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 language | English |
|---|---|
| Pages (from-to) | 100-108 |
| Number of pages | 9 |
| Journal | Cardiovascular Therapeutics |
| Volume | 30 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Apr 2012 |
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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
Chronotropic Incompentence and Functional Capacity in Chronic Heart Failure : No Role of β-Blockers and β-Blocker Dose. / Magrì, Damiano; Palermo, Pietro; Cauti, Filippo M.; Contini, Mauro; Farina, Stefania; Cattadori, Gaia; Apostolo, Anna; Salvioni, Elisabetta; Magini, Alessandra; Vignati, Carlo; Alimento, Marina; Sciomer, Susanna; Bussotti, Maurizio; Agostoni, Piergiuseppe.
In: Cardiovascular Therapeutics, Vol. 30, No. 2, 04.2012, p. 100-108.Research output: Contribution to journal › Article
}
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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UR - http://www.scopus.com/inward/citedby.url?scp=84858177090&partnerID=8YFLogxK
U2 - 10.1111/j.1755-5922.2010.00184.x
DO - 10.1111/j.1755-5922.2010.00184.x
M3 - Article
C2 - 20553283
AN - SCOPUS:84858177090
VL - 30
SP - 100
EP - 108
JO - Cardiovascular Therapeutics
JF - Cardiovascular Therapeutics
SN - 1755-5914
IS - 2
ER -