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

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Wolsk, Emil ; Kaye, David M ; Komtebedde, Jan ; Shah, Sanjiv J ; Borlaug, Barry A ; Burkhoff, Daniel ; Kitzman, Dalane W ; Cleland, John G ; Hasenfuß, Gerd ; Hassager, Christian ; Møller, Jacob E ; Gustafsson, Finn. / Determinants and consequences of heart rate and stroke volume response to exercise in patients with heart failure and preserved ejection fraction. I: European Journal of Heart Failure. 2021 ; Bind 23, Nr. 5. s. 754-764.

Bibtex

@article{59a71a3544e7436f95fd531d1b0a44e0,
title = "Determinants and consequences of heart rate and stroke volume response to exercise in patients with heart failure and preserved ejection fraction",
abstract = "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. ",
keywords = "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",
author = "Emil Wolsk and Kaye, {David M} and Jan Komtebedde and Shah, {Sanjiv J} and Borlaug, {Barry A} and Daniel Burkhoff and Kitzman, {Dalane W} and Cleland, {John G} and Gerd Hasenfu{\ss} and Christian Hassager and M{\o}ller, {Jacob E} and Finn Gustafsson",
note = "{\textcopyright} 2021 European Society of Cardiology.",
year = "2021",
month = may,
doi = "10.1002/ejhf.2146",
language = "English",
volume = "23",
pages = "754--764",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Wiley",
number = "5",

}

RIS

TY - JOUR

T1 - Determinants and consequences of heart rate and stroke volume response to exercise in patients with heart failure and preserved ejection fraction

AU - Wolsk, Emil

AU - Kaye, David M

AU - Komtebedde, Jan

AU - Shah, Sanjiv J

AU - Borlaug, Barry A

AU - Burkhoff, Daniel

AU - Kitzman, Dalane W

AU - Cleland, John G

AU - Hasenfuß, Gerd

AU - Hassager, Christian

AU - Møller, Jacob E

AU - Gustafsson, Finn

N1 - © 2021 European Society of Cardiology.

PY - 2021/5

Y1 - 2021/5

N2 - 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.

AB - 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.

KW - Exercise Test

KW - Exercise Tolerance

KW - Heart Failure

KW - Heart Rate

KW - Humans

KW - Prospective Studies

KW - Stroke Volume

KW - Heart failure with preserved ejection fraction

KW - Stroke volume reserve

KW - HemReX

KW - Chronotropic incompetence

KW - Exercise

KW - Haemodynamics

KW - REDUCE-LAP HF

UR - http://www.scopus.com/inward/record.url?scp=85102848326&partnerID=8YFLogxK

U2 - 10.1002/ejhf.2146

DO - 10.1002/ejhf.2146

M3 - Journal article

C2 - 33686716

VL - 23

SP - 754

EP - 764

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

IS - 5

ER -

ID: 68355500