Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Determinants and consequences of heart rate and stroke volume response to exercise in patients with heart failure and preserved ejection fraction

Research output: Contribution to journalJournal articleResearchpeer-review

DOI

  1. Efficacy of the COVID-19 vaccine in heart transplant recipients: what we know and what we ignore

    Research output: Contribution to journalEditorialResearchpeer-review

  2. Piecing together the puzzle of sex-specific differences in left ventricular ejection fraction

    Research output: Contribution to journalEditorialResearchpeer-review

View graph of relations

Aims: A hallmark of heart failure with preserved ejection fraction (HFpEF) is impaired exercise capacity of varying severity. The main determinant of exercise capacity is cardiac output (CO), however little information is available about the relation between the constituents of CO – heart rate and stroke volume – and exercise capacity in HFpEF. We sought to determine if a heterogeneity in heart rate and stroke volume response to exercise exists in patients with HFpEF and describe possible clinical phenotypes associated with differences in these responses. Methods and results: Data from two prospective trials of HFpEF (n = 108) and a study of healthy participants (n = 42) with invasive haemodynamic measurements during exercise were utilized. Differences in central haemodynamic responses were analysed with regression models. Chronotropic incompetence was present in 39–56% of patients with HFpEF and 3–56% of healthy participants depending on the definition used, but some (n = 47, 44%) had an increase in heart rate similar to that of healthy controls. Patients with HFpEF had a smaller increase in their stroke volume index (SVI) (HFpEF: +4 ± 10 mL/m 2, healthy participants: +24 ± 12 mL/m 2, P < 0.0001), indeed, SVI fell in 28% of patients at peak exercise. Higher body mass index and lower SVI at rest were associated with smaller increases in heart rate during exercise, whereas higher resting heart rate, and angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use were associated with a greater increase in SVI in patients with HFpEF. Conclusion: The haemodynamic response to exercise was very heterogeneous among patients with HFpEF, with chronotropic incompetence observed in up to 56%, and 28% had impaired increase in SVI. This suggests that haemodynamic exercise testing may be useful to identify which HFpEF patients may benefit from interventions targeting stroke volume and chronotropic response.

Original languageEnglish
JournalEuropean Journal of Heart Failure
Volume23
Issue number5
Pages (from-to)754-764
Number of pages11
ISSN1388-9842
DOIs
Publication statusPublished - May 2021

Bibliographical note

© 2021 European Society of Cardiology.

    Research areas

  • Exercise Test, Exercise Tolerance, Heart Failure, Heart Rate, Humans, Prospective Studies, Stroke Volume, Heart failure with preserved ejection fraction, Stroke volume reserve, HemReX, Chronotropic incompetence, Exercise, Haemodynamics, REDUCE-LAP HF

ID: 68355500