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Chronotropic incompetency

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https://www.readbyqxmd.com/read/27913834/key-role-of-pacing-site-as-determinant-factor-of-exercise-testing-performance-in-pediatric-patients-with-chronic-ventricular-pacing
#1
Michel Cabrera Ortega, Hiram Tápanes Duamy, Dunia B Benítez Ramos
Chronic right ventricular (RV) apical pacing has been associated with deterioration of functional capacity and chronotropic incompetence during exercise testing in children. The effects of alternative pacing site on exercise performance in pediatric population remain unknown. We evaluated the influence of ventricular pacing site on exercise capacity in pediatric patients with complete congenital atrioventricular block requiring permanent pacemaker therapy. Sixty-four children paced from RV apex (n = 26), RV midseptum (n = 15) and left ventricular (LV) apex (n = 23) were studied cross-sectionally...
December 2, 2016: Pediatric Cardiology
https://www.readbyqxmd.com/read/27887692/mechanisms-of-effort-intolerance-in-patients-with-heart-failure-and-borderline-ejection-fraction
#2
Yan Topilsky, Zach Rozenbaum, Shafik Khoury, Gregg S Pressman, Yaniv Gura, Jack Sherez, Avi Man, Jason Shimiaie, Sanford Edwards, Joshua Berookhim, Thierry Le Tourneau, Amir Halkin, Simon Biner, Gad Keren, Galit Aviram
Combining echocardiography and cardiopulmonary stress testing allows noninvasive assessment of hemodynamics, and oxygen extraction (A-VO2 difference). We evaluated mechanisms of effort intolerance in patients with heart failure with borderline (40% to 49%) left ventricular ejection fraction (EF) (HF and Borderline Ejection fraction). We included 89 consecutive patients with HF and Borderline Ejection fraction (n = 25; 63.6 ± 14 years, 64% men), control subjects (n = 22), patients with HF with preserved EF (n = 26; EF ≥50%), and patients with HF with reduced EF (n = 16; <40%)...
November 1, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27865723/mechanisms-of-effort-intolerance-in-patients-with-rheumatic-mitral-stenosis-combined-echocardiography-and-cardiopulmonary-stress%C3%A2-protocol
#3
Michal Laufer-Perl, Yaniv Gura, Jason Shimiaie, Jack Sherez, Gregg S Pressman, Galit Aviram, Simon Maltais, Ricki Megidish, Amir Halkin, Meirav Ingbir, Simon Biner, Gad Keren, Yan Topilsky
OBJECTIVES: This study sought to evaluate mechanisms of effort intolerance in patients with rheumatic mitral stenosis (MS). BACKGROUND: Combined stress echocardiography and cardiopulmonary testing allows assessment of cardiac function, hemodynamics, and oxygen extraction (A-Vo2 difference). METHODS: Using semirecumbent bicycle exercise, 20 patients with rheumatic MS (valve area 1.36 ± 0.4 cm(2)) were compared to 20 control subjects at 4 pre-defined activity stages (rest, unloaded, anaerobic threshold, and peak)...
November 10, 2016: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27810293/usefulness-of-stroke-volume-monitoring-during-upright-ramp-incremental-cycle-exercise-in-young-patients-with-fontan-circulation
#4
Antoine Legendre, Aurore Guillot, Magalie Ladouceur, Damien Bonnet
BACKGROUND: Aerobic capacity (VO2 max) of patients with Fontan circulation (FC) is lowest within patients with congenital heart disease. The reasons have not been completely elucidated. METHODS: Twenty five young patients with non-failing FC underwent a cardiopulmonary test during an upright ramp cycling. By using a signal morphology impedance cardiography device (physioflow®), stroke volume (SV) was evaluated along with effort. The results were compared with paired healthy controls...
October 29, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27799755/chronotropic-incompetence-can-limit-exercise-tolerance-in-copd-patients-with-lung-hyperinflation
#5
Sébastien Hulo, Jocelyn Inamo, Aurélie Dehon, Olivier Le Rouzic, Jean-Louis Edme, Remi Neviere
PURPOSE: Metabolic-chronotropic relationship is the only concept that assesses the entire chronotropic function during exercise, as it takes into account individual fitness. To better understand interrelationships between chronotropic incompetence (CI), dynamic hyperinflation (DH) and exercise limitation among Global initiative for chronic Obstructive Lung Disease (GOLD) stages of chronic obstructive pulmonary disease (COPD) disease severity, we evaluated cardiopulmonary responses to symptom-limited cycle exercise in stable patients...
2016: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/27754982/clinical-feasibility-of-a-new-method-to-identify-chronotropic-incompetence-in-heart-failure-patients
#6
Hui Li, Jingbo Li, Xiaohong Zhou, Jianrong Zhao, Fengru Zhang, Liqun Wu, Hong Shen, Qing Wan, Jing Huang, Shungang Yang, Ping Wang
Heart failure patients have a high incidence of chronotropic incompetence (CI) that receives less clinical attention. This study assessed a method using wearable devices to identify CI in heart failure patients. Twenty-six heart failure patients (LVEF: 43.9  ±  5.7% with LVEF  ⩾40% in 19 patients; age: 52.8  ±  12.4 years, female patients  =  6) were enrolled. Each patient underwent symptom-limited treadmill maximal exercise testing during which the simultaneous recording of ECG Holter and physical activity using Actigraph was conducted...
October 18, 2016: Physiological Measurement
https://www.readbyqxmd.com/read/27721226/hemodynamic-response-to-exercise-for-prediction-of-development-of-kidney-failure-revealing-a-cardiorenal-secret-cross-talk
#7
Alireza Khoshdel, Shane Carney, Saxon White, Alastair Gillies
INTRODUCTION: Kidney disease increases the risk of cardiovascular disease. The corollary of that observation should be that cardiovascular disease would not only increase the risk of kidney dysfunction, but also cause kidney damage, a concept not previously proposed. MATERIALS AND METHODS: Hemodynamic response to a graded exercise stress test was measured in 70 candidates to evaluate the association of heart rate and blood pressure change, heart rate reserve, chronotropic incompetence (percentage of achievement of maximal predicted heart rate), and circulatory power with development of kidney failure (glomerular filtration rate < 30 mL/min/1...
September 2016: Iranian Journal of Kidney Diseases
https://www.readbyqxmd.com/read/27670797/effect-of-beta-blocker-therapy-maximal-heart-rate-and-exercise-capacity-during-stress-testing-on-long-term-survival-from-the-henry-ford-exercise-testing-project
#8
Rupert K Hung, Mouaz H Al-Mallah, Seamus P Whelton, Erin D Michos, Roger S Blumenthal, Jonathan K Ehrman, Clinton A Brawner, Steven J Keteyian, Michael J Blaha
Whether lower heart rate thresholds (defined as the percentage of age-predicted maximal heart rate achieved, or ppMHR) should be used to determine chronotropic incompetence in patients on beta-blocker therapy (BBT) remains unclear. In this retrospective cohort study, we analyzed 64,549 adults without congestive heart failure or atrial fibrillation (54 ± 13 years old, 46% women, 29% black) who underwent clinician-referred exercise stress testing at a single health care system in Detroit, Michigan from 1991 to 2009, with median follow-up of 10...
December 1, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27542737/juvenile-fibromyalgia-syndrome-blunted-heart-rate-response-and-cardiac-autonomic-dysfunction-at-diagnosis
#9
Magda M Maia, Bruno Gualano, Ana L Sá-Pinto, Adriana M E Sallum, Rosa M R Pereira, Claudio A Len, Maria T A Terreri, Cassia M Barbosa, Hamilton Roschel, Clovis A Silva
OBJECTIVE: To assess aerobic capacity and cardiac autonomic modulation in juvenile fibromyalgia syndrome (JFM) patients at diagnosis in response to graded exercise text. METHODS: A multicenter cross-sectional study included 25 JFM patients and 25 healthy controls. Both groups participated only in physical education classes at school. A treadmill graded cardiorespiratory test was performed and the heart-rate (HR) response during exercise was evaluated by the chronotropic reserve (CR)...
July 16, 2016: Seminars in Arthritis and Rheumatism
https://www.readbyqxmd.com/read/27481271/the-relevance-of-performing-exercise-test-before-starting-supervised-physical-exercise-in-asymptomatic-cardiovascular-patients-with-rheumatic-diseases
#10
Bárbara Nascimento de Carvalho Klemz, Edgard Torres Dos Reis-Neto, Fábio Jennings, Usmary Sardinha Siqueira, Fábio Kadratz Klemz, Helder Henrique Costa Pinheiro, Emília Inoue Sato, Jamil Natour, Vera Lúcia Szejnfeld, Marcelo de Medeiros Pinheiro
OBJECTIVES: To evaluate the impact and risk factors associated with an abnormal exercise test (ET) in systemic inflammatory rheumatic disease (SIRD) patients before commencing supervised physical exercise. METHODS: A total of 235 SIRD patients were enrolled in three controlled clinical trials, including 103 RA, 42 SLE and 57 AS patients. The control group consisted of 231 healthy, sedentary subjects matched for age, gender and BMI. All performed an ET, according to Bruce's or Ellestad's protocol...
November 2016: Rheumatology
https://www.readbyqxmd.com/read/27343419/post-aortic-dissection-gap-between-activity-recommendation-and-real-life-patients-aerobic-capacities
#11
Pascal Delsart, Pauline Maldonado-Kauffmann, Mathieu Bic, Fanny Boudghene-Stambouli, Jonathan Sobocinski, Francis Juthier, Olivia Domanski, Augustin Coisne, Richard Azzaoui, Natacha Rousse, George Fayad, Thomas Modine, Stephan Haulon, Andre Vincentelli, Claire Mounier-Vehier, David Montaigne
BACK GROUND: Regular exercise at a safe level, i.e. 3-5 metabolic equivalents, is recommended to improve blood pressure control and quality of life even after aortic dissection, although aerobic exercise capacities in these patients are unexplored yet. METHODS: We prospectively collected data from 105 patients with a history of post aortic dissection referred for a cardiopulmonary exercise testing (CPX) aiming to guide exercise rehabilitation. RESULTS: The population was composed of 76% of male, with a mean age of 57...
September 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27176067/-bradyarrhythmias-diagnostics
#12
Carsten Walter Israel
Bradyarrhythmias cause symptoms such as syncope, dizziness, or exercise intolerance and lead to the implantation of > 100 000 pacemakers in Germany annually. They are caused either by sinus node dysfunction (sinus bradycardia, sinoatrial block, sinusarrest, preautomatic pauses in paroxysmal atrial fibrillation, chronotropic incompetence) or by atrioventricular (AV) conduction abnormalities (AV block, complex bundle branch block). Optimal therapy of bradycardia crucially depends on ECG documentation which frequently requires Holter monitoring in the case of intermittent bradycardia...
May 2016: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27102504/chronotropic-incompetence-does-not-limit-exercise-capacity-in-chronic-heart-failure
#13
COMPARATIVE STUDY
Haqeel A Jamil, John Gierula, Maria F Paton, Roo Byrom, Judith E Lowry, Richard M Cubbon, David A Cairns, Mark T Kearney, Klaus K Witte
BACKGROUND: Limited heart rate (HR) rise (HRR) during exercise, known as chronotropic incompetence (CI), is commonly observed in chronic heart failure (CHF). HRR is closely related to workload, the limitation of which is characteristic of CHF. Whether CI is a causal factor for exercise intolerance, or simply an associated feature remains unknown. OBJECTIVES: This study sought to clarify the role of the HR on exercise capacity in CHF. METHODS: This series of investigations consisted of a retrospective cohort study and 2 interventional randomized crossover studies to assess: 1) the relationship between HRR and exercise capacity in CHF; and 2) the effect of increasing and lowering HR on exercise capacity in CHF as assessed by symptom-limited treadmill exercise testing and measurement of peak oxygen consumption in patients with CHF due to left ventricular systolic dysfunction...
April 26, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27001125/atrial-rate-responsive-pacing-and-incidence-of-sustained-atrial-arrhythmias-in-patients-with-implantable-cardioverter-defibrillators
#14
Adolfo Fontenla, Rafael Salguero, Jose B Martinez-Ferrer, Anibal Rodriguez, Javier Alzueta, Enrique Garcia, Nuria Basterra, Rafael Romero, Joaquin Fernandez DE LA Concha, Xavier Viñolas, Julian Villacastin, Maria Lopez-Gil, Fernando Arribas
BACKGROUND: Atrial rate-responsive pacing (RRP) has proved to be safe in pacemaker recipients with chronotropic incompetence. Although RRP is available in all current implantable cardioverter defibrillators (ICDs), the outcomes of this pacing mode in ICD patients are unknown. The aim is to evaluate the relationship between atrial RRP and atrial arrhythmias in ICD recipients. METHODS: Dual-chamber and triple-chamber ICD patients were included in this multicenter cohort study...
June 2016: Pacing and Clinical Electrophysiology: PACE
https://www.readbyqxmd.com/read/26857994/loss-of-the-transcription-factor-meis1-prevents-sympathetic-neurons-target-field-innervation-and-increases-susceptibility-to-sudden-cardiac-death
#15
Fabrice Bouilloux, Jérôme Thireau, Stéphanie Ventéo, Charlotte Farah, Sarah Karam, Yves Dauvilliers, Jean Valmier, Neal G Copeland, Nancy A Jenkins, Sylvain Richard, Frédéric Marmigère
Although cardio-vascular incidents and sudden cardiac death (SCD) are among the leading causes of premature death in the general population, the origins remain unidentified in many cases. Genome-wide association studies have identified Meis1 as a risk factor for SCD. We report that Meis1 inactivation in the mouse neural crest leads to an altered sympatho-vagal regulation of cardiac rhythmicity in adults characterized by a chronotropic incompetence and cardiac conduction defects, thus increasing the susceptibility to SCD...
2016: ELife
https://www.readbyqxmd.com/read/26850445/klinefelter-syndrome-cardiovascular-system-and-thromboembolic-disease-review-of-literature-and-clinical-perspectives
#16
REVIEW
Andrea Salzano, Michele Arcopinto, Alberto M Marra, Emanuele Bobbio, Daniela Esposito, Giacomo Accardo, Francesco Giallauria, Eduardo Bossone, Carlo Vigorito, Andrea Lenzi, Daniela Pasquali, Andrea M Isidori, Antonio Cittadini
Klinefelter syndrome (KS) is the most frequently occurring sex chromosomal aberration in males, with an incidence of about 1 in 500-700 newborns. Data acquired from large registry-based studies revealed an increase in mortality rates among KS patients when compared with mortality rates among the general population. Among all causes of death, metabolic, cardiovascular, and hemostatic complication seem to play a pivotal role. KS is associated, as are other chromosomal pathologies and genetic diseases, with cardiac congenital anomalies that contribute to the increase in mortality...
July 2016: European Journal of Endocrinology
https://www.readbyqxmd.com/read/26792295/the-nitrate-nitrite-no-pathway-and-its-implications-for-heart-failure-and-preserved-ejection-fraction
#17
REVIEW
Julio A Chirinos, Payman Zamani
The pathogenesis of exercise intolerance in patients with heart failure and preserved ejection fraction (HFpEF) is likely multifactorial. In addition to cardiac abnormalities (diastolic dysfunction, abnormal contractile reserve, chronotropic incompetence), several peripheral abnormalities are likely to be involved. These include abnormal pulsatile hemodynamics, abnormal arterial vasodilatory responses to exercise, and abnormal peripheral O2 delivery, extraction, and utilization. The nitrate-nitrite-NO pathway is emerging as a potential target to modify key physiologic abnormalities, including late systolic left ventricular (LV) load from arterial wave reflections (which has deleterious short- and long-term consequences for the LV), arterial vasodilatory reserve, muscle O2 delivery, and skeletal muscle mitochondrial function...
February 2016: Current Heart Failure Reports
https://www.readbyqxmd.com/read/26701872/resting-heart-rate-and-measures-of-effort-related-cardiac-autonomic-dysfunction-predict-cardiovascular-events-in-asymptomatic-type-2-diabetes
#18
Barak Zafrir, Mali Azencot, Idit Dobrecky-Mery, Basil S Lewis, Moshe Y Flugelman, David A Halon
BACKGROUND: Autonomic control of the cardiovascular system may be impaired in type 2 diabetes and is associated with increased morbidity and mortality. Parameters obtained during stress testing may reflect early stages of cardiac autonomic dysfunction and provide prognostic information in asymptomatic type 2 diabetes. METHODS: We performed maximal exercise treadmill testing in 594 patients with type 2 diabetes without known coronary heart disease. The prognostic significance of physiological parameters associated with autonomic dysfunction was assessed, including chronotropic incompetence (<80% heart rate reserve), abnormal heart rate recovery at 1 minute <18 beats/minute, and resting tachycardia >100 beats/minute...
August 2016: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/26556777/exercise-capacity-long-term-after-arterial-switch-operation-for-transposition-of-the-great-arteries
#19
Flávia Samos, Gabriela Fuenmayor, Carlos Hossri, Patrícia Elias, Leandro Ponce, Rogério Souza, Ieda Jatene
UNLABELLED: Transposition of the great arteries (TGA) is a congenital heart defect successfully corrected through arterial switch operation (ASO). Although this technique had significant impact in improving survival, little is known about the functional capacity of the operated patients long-term after surgery. OBJECTIVE: The aim of this study was to compare the functional capacity of children with TGA long-term after ASO with that of healthy children. DESIGN: Retrospective study...
March 2016: Congenital Heart Disease
https://www.readbyqxmd.com/read/26449998/determinants-of-effort-intolerance-in-patients-with-heart-failure-combined-echocardiography-and-cardiopulmonary-stress-protocol
#20
COMPARATIVE STUDY
Jason Shimiaie, Jack Sherez, Galit Aviram, Ricki Megidish, Sami Viskin, Amir Halkin, Meirav Ingbir, Nahum Nesher, Simon Biner, Gad Keren, Yan Topilsky
OBJECTIVES: The purpose of this study was to assess individual mechanisms of effort intolerance in patients with heart failure with preserved ejection fraction (HFpEF), heart failure with reduced ejection fraction (HFrEF), or normal cardiac function using combined echocardiography and cardiopulmonary stress testing. BACKGROUND: Combined stress echocardiography and cardiopulmonary tests visualize cardiac chambers in 4 well-defined activity levels (rest, unloaded, anaerobic threshold, and peak), allowing noninvasive assessment of cardiac function, hemodynamics, and arterial venous oxygen content difference (AVo(2)Diff) during all stages...
October 2015: JACC. Heart Failure
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