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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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.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | European Journal of Heart Failure |
| Vol/bind | 23 |
| Udgave nummer | 5 |
| Sider (fra-til) | 754-764 |
| Antal sider | 11 |
| ISSN | 1388-9842 |
| DOI | |
| Status | Udgivet - 2021 |
Bibliografisk note
Funding Information:
: E.W.: speaker fees from Orion Pharma, Novartis Healthcare, Boehringer‐Ingelheim, Merck. D.M.K.:s grants from National Health and Medical Research Council of Australia; advisor to Abbott, Cardiora, Corvia, Novartis. J.K.: employee of Corvia Medical, Inc.; salary and stock options. S.J.S.: grants from the National Institutes of Health (R01 HL140731, R01 HL120728, R01 HL107577, and R01 HL149423), American Heart Association, Actelion, AstraZeneca, Corvia, and Novartis; consulting fees from Actelion, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cardiora, Eisai, Ionis, Ironwood, Merck, Novartis, Pfizer, Sanofi, and United Therapeutics. B.A.B.: grant support from NIH/NHLBI (R01 HL128526, U01 HL125205), AstraZeneca, Corvia, Medtronic, Mesoblast, GlaxoSmithKline, TENAX; advisory board/consulting: Merck, Novartis, Lilly, Novo Nordisk. D.B.: consultant to Corvia for hemodynamic core laboratory. D.W.K.: consultant for Abbvie, Bayer, Merck, Medtronic, Relypsa, Merck, Corvia Medical, Boehringer Ingelheim, AstraZeneca, and Novartis; grant funding from Novartis, Bayer, AstraZeneca, and National Institutes of Health; and stock ownership in Gilead Sciences. J.G.C.: received travel support for advisory boards for Corvia and have received honoraria for speaking and advisory boards from Abbott, Amgen, Bayer, Medtronic, Novartis, Pharmacosmos and Vifor. G.H.: Berlin Chemie, honorarium for lectures; Corvia, consulting; Impulse Dynamics, consulting, honorarium for lectures, co‐PI; Novartis, Servier and Vifor Pharma, consulting, honorarium for lectures; Springer, editorial board. C.H.: none. J.E.M.: advisor for Abiomed, Novo Nordic; grants from Abiomed; speaker fee from Orion Pharma, Abiomed, Novartis. F.G.: advisor for Boehringer Ingelheim, Pfizer, Abbott, Carmat; unpaid advisor to Corvia; speaker fee from Orion Pharma, AstraZeneca, Novartis. Conflict of interest
Publisher Copyright:
© 2021 European Society of Cardiology.
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