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Review
. 2011 Mar 8;123(9):1010-20.
doi: 10.1161/CIRCULATIONAHA.110.940577.

Chronotropic incompetence: causes, consequences, and management

Peter H Brubaker  1 , Dalane W Kitzman
Affiliations
Review

Chronotropic incompetence: causes, consequences, and management

Peter H Brubaker et al. Circulation. .
No abstract available

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Figures

Figure 1
Figure 1
Influence of parasympathetic tone on heart rate recovery. A. Absolute heart rates (after log transformation) during the first 3 minutes ater exercise in 3 groups of subjects. Among athlets and normal subjects, there is a biexponential relationship which is absent in heart failure patients. B. After atropine, the initial steep slope is absent. From Lauer MS, Cleve Clin J of Med. 2009;76:S18-S22.
Figure 2
Figure 2
Relationship between age and maximal heart rate in over 5,000 asymptomatic women, with 95% confidence limts. From these data, a new prediction equation was proposed: peak heart rate = 206 − 0.88 (age). From Tanaka H, JACC 2001;37:153-156.
Figure 3
Figure 3
There is a significant relationship between change in heart rate during exercise and VO2peak in patients with HFrEF, but there is no significant difference in this relationship between those patients taking beta-blockers verson not taking them. From Magri et al; Cardiovascular Therapeutics 2010; In press.
Figure 4
Figure 4
In patients with HF, beta blockers do not significantly impact the relationship between heart rate and exercise time, regardless of whether CI is present. From Jorde et al; European J of Heart Failure 2008;96-101.
Figure 5
Figure 5
Markedly reduced survival during long-term follow-up among asymptomatic women with peak HR ≥ 1 SD below the average. From Gulati et al, Circulation 2010;122:130-137.
Figure 6
Figure 6
Relationship of heart rate reserve (HRR) to peak exercise oxygen consumption (VO2 peak) in older patients with HFrEF and HFpEF with (open circles) and without (closed circles) CI. There is a significant correlation between HRR and VO2 peak in those with (R=.39 p=0.04) and without CI (R=.41 p =0.01 ). From Brubaker, et al, Journal of Cardiopulmonary Rehabilitation 2006; 26:86-89.
Figure 7
Figure 7
Heart rate profiles during and after cycle ergometry in patients with HFpEF compared to age and gender matched subjects who possessed similar co-morbidities to the HFpEF group including left ventricular hypertrophy (Control). These data demonstrate the delayed and attenuated heart rate response often seen in chronotropically impaired heart failure patients. From Borlaug et al, Circulation 2006; 114:2138-2147.
See this image and copyright information in PMC

References

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    1. Higginbotham MB, Morris KG, Williams RS, McHale PA, Coleman RD, Cobb FR. Regulation of stroke volume during submaximal and maximal upright exercise in normal man. Circ Res. 1986;58:281–291. - PubMed
    1. Higginbotham MB, Morris KG, Williams RS. Physiologic basis for the age-related decline in aerobic work capacity. Am J Cardiol. 1986;57:1374–1379. - PubMed
    1. Orso F, Baldasseroni S, Maggioni A. Heart rate in coronary syndromes and heart failure. Prog Cardiovasc Dis. 2009;52:38–45. - PubMed
    1. Kannel WB. New perspectives on cardiovascular risk factors. Am Heart J. 1987;114:213–219. - PubMed

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