Chronotropic index and long-term outcomes in heart failure with preserved ejection fraction

Autores de INCLIVA

• Patricia Palau Sampio

  Autor

• Clara Sastre Arbona

  Autor

• 

  Juan Sanchis Fores

  Autor

• Laura Lopez Bueno

  Autor

• 

  Vicent Bodí Peris

  Autor

• Gema Miñana Escriva

  Autor

• 

  Rafael De La Espriella Juan

  Autor

• 

  Julio Nuñez Villota

  Autor

Participantes ajenos a INCLIVA

• Dominguez, Eloy
• Seller, Julia
• Llacer, Pau
• Bayes-Genis, Antoni

Grupos y Plataformas de I+D+i

• Grupo de investigación en Cardiología Clínica

  

  Leading Researcher

  Juan Sanchis Fores

• Grupo de Investigación en Insuficiencia Cardiaca

  

  Established Researcher

  Julio Nuñez Villota

• Grupo de Investigación Traslacional en Cardiopatía Isquémica

  

  Leading Researcher

  Vicent Bodí Peris

Abstract

Introduction and objectives: Little is known about the usefulness of heart rate (HR) response to exercise for risk stratification in heart failure with preserved ejection fraction (HFpEF). Therefore, this study aimed to assess the association between HR response to exercise and the risk of total episodes of worsening heart failure (WHF) in symptomatic stable patients with HFpEF.Methods: This single-center study included 133 patients with HFpEF (NYHA II-III) who performed maximal cardiopulmonary exercise testing. HR response to exercise was evaluated using the chronotropic index (CIx) formula. A negative binomial regression method was used.Results: The mean age of the sample was 73.2 & PLUSMN; 10.5 years; 56.4% were female, and 51.1% were in atrial fibrillation. The median for CIx was 0.4 [0.3-0.55]. At a median follow-up of 2.4 [1.6-5.3] years, a total of 146 WHF events in 58 patients and 41 (30.8%) deaths were registered. In the whole sample, CIx was not associated with adverse outcomes (death, P = .319, and WHF events, P = .573). However, we found a differential effect across electrocardiographic rhythms for WHF events (P for interaction = .002). CIx was inversely and linearly associated with the risk of WHF events in patients with sinus rhythm and was positively and linearly associated with those with atrial fibrillation.Conclusions: In patients with HFpEF, CIx was differentially associated with the risk of total WHF events across rhythm status. Lower CIx emerged as a risk factor for predicting higher risk in patients with sinus rhythm. In contrast, higher CIx identified a higher risk in those with atrial fibrillation.?C 2022 Sociedad Espan & SIM;ola de Cardiologi & PRIME;a. Published by Elsevier Espan & SIM;a, S.L.U. All rights reserved.

Copyright © 2022 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Keywords

• Heart failure with preserved ejection; fraction; Chronotropic response; Exercise heart rate response; Cardiopulmonary exercise testing; Prognosis; Rhythm status