Chronotropic Incompetence Limits Aerobic Exercise Capacity in Patients Taking Beta-Blockers: Real-Life Observation of Consecutive Patients
Abstract
:1. Introduction
2. Methods
2.1. Study Population and Inclusion Criteria
2.2. Echocardiography
2.3. Cardiopulmonary Exercise Test
2.4. Statistical Methods
3. Ethics
4. Results
5. Discussion
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
CI | chronotropic index |
EC | exercise capacity |
HR | heart rate |
VO2 | oxygen uptake |
References
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All Patients (n = 140) | Chronotropic Incompetence a | p-Value | ||
---|---|---|---|---|
Yes (n = 113) | No (n = 27) | |||
Demographics | ||||
Age, years | 61.0 ± 9.7 | 60.7 ± 10.0 | 62.1 ± 8.5 | 0.525 |
Male sex, n (%) | 102 (73) | 78 (69) | 24 (89) | 0.065 |
BMI, kg/m2 | 27.8 ± 4.1 | 27.8 ± 4.0 | 27.7 ± 4.5 | 0.953 |
Comorbidity, n (%) | ||||
Chronic heart failure | 89 (64) | 74 (65) | 15 (56) | 0.514 |
NYHA functional class | ||||
I | 71 (51) | 59 (52) | 12 (44) | 0.609 |
II | 8 (6) | 7 (6) | 1 (4) | 0.968 |
III | 10 (7) | 8 (7) | 2 (7) | 0.968 |
CAD | 115 (82) | 94 (83) | 21 (78) | 0.704 |
MI | 110 (79) | 90 (80) | 20 (74) | 0.709 |
Coronary angiography | 118 (84) | 96 (85) | 22 (81) | 0.880 |
PCI | 107 (76) | 87 (77) | 20 (74) | 0.945 |
CABG | 5 (4) | 4 (4) | 1 (4) | 1 |
DM/IFG | 29 (20) | 28 (24) | 1 (4) | 0.033 |
Hypertension | 88 (63) | 74 (65) | 14 (52) | 0.273 |
Current smoker | 42 (30) | 35 (31) | 7 (26) | 0.779 |
Paroxysmal atrial fibrillation | 14 (10) | 12 (11) | 2 (7) | 0.886 |
Biochemistry | ||||
Hemoglobin, g/L | 13.8 ± 1.5 | 13.8 ± 1.5 | 13.8 ± 1.5 | 0.934 |
Serum creatinine (IQR), mg/dL | 0.9 (0.8–1.1) | 0.9 (0.8–1.1) | 1.1 (0.9–1.3) | 0.005 |
Creatinine clearance, mL/min/1.73 m2 | 95 ± 30 | 97 ± 31 | 88 ± 29 | 0.188 |
Medication, n (%) | ||||
Bisoprolol | 77 (55) | 67 (59) | 10 (37) | 0.061 |
Metoprolol | 49 (35) | 35 (31) | 14 (52) | 0.069 |
Carvedilol | 9 (6) | 7 (6) | 2 (7) | 1 |
Sotalol | 2 (1) | 2 (2) | 0 (0) | NA |
Nebivolol | 2 (1) | 1 (1) | 1 (4) | 0.837 |
Other heart rate lowering drugs b | 8 (6) | 6 (5) | 2 (7) | 0.950 |
Dihydropyridine CCB | 18 (13) | 16 (14) | 2 (7) | 0.554 |
ACEI/ARB | 111 (79) | 92 (81) | 19 (70) | 0.313 |
Diuretics | 35 (25) | 30 (27) | 5 (19) | 0.536 |
BB dose, bisoprolol equivalent (IQR), mg | 2.5 (2.5–5) | 2.5 (2.5–5.0) | 2.5 (1.2–2.5) | 0.033 |
Echocardiography | ||||
LV end-diastolic dimension, mm | 47 (44–50) | 46.0 (44–50) | 47 (44–50) | 0.523 |
Left atrium dimension, mm | 40 ± 5 | 40 ± 5 | 39 ± 5 | 0.558 |
LVEF, % | 53.3 ± 11.6 | 53.4 ± 11.9 | 52.8 ± 10.5 | 0.816 |
WMSI (IQR) | 1.4 (1.1–1.7) | 1.4 (1.1–1.8) | 1.5 (1.0–1.6) | 0.940 |
LV diastolic dysfunction, n (%) | 0.702 | |||
Grade 1 | 114 (81) | 90 (80) | 24 (89) | 0.404 |
Grade 2 | 8 (6) | 7 (6) | 1 (4) | 0.968 |
Grade 3 | 2 (1) | 2 (2) | 0 (0) | NA |
MR moderate, n (%) | 33 (24) | 25 (22) | 8 (30) | 0.567 |
RV end-diastolic dimension (IQR), mm | 34 (30–36) | 34 (29–36) | 35 (32–38) | 0.096 |
Right atrium dimension, mm | 35 ± 6 | 36 ± 6 | 34 ± 5 | 0.267 |
RV systolic dysfunction, n (%) | 38 (27) | 33 (29) | 5 (19) | 0.378 |
TR moderate, n (%) | 11 (8) | 9 (8) | 2 (7) | 1 |
All Patients (n = 140) | Chronotropic Incompetence a | p-Value | ||
---|---|---|---|---|
Yes (n = 113) | No (n = 27) | |||
Treadmill exercise test, n (%) | 109 (78) | 86 (76) | 23 (85) | 0.446 |
Cycle ergometer exercise test, n (%) | 31 (22) | 27 (24) | 4 (15) | 0.446 |
VO2 at anaerobic threshold, mL/kg/min | 13.7 ± 3.7 | 13.2 ± 3.7 | 16.0 ± 2.9 | <0.001 |
VO2 at peak, mL/kg/min | 19.4 ± 6.1 | 18.3 ± 5.7 | 24.0 ± 5.3 | <0.001 |
VO2 at peak, mL/kg/min % predicted | 73 ± 19 | 69 ± 17 | 89 ± 18 | <0.001 |
CO2 at peak, L/min | 1.8 ± 0.8 | 1.6 ± 0.7 | 2.4 ± 0.9 | <0.001 |
METs at peak | 5.5 ± 1.7 | 5.2 ± 1.6 | 6.9 ± 1.5 | <0.001 |
HR at rest (IQR), bpm | 72 (64–83) | 72 (64–82) | 77 (67–86) | 0.091 |
HR at anaerobic threshold, bpm | 97 ± 13 | 95 ± 13 | 106 ± 10 | <0.001 |
HR at peak, bpm | 115 ± 17 | 110 ± 15 | 136 ± 10 | <0.001 |
HR at peak, % predicted | 72 ± 10 | 69 ± 8 | 86 ± 4 | <0.001 |
Chronotropic index, % | 48.6 ± 17.3 | 42.7 ± 13.0 | 73.1 ± 9.3 | <0.001 |
SBP at rest, mmHg | 127 ± 13 | 127 ± 13 | 130 ± 13 | 0.289 |
SBP at peak (IQR), mmHg | 170 (155–180) | 170 (150–180) | 180 (160–190) | 0.075 |
RER at peak (IQR) | 1.10 (1.05–1.16) | 1.09 (1.05–1.16) | 1.14 (1.06–1.21) | 0.072 |
Min. ventilation vs. CO2 slope (IQR) | 24 (22–28) | 25 (23–28) | 23.6 (21–25) | 0.095 |
Breathing reserve at peak (IQR), % | 45 (25–57) | 46 (44–50) | 47 (44–50) | 0.523 |
FEV 1/IVC, % predicted | 93 ± 21 | 93 ± 20 | 94 ± 23 | 0.841 |
Univariate Analysis | Multivariate Analysis | ||||||
---|---|---|---|---|---|---|---|
β Regression Coefficient a | 95% CI | p-Value | β regression Coefficient a | 95% CI | p-Value | Explained Variance (%) b | |
Chronotropic index, % | 0.20 | 0.15 to 0.24 | <0.001 | 0.14 | 0.09 to 0.18 | <0.001 | 24.7 |
Male gender | 7.01 | 5.05 to 8.97 | <0.001 | 5.12 | 2.86 to 7.38 | <0.001 | 14.0 |
Age, years | −0.22 | −0.32 to −0.13 | <0.001 | −0.17 | −0.26 to −0.09 | <0.001 | 12.9 |
Heart failure | −4.55 | −6.52 to −2.60 | <0.001 | −3.35 | −4.97 to −1.72 | <0.001 | 11.8 |
WMSI | 0.483 | 0.050 | 3.1 | ||||
Treadmill vs. cycle ergometer | 3.92 | 1.56 to 6.28 | 0.001 | 0.066 | 2.7 | ||
BB daily dose, bisoprolol equivalent, mg | 0.743 | 0.140 | 1.8 | ||||
LVEF, % | 0.147 | 0.224 | 1.2 | ||||
Hemoglobin, g/L | 0.81 | 0.15 to 1.48 | 0.017 | 0.298 | 0.9 | ||
Serum creatinine, mg/dL | 0.295 | 0.343 | 0.7 | ||||
LV diastolic dysfunction, grade 2 and 3 | 0.108 | 0.413 | 0.5 | ||||
Height, cm | 0.430 | 0.430 | 0.5 | ||||
DM/IFG | −3.25 | −5.70 to −0.80 | 0.010 | 0.560 | 0.3 | ||
Current smoker | 0.670 | 0.586 | 0.2 | ||||
RV systolic dysfunction | 0.931 | 0.948 | 0.0 | ||||
SBP at peak exercise, mmHg | 0.05 | 0.00 to 0.09 | 0.034 | ||||
Hypertension | 0.137 | ||||||
CAD | 0.133 |
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Smarz, K.; Tysarowski, M.; Zaborska, B.; Pilichowska-Paszkiet, E.; Sikora-Frac, M.; Budaj, A.; Jaxa-Chamiec, T. Chronotropic Incompetence Limits Aerobic Exercise Capacity in Patients Taking Beta-Blockers: Real-Life Observation of Consecutive Patients. Healthcare 2021, 9, 212. https://doi.org/10.3390/healthcare9020212
Smarz K, Tysarowski M, Zaborska B, Pilichowska-Paszkiet E, Sikora-Frac M, Budaj A, Jaxa-Chamiec T. Chronotropic Incompetence Limits Aerobic Exercise Capacity in Patients Taking Beta-Blockers: Real-Life Observation of Consecutive Patients. Healthcare. 2021; 9(2):212. https://doi.org/10.3390/healthcare9020212
Chicago/Turabian StyleSmarz, Krzysztof, Maciej Tysarowski, Beata Zaborska, Ewa Pilichowska-Paszkiet, Małgorzata Sikora-Frac, Andrzej Budaj, and Tomasz Jaxa-Chamiec. 2021. "Chronotropic Incompetence Limits Aerobic Exercise Capacity in Patients Taking Beta-Blockers: Real-Life Observation of Consecutive Patients" Healthcare 9, no. 2: 212. https://doi.org/10.3390/healthcare9020212