Chronotropic incompetence and its relation to exercise intolerance in hypertrophic cardiomyopathy

Efthimiadis, Georgios K.; Giannakoulas, George; Parcharidou, Despina; Pagourelias, Efstathios D; Kouidi, Evangelia; Spanos, Georgios; Kamperidis, Vasileios; Gavrielides, Stavros; Karvounis, Haralambos; Styliadis, Ioannis H.; Parcharidis, Georgios

doi:10.1016/j.ijcard.2010.08.026

Cited by 47 publications

(47 citation statements)

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“…6, 7 Furthermore it helps in providing patients with a tailored exercise regimen and can provide information on autonomic function in HCM. 8 While exercise has been shown to ameliorate hypertrophy in mouse models of HCM, it can also serve as a trigger for ventricular arrhythmias and sudden death. 6, 9 Hence, in clinical practice, HCM patients with high LVOT pressure gradients, e.g.…”

Section: Introductionmentioning

confidence: 99%

Safety profile and utility of treadmill exercise in patients with high-gradient hypertrophic cardiomyopathy

Sorensen

Liang

Pinheiro

et al. 2017

American Heart Journal

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Background Exercise echocardiography in the evaluation of Hypertrophic Cardiomyopathy (HCM) provides valuable information for risk stratification, selection of optimal treatment and prognostication. However, HCM patients with left ventricular outflow (LVOT) gradients ≥30 mmHg are often excluded from exercise testing because of safety considerations. We examined the safety and utility of exercise testing in high-gradient HCM patients. Methods We evaluated clinical characteristics, hemodynamics and imaging variables in 499 consecutive HCM patients who performed 959 exercise tests. Patients were divided on the basis of peak LVOT gradients using a 30 mmHg threshold into: obstructive (n=152), labile-obstructive (n=178) and non-obstructive (n=169) groups. Results There were no deaths during exercise testing. We noted 20 complications (2.1% of tests) including 3 serious ventricular arrhythmias (0.3% of tests). There was no difference in complication rate between groups. Obstructive HCM patients had a higher frequency of abnormal blood pressure response (obstructive: 53% versus labile-obstructive: 41% and non-obstructive: 37%, p=0.008). Obstructive patients also displayed a lower work capacity (obstructive: 8.4±3.4 versus labile-obstructive: 10.9±4.2 and non-obstructive: 10.2±4.0, METs, p<0.001). Exercise testing provided incremental information regarding sudden cardiac death risk in 19% of high gradient HCM patients and we found poor correlation between patient-reported functional class and work capacity. Conclusion Our results suggest that exercise testing in HCM is safe and serious adverse events are rare. Although numbers are limited, exercise testing in high gradient HCM appears to confer no significant additional safety hazard in our selected cohort and could potentially provide valuable information.

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Section: Introductionmentioning

confidence: 99%

Safety profile and utility of treadmill exercise in patients with high-gradient hypertrophic cardiomyopathy

Sorensen

Liang

Pinheiro

et al. 2017

American Heart Journal

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“…Several mechanisms may contribute to exercise limitation in these patients, including diastolic dysfunction, dynamic obstruction of the left ventricular outflow tract (LVOT) and left ventricular (LV) systolic dysfunction (in end-stage disease) (3,4). More recently, chronotropic incompetence has also been proposed as a potential cause of exercise intolerance in patients with HCM (5).…”

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confidence: 99%

Cardiopulmonary Responses and Prognosis in Hypertrophic Cardiomyopathy

Finocchiaro

Haddad

Knowles

et al. 2015

JACC: Heart Failure

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“…This supports previous studies, (115,259) importantly glycaemic neuropathy may result in decreased cardiorespiratory fitness through chronotropic incompetence, a restriction in the ability to raise heart rate during exercise. (359) However, this study found no association between chronotropic measures and the global measure of HRV, SDNN. This may indicate that autonomic dysfunction is influencing cardiorespiratory fitness through mechanisms other than chronotropic incompetence.…”

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confidence: 68%

Exercise and lifestyle intervention and high intensity interval training in patients with chronic kidney disease

Beetham¹

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Chronic kidney disease (CKD) patients have a shorter life expectancy than healthy individuals, from the premature development of cardiovascular disease due to traditional and non-traditional risk factors. It is therefore pertinent that management of CKD be aimed at modifying these cardiovascular disease risk factors. Exercise therapy, in particular aerobic exercise, in the end stage kidney disease population has been shown to decrease cardiovascular disease risk factors and subsequent cardiovascular disease. However, Section 2 contains the second trial that investigated the feasibility and efficacy of a 12 week HIIT program in CKD patients. Recruitment for the HIIT study was through participants who had completed the LM3 study.Chapter 1 provides an introduction to the studies, including the aims of the thesis. Topics reviewed include; pathophysiology of CKD, exercise capacity, autonomic dysfunction, haemoglobin, muscle atrophy, oxidative stress, inflammation, blood lipids and HIIT. Section 1 starts with the detailed methods of the LM3 study (Chapter 2). Further methods applicable to specific studies are reported in the relevant chapter.Chapter 3 investigates the determinants of reduced muscle strength at baseline through a cross-sectional analysis of the LM3 study. This study identified the association of oxidative 3 stress with low muscle strength and reduced lean mass. The relationship was independent of known influences on muscle mass and strength.The feasibility and determinants of the LI group participating in higher intensity exercise training in the first 12 months of the LM3 study was investigated in Chapter 4. The findings identified that higher intensity exercise training was indeed feasible in the CKD cohort, with the number of participants reporting higher intensity exercise increasing from 20% to 43%.Reported higher intensity exercise during the LI was also associated with the greatest exercise capacity at 12 months. Furthermore, the analysis identified haemoglobin to be the greatest predictor of individuals reporting higher intensity exercise.Chapter 5 investigates the agreement between creatinine and cystatin-C estimated glomerular filtration rate (eGFR) measurements in patients completing 12 months of the LM3 study. This chapter explores whether discrepancies in the CKD Epidemiology Collaboration (CKD-EPI)cystatin-C, CKD-EPIcreatinine and modification of diet in renal disease (MDRD) eGFR equations occur after an exercise intervention. It was identified that cystatin-C based eGFR measurements were considerably lower than creatinine based eGFR measurements. Despite this discrepancy at baseline, the agreement between the different GFR estimates did not change after exercise training.Chapter 6 contains the main study from LM3, which investigates the changes in cardiorespiratory fitness, exercise capacity, functional capacity, blood biochemistry, anthropometry measures and other cardiovascular disease risk factors after 3 years of LI compared to the control group. The primary finding from this...

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Chronotropic incompetence and its relation to exercise intolerance in hypertrophic cardiomyopathy

Cited by 47 publications

References 44 publications

Safety profile and utility of treadmill exercise in patients with high-gradient hypertrophic cardiomyopathy

Safety profile and utility of treadmill exercise in patients with high-gradient hypertrophic cardiomyopathy

Cardiopulmonary Responses and Prognosis in Hypertrophic Cardiomyopathy

Exercise and lifestyle intervention and high intensity interval training in patients with chronic kidney disease

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