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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Determinants and consequences of heart rate and stroke volume response to exercise in patients with heart failure and preserved ejection fraction. / 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.
I: European Journal of Heart Failure, Bind 23, Nr. 5, 2021, s. 754-764.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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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 - Publisher Copyright: © 2021 European Society of Cardiology.
PY - 2021
Y1 - 2021
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/m2, healthy participants: +24 ± 12 mL/m2, 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/m2, healthy participants: +24 ± 12 mL/m2, 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 - Chronotropic incompetence
KW - Exercise
KW - Haemodynamics
KW - Heart failure with preserved ejection fraction
KW - HemReX
KW - REDUCE-LAP HF
KW - Stroke volume reserve
U2 - 10.1002/ejhf.2146
DO - 10.1002/ejhf.2146
M3 - Journal article
C2 - 33686716
AN - SCOPUS:85102848326
VL - 23
SP - 754
EP - 764
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1567-4215
IS - 5
ER -
ID: 303037525