from both {\%}Max PHR and {\%}HRR, showed higher NYHA and pVO2 regardless of drug dose, whereas, in not β-blocked patients, only {\%}HRR revealed a difference in functional capacity. At multivariable analysis, HR increase during exercise (ΔHR) was the variable most strongly associated to pVO2 (β: 0.572; SE: 0.008; P <0.0001) and NYHA class (β: -0.499; SE: 0.001; P <0.0001). Conclusions: ΔHR is a powerful predictor of CHF severity regardless of the presence of β-blocker therapy and of β-blocker daily dose.",
keywords = "β-Blocker, Cardiopulmonary test, Chronic heart failure, Chronotropic incompetence, Exercise capacity",
author = "Damiano Magr{\`i} and Pietro Palermo and Cauti, {Filippo M.} and Mauro Contini and Stefania Farina and Gaia Cattadori and Anna Apostolo and Elisabetta Salvioni and Alessandra Magini and Carlo Vignati and Marina Alimento and Susanna Sciomer and Maurizio Bussotti and Piergiuseppe Agostoni",
year = "2012",
month = "4",
doi = "10.1111/j.1755-5922.2010.00184.x",
language = "English",
volume = "30",
pages = "100--108",
journal = "Cardiovascular Therapeutics",
issn = "1755-5914",
publisher = "Blackwell Publishing Ltd",
number = "2",

}

TY - JOUR

T1 - Chronotropic Incompentence and Functional Capacity in Chronic Heart Failure

T2 - No Role of β-Blockers and β-Blocker Dose

AU - Magrì, Damiano

AU - Palermo, Pietro

AU - Cauti, Filippo M.

AU - Contini, Mauro

AU - Farina, Stefania

AU - Cattadori, Gaia

AU - Apostolo, Anna

AU - Salvioni, Elisabetta

AU - Magini, Alessandra

AU - Vignati, Carlo

AU - Alimento, Marina

AU - Sciomer, Susanna

AU - Bussotti, Maurizio

AU - Agostoni, Piergiuseppe

PY - 2012/4

Y1 - 2012/4

N2 - Aim: To assess the effect of chronotropic incompetence on functional capacity in chronic heart failure (CHF) patients, as evaluated as NYHA and peak oxygen consumption (pVO 2), focusing on the presence and dose of β-blocker treatment. Methods: Nine hundred and sixty-seven consecutive CHF patients were evaluated, 328 of whom were discarded because they failed to meet the study criteria. Of the 639 analyzed, 90 were not treated with β-blockers whereas the other 549 were. The latter were further subdivided in high (n = 184) and low (n = 365) β-blockers daily dose group in accordance with an arbitrary cut-off of 25 mg for carvedilol and of 5 mg for bisoprolol. Failure to achieve 80% of the percentage of maximum age predicted peak heart rate (%Max PHR) or of HR reserve (%HRR) constituted chronotropic incompetence. Results: No differences were found in NYHA or pVO2 between patients with and without β-blockers and, similarly, between high and low β-blocker dose groups. Twenty and sixty-nine percent of not β-blocked patients showed chronotropic incompetence according to %Max PHR and %HRR, respectively, whereas this prevalence rose to 61% and 84% in those on β-blocker therapy. Patients taking β-blockers without chronotropic incompetence, as inferable from both %Max PHR and %HRR, showed higher NYHA and pVO2 regardless of drug dose, whereas, in not β-blocked patients, only %HRR revealed a difference in functional capacity. At multivariable analysis, HR increase during exercise (ΔHR) was the variable most strongly associated to pVO2 (β: 0.572; SE: 0.008; P <0.0001) and NYHA class (β: -0.499; SE: 0.001; P <0.0001). Conclusions: ΔHR is a powerful predictor of CHF severity regardless of the presence of β-blocker therapy and of β-blocker daily dose.

AB - Aim: To assess the effect of chronotropic incompetence on functional capacity in chronic heart failure (CHF) patients, as evaluated as NYHA and peak oxygen consumption (pVO 2), focusing on the presence and dose of β-blocker treatment. Methods: Nine hundred and sixty-seven consecutive CHF patients were evaluated, 328 of whom were discarded because they failed to meet the study criteria. Of the 639 analyzed, 90 were not treated with β-blockers whereas the other 549 were. The latter were further subdivided in high (n = 184) and low (n = 365) β-blockers daily dose group in accordance with an arbitrary cut-off of 25 mg for carvedilol and of 5 mg for bisoprolol. Failure to achieve 80% of the percentage of maximum age predicted peak heart rate (%Max PHR) or of HR reserve (%HRR) constituted chronotropic incompetence. Results: No differences were found in NYHA or pVO2 between patients with and without β-blockers and, similarly, between high and low β-blocker dose groups. Twenty and sixty-nine percent of not β-blocked patients showed chronotropic incompetence according to %Max PHR and %HRR, respectively, whereas this prevalence rose to 61% and 84% in those on β-blocker therapy. Patients taking β-blockers without chronotropic incompetence, as inferable from both %Max PHR and %HRR, showed higher NYHA and pVO2 regardless of drug dose, whereas, in not β-blocked patients, only %HRR revealed a difference in functional capacity. At multivariable analysis, HR increase during exercise (ΔHR) was the variable most strongly associated to pVO2 (β: 0.572; SE: 0.008; P <0.0001) and NYHA class (β: -0.499; SE: 0.001; P <0.0001). Conclusions: ΔHR is a powerful predictor of CHF severity regardless of the presence of β-blocker therapy and of β-blocker daily dose.

KW - β-Blocker

KW - Cardiopulmonary test

KW - Chronic heart failure

KW - Chronotropic incompetence

KW - Exercise capacity

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