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. 2024 Jan 25;31(2):263-271.
doi: 10.1093/eurjpc/zwad338.

What about chronotropic incompetence in heart failure with mildly reduced ejection fraction? Clinical and prognostic implications from the Metabolic Exercise combined with Cardiac and Kidney Indexes score dataset

Damiano Magrì  1 , Giovanna Gallo  1 , Massimo Piepoli  2 , Elisabetta Salvioni  3 , Massimo Mapelli  3 , Carlo Vignati  3 , Emiliano Fiori  1 , Melwyn Luis Muthukkattil  1 , Ugo Corrà  4 , Marco Metra  5 , Stefania Paolillo  6 , Antonello Maruotti  7 , Pierfrancesco Alaimo Di Loro  7 , Michele Senni  8 , Rocco Lagioia  9 , Domenico Scrutinio  9 , Michele Emdin  10   11 , Claudio Passino  10   11 , Gianfranco Parati  12 , Gianfranco Sinagra  13 , Michele Correale  14 , Roberto Badagliacca  15 , Susanna Sciomer  15 , Andrea Di Lenarda  16 , Piergiuseppe Agostoni  3   17 , Pasquale Perrone Filardi  6
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Free article

What about chronotropic incompetence in heart failure with mildly reduced ejection fraction? Clinical and prognostic implications from the Metabolic Exercise combined with Cardiac and Kidney Indexes score dataset

Damiano Magrì et al. Eur J Prev Cardiol. .
Free article

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Eur J Prev Cardiol. 2024 Jan 25;31(2):274. doi: 10.1093/eurjpc/zwad396. Eur J Prev Cardiol. 2024. PMID: 38195099 No abstract available.

Abstract

Aims: Chronotropic incompetence (CI) is a strong predictor of outcome in heart failure with reduced ejection fraction, however no data on its clinical and prognostic impacts in heart failure with mildly reduced ejection fraction (HFmrEF) are available. Therefore, the study aims to investigate, in a large multicentre HFmrEF cohort, the prevalence of CI as well as its relationship with exercise capacity and its prognostic role over the cardiopulmonary exercise testing (CPET) parameters.

Methods and results: Within the Metabolic Exercise combined with Cardiac and Kidney Indexes (MECKI) database, we analysed data of 864 HFmrEF out of 1164 stable outpatients who performed a maximal CPET at the cycle ergometer and who had no significant rhythm disorders or comorbidities. The primary study endpoint was cardiovascular (CV) death. All-cause death was also explored. Chronotropic incompetence prevalence differed depending on the method (peak heart rate, pHR% vs. pHR reserve, pHRR%) and the cut-off adopted (pHR% from ≤75% to ≤60% and pHRR% ≤ 65% to ≤50%), ranging from 11% to 62%. A total of 84 (9.7%) CV deaths were collected, with 39 (4.5%) occurring within 5 years. At multivariate analysis, both pHR% [hazard ratio 0.97 (0.95-0.99), P < 0.05] and pHRR% [hazard ratio 0.977 (0.961-0.993), P < 0.01] were associated with the primary endpoint. A pHR% ≤ 75% and a pHRR% ≤ 50% represented the most accurate cut-off values in predicting the outcome.

Conclusion: The study suggests an association between blunted exercise-HR response, functional capacity, and CV death risk among patients with HFmrEF. Whether the CI presence might be adopted in daily HFmrEF management needs to be addressed in larger prospective studies.

Keywords: Cardiopulmonary exercise test; Chronotropic incompetence; Heart failure; Heart rate; MECKI score; Prognosis.

Plain language summary

Chronotropic incompetence is an easy-to-obtain additive parameter for cardiovascular death risk stratification in heart failure with mildly reduced ejection fraction (HFmrEF). Peak heart rate and peak heart rate reserve are associated with exercise capacity in HFmrEF. Peak heart rate and peak heart rate reserve are associated with cardiovascular death in HFmrEF.

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Conflict of interest statement

Conflict of interest: none declared.