What about chronotropic incompetence in heart failure with mildly reduced ejection fraction? Clinical and prognostic implications from the Metabolic Exercise combined with Cardiac and Kidney Indexes score dataset
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com..
AIMS: Chronotropic incompetence (CI) is a strong predictor of outcome in heart failure with reduced ejection fraction, however no data on its clinical and prognostic impacts in heart failure with mildly reduced ejection fraction (HFmrEF) are available. Therefore, the study aims to investigate, in a large multicentre HFmrEF cohort, the prevalence of CI as well as its relationship with exercise capacity and its prognostic role over the cardiopulmonary exercise testing (CPET) parameters.
METHODS AND RESULTS: Within the Metabolic Exercise combined with Cardiac and Kidney Indexes (MECKI) database, we analysed data of 864 HFmrEF out of 1164 stable outpatients who performed a maximal CPET at the cycle ergometer and who had no significant rhythm disorders or comorbidities. The primary study endpoint was cardiovascular (CV) death. All-cause death was also explored. Chronotropic incompetence prevalence differed depending on the method (peak heart rate, pHR% vs. pHR reserve, pHRR%) and the cut-off adopted (pHR% from ≤75% to ≤60% and pHRR% ≤ 65% to ≤50%), ranging from 11% to 62%. A total of 84 (9.7%) CV deaths were collected, with 39 (4.5%) occurring within 5 years. At multivariate analysis, both pHR% [hazard ratio 0.97 (0.95-0.99), P < 0.05] and pHRR% [hazard ratio 0.977 (0.961-0.993), P < 0.01] were associated with the primary endpoint. A pHR% ≤ 75% and a pHRR% ≤ 50% represented the most accurate cut-off values in predicting the outcome.
CONCLUSION: The study suggests an association between blunted exercise-HR response, functional capacity, and CV death risk among patients with HFmrEF. Whether the CI presence might be adopted in daily HFmrEF management needs to be addressed in larger prospective studies.
| Errataetall: |
ErratumIn: Eur J Prev Cardiol. 2024 Jan 09;:. - PMID 38195099 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:31 |
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| Enthalten in: |
European journal of preventive cardiology - 31(2024), 2 vom: 25. Jan., Seite 263-271 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Magrì, Damiano [VerfasserIn] |
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| Links: |
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| Themen: |
Cardiopulmonary exercise test |
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| Anmerkungen: |
Date Completed 26.01.2024 Date Revised 26.01.2024 published: Print ErratumIn: Eur J Prev Cardiol. 2024 Jan 09;:. - PMID 38195099 Citation Status MEDLINE |
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| doi: |
10.1093/eurjpc/zwad338 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM363820965 |
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| 245 | 1 | 0 | |a What about chronotropic incompetence in heart failure with mildly reduced ejection fraction? Clinical and prognostic implications from the Metabolic Exercise combined with Cardiac and Kidney Indexes score dataset |
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| 500 | |a Date Revised 26.01.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a ErratumIn: Eur J Prev Cardiol. 2024 Jan 09;:. - PMID 38195099 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a AIMS: Chronotropic incompetence (CI) is a strong predictor of outcome in heart failure with reduced ejection fraction, however no data on its clinical and prognostic impacts in heart failure with mildly reduced ejection fraction (HFmrEF) are available. Therefore, the study aims to investigate, in a large multicentre HFmrEF cohort, the prevalence of CI as well as its relationship with exercise capacity and its prognostic role over the cardiopulmonary exercise testing (CPET) parameters | ||
| 520 | |a METHODS AND RESULTS: Within the Metabolic Exercise combined with Cardiac and Kidney Indexes (MECKI) database, we analysed data of 864 HFmrEF out of 1164 stable outpatients who performed a maximal CPET at the cycle ergometer and who had no significant rhythm disorders or comorbidities. The primary study endpoint was cardiovascular (CV) death. All-cause death was also explored. Chronotropic incompetence prevalence differed depending on the method (peak heart rate, pHR% vs. pHR reserve, pHRR%) and the cut-off adopted (pHR% from ≤75% to ≤60% and pHRR% ≤ 65% to ≤50%), ranging from 11% to 62%. A total of 84 (9.7%) CV deaths were collected, with 39 (4.5%) occurring within 5 years. At multivariate analysis, both pHR% [hazard ratio 0.97 (0.95-0.99), P < 0.05] and pHRR% [hazard ratio 0.977 (0.961-0.993), P < 0.01] were associated with the primary endpoint. A pHR% ≤ 75% and a pHRR% ≤ 50% represented the most accurate cut-off values in predicting the outcome | ||
| 520 | |a CONCLUSION: The study suggests an association between blunted exercise-HR response, functional capacity, and CV death risk among patients with HFmrEF. Whether the CI presence might be adopted in daily HFmrEF management needs to be addressed in larger prospective studies | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Cardiopulmonary exercise test | |
| 650 | 4 | |a Chronotropic incompetence | |
| 650 | 4 | |a Heart failure | |
| 650 | 4 | |a Heart rate | |
| 650 | 4 | |a MECKI score | |
| 650 | 4 | |a Prognosis | |
| 700 | 1 | |a Gallo, Giovanna |e verfasserin |4 aut | |
| 700 | 1 | |a Piepoli, Massimo |e verfasserin |4 aut | |
| 700 | 1 | |a Salvioni, Elisabetta |e verfasserin |4 aut | |
| 700 | 1 | |a Mapelli, Massimo |e verfasserin |4 aut | |
| 700 | 1 | |a Vignati, Carlo |e verfasserin |4 aut | |
| 700 | 1 | |a Fiori, Emiliano |e verfasserin |4 aut | |
| 700 | 1 | |a Muthukkattil, Melwyn Luis |e verfasserin |4 aut | |
| 700 | 1 | |a Corrà, Ugo |e verfasserin |4 aut | |
| 700 | 1 | |a Metra, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Paolillo, Stefania |e verfasserin |4 aut | |
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| 700 | 1 | |a Di Loro, Pierfrancesco Alaimo |e verfasserin |4 aut | |
| 700 | 1 | |a Senni, Michele |e verfasserin |4 aut | |
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| 700 | 1 | |a Scrutinio, Domenico |e verfasserin |4 aut | |
| 700 | 1 | |a Emdin, Michele |e verfasserin |4 aut | |
| 700 | 1 | |a Passino, Claudio |e verfasserin |4 aut | |
| 700 | 1 | |a Parati, Gianfranco |e verfasserin |4 aut | |
| 700 | 1 | |a Sinagra, Gianfranco |e verfasserin |4 aut | |
| 700 | 1 | |a Correale, Michele |e verfasserin |4 aut | |
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