Effect of carvedilol on heart rate response to cardiopulmonary exercise up to the anaerobic threshold in patients with subacute myocardial infarction

Nemoto, Shinji; Kasahara, Yusuke; Izawa, Kazuhiro P.; Watanabe, Satoshi; Yoshizawa, Kazuya; Takeichi, Naoya; Kamiya, Kentaro; Suzuki, Norio; Omiya, Kazuto; Matsunaga, Atsuhiko; Akashi, Yoshihiro J.

doi:10.1007/s00380-018-01326-5

Cited by 3 publications

(6 citation statements)

References 26 publications

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“…The effect of beta-blocker type on this simplified method of exercise prescription, therefore, remains unclear. Our previous study [31] examined the effect of αβ-blocker treatment on HR response during incremental exercise in subacute MI patients, because αβ-blockers are frequently prescribed for MI patients due to their effectiveness [9]. αβ-blocker treatment was found to have no effect on HR response to exercise up to the AT in subacute MI patients [31], suggesting that exercise intensity can be prescribed using the simplified method (i.e., resting HR plus 30 bpm) in subacute MI patients regardless of αβ-blocker use.…”

Section: Discussionmentioning

confidence: 99%

“…Our previous study [31] examined the effect of αβ-blocker treatment on HR response during incremental exercise in subacute MI patients, because αβ-blockers are frequently prescribed for MI patients due to their effectiveness [9]. αβ-blocker treatment was found to have no effect on HR response to exercise up to the AT in subacute MI patients [31], suggesting that exercise intensity can be prescribed using the simplified method (i.e., resting HR plus 30 bpm) in subacute MI patients regardless of αβ-blocker use. Although β1-blockers are also frequently used in MI patients [10,11], the effect of β1-blockers on HR response during incremental exercise in subacute MI patients remains unclear.…”

Section: Discussionmentioning

confidence: 99%

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Effects of αβ-Blocker Versus β1-Blocker Treatment on Heart Rate Response During Incremental Cardiopulmonary Exercise in Japanese Male Patients with Subacute Myocardial Infarction

Nemoto

Kasahara

Izawa

et al. 2019

IJERPH

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A simplified substitute for heart rate (HR) at the anaerobic threshold (AT), i.e., resting HR plus 30 beats per minute or a percentage of predicted maximum HR, is used as a way to determine exercise intensity without cardiopulmonary exercise testing (CPX) data. However, difficulties arise when using this method in subacute myocardial infarction (MI) patients undergoing beta-blocker therapy. This study compared the effects of αβ-blocker and β1-blocker treatment to clarify how different beta blockers affect HR response during incremental exercise. MI patients were divided into αβ-blocker (n = 67), β1-blocker (n = 17), and no-β-blocker (n = 47) groups. All patients underwent CPX one month after MI onset. The metabolic chronotropic relationship (MCR) was calculated as an indicator of HR response from the ratio of estimated HR to measured HR at AT (MCR-AT) and peak exercise (MCR-peak). MCR-AT and MCR-peak were significantly higher in the αβ-blocker group than in the β1-blocker group (p < 0.001, respectively). Multiple regression analysis revealed that β1-blocker but not αβ-blocker treatment significantly predicted lower MCR-AT and MCR-peak (β = −0.432, p < 0.001; β = −0.473, p < 0.001, respectively). Based on these results, when using the simplified method, exercise intensity should be prescribed according to the type of beta blocker used.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of αβ-Blocker Versus β1-Blocker Treatment on Heart Rate Response During Incremental Cardiopulmonary Exercise in Japanese Male Patients with Subacute Myocardial Infarction

Nemoto

Kasahara

Izawa

et al. 2019

IJERPH

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“…Previous data suggest that adding ~30 bpm to resting HR is a simple way to infer HR VT1 values when a CPET was not performed ( Nemoto et al, 2019 ). Although our HRR VT1 values (31±11 bpm) were close to the suggested values, we believe that performing the 6MWT may be a more accurate form of exercise prescription.…”

Section: Discussionmentioning

confidence: 99%

Agreement between heart rate at first ventilatory threshold on treadmill and at 6-min walk test in coronary artery disease patients on β-blockers treatment

et al. 2021

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The purpose of this study was to verify the accuracy of the agreement between heart rate at the first ventilatory threshold (HRVT1) and heart rate at the end of the 6-min walk test (HR6MWT) in coronary artery disease (CAD) patients on β-blockers treatment. This was a cross-sectional study with stable CAD patients, which performed a cardiopulmonary exercise test (CPET) on a treadmill and a 6-min walk test (6MWT) on nonconsecutive days. The accuracy of agreement between HRVT1 and HR6MWT was evaluated by Bland–Altman analysis and Lin’s concordance correlation coefficient (rc), mean absolute percentage error (MAPE), and standard error of estimate (SEE). Seventeen stable CAD patients on β-blockers treatment (male, 64.7%; age, 61± 10 years) were included in data analysis. The Bland–Altman analysis revealed a negative bias of -0.41 ± 6.4 bpm (95% limits of agreements, -13 to 12.2 bpm) between HRVT1 and HR6MWT. There was acceptable agreement between HRVT1 and HR6MWT (rc = 0.84; 95% confidence interval, 0.63 to 0.93; study power analysis= 0.79). The MAPE of the HR6MWT was 5.1% and SEE was 6.6 bpm. The ratio HRVT1/HRpeak and HR6MWT/HRpeak from CPET were not significantly different (81%± 5% vs. 81%± 6%, P= 0.85); respectively. There was a high correlation between HRVT1 and HR6MWT (r= 0.85, P< 0.0001). Finally, the results of the present study demonstrate that there was an acceptable agreement between HRVT1 and HR6MWT in CAD patients on β-blockers treatment and suggest that HR6MWT may be useful to prescribe and control aerobic exercise intensity in cardiac rehabilitation programs.

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“…Although both αβ -blockers and β 1-blockers are frequently prescribed for MI patients due to their effectiveness,12–14 our previous studies suggested that only β 1-blockers strongly decrease HR response during incremental CPX in MI patients 15,16. Thus, we hypothesized that it would be possible to predict HR AT with a new formula that includes β 1-blockers as a predictor variable.…”

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confidence: 99%

“…9-11 Thus, it is necessary to establish a practical method to predict HR AT that considers the effects of β-blockers in MI patients.Although both α β-blockers and β1-blockers are frequently prescribed for MI patients due to their effectiveness, 12-14 our previous studies suggested that only β1-blockers strongly decrease HR response during incremental CPX in MI patients. 15,16 Thus, we hypothesized that it would be possible to predict HR AT with a new formula that includes β1-blockers as a predictor variable. The aim of the present study was to create a new formula to accurately predict HR AT that considers the effects of β-blockers in MI patients and to validate the accuracy of the new formula.…”

mentioning

confidence: 99%

New Formula to Predict Heart Rate at Anaerobic Threshold That Considers the Effects of β-Blockers in Patients With Myocardial Infarction

Nemoto

Kasahara

Izawa

et al. 2021

Journal of Cardiopulmonary Rehabilitation and Prevention

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It is recommended that patients with myocardial infarction (MI) be prescribed exercise by target heart rate (HR) at the anaerobic threshold (AT) via cardiopulmonary exercise testing (CPX). Although percent HR reserve using predicted HR max (%HRR pred ) is used to prescribe exercise if CPX or an exercise test cannot be performed, %HRR pred is especially difficult to use when patients take β-blockers. We devised a new formula to predict HR at AT (HR AT ) that considers β-blocker effects in MI patients and validated its accuracy. Methods: The new formula was created using the data of 196 MI patients in our hospital (derivation sample), and its accuracy was assessed using the data of 71 MI patients in other hospitals (validation sample). All patients underwent CPX 1 mo after MI onset, and resting HR, resting systolic blood pressure (SBP), and HR AT were measured during CPX. Results:The results of multiple regression analysis in the derivation sample gave the following formula (R 2 = 0.605, P < .001): predicted HR AT = 2.035 × (≥65 yr:−1, <65 yr:1) + 3.648 × (body mass index <18.5 kg/m 2 :−1, body mass index ≥18.5 kg/m 2 :1) + 4.284 × (β1-blocker(+):−1, β1-blocker(−):1) + 0.734 × (HR rest ) + 0.078 × (SBP rest ) + 36.812. This formula consists entirely of predictors that can be obtained at rest. HR AT and predicted HR AT with the new formula were not significantly different in the validation sample (mean absolute error: 5.5 ± 4.1 bpm). Conclusions: The accuracy of the new formula appeared to be favorable. This new formula may be a practical method for E xercise training is associated with reduced cardiovascular events and mortality after acute myocardial infarction (MI), and many guidelines recommend exercise training for MI patients. 1,2 It is very important to determine the optimum exercise intensity to prescribe safe and effective training. 3 Exercise prescription using target heart rate (HR) at the anaerobic threshold (AT) via cardiopulmonary exercise testing (CPX) is effective and safe for MI patients. [4][5][6] Although prescribing exercise intensity based on the AT measured by CPX is desirable, it is not yet widely available. It has been recommended to determine the target HR range by 40-70% HR reserve (HRR) using predicted maximum HR (HRR pred ) if gas-exchange analysis data or exercise test data cannot be obtained. 2,7 However, a recent study reported that 41% of patients had their AT identified outside of the 40-70% HRR pred exercise training zone. 8 In addition, HRR pred is considered difficult to use if patients are undergoing β-blocker treatment because β-blockers affect calculations by reducing HR responses at rest and during incremental exercise. 9-11 Thus, it is necessary to establish a practical method to predict HR AT that considers the effects of β-blockers in MI patients.Although both α β-blockers and β1-blockers are frequently prescribed for MI patients due to their effectiveness, 12-14 our previous studies suggested that only β1-blockers strongly decrease HR response during incremental CPX in MI ...

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Effect of carvedilol on heart rate response to cardiopulmonary exercise up to the anaerobic threshold in patients with subacute myocardial infarction

Cited by 3 publications

References 26 publications

Effects of αβ-Blocker Versus β1-Blocker Treatment on Heart Rate Response During Incremental Cardiopulmonary Exercise in Japanese Male Patients with Subacute Myocardial Infarction

Effects of αβ-Blocker Versus β1-Blocker Treatment on Heart Rate Response During Incremental Cardiopulmonary Exercise in Japanese Male Patients with Subacute Myocardial Infarction

Agreement between heart rate at first ventilatory threshold on treadmill and at 6-min walk test in coronary artery disease patients on β-blockers treatment

New Formula to Predict Heart Rate at Anaerobic Threshold That Considers the Effects of β-Blockers in Patients With Myocardial Infarction

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