Sinus tachycardia is associated with impaired exercise tolerance following heart transplantation

Peled, Yael; Varnado, Sara; Lowes, Brian D.; Zolty, Ronald; Lyden, Elizabeth; Moulton, Michael J.; Um, J.; Raichlin, Eugenia

doi:10.1111/ctr.12946

Cited by 5 publications

(16 citation statements)

References 61 publications

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“…Some studies suggest alcohol increases donor heart susceptibility to this type of injury . Additionally, direct alcoholic toxicity to the intracardiac conduction system may mediate a negative chronotropic effect . While animal models suggest the potential for fast recovery from alcohol‐related ischemia‐reperfusion injury, in our study AD recipients were more likely to have a slower HR than NAD patients up to one year following HTx, suggesting prolonged damage.…”

Section: Discussionmentioning

confidence: 58%

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The effect of donor alcohol abuse on outcomes following heart transplantation

Newman

Liebo

Lowes

et al. 2019

Clinical Transplantation

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Background: Current guidelines recommend against the use of hearts from donors that abuse alcohol. We explored the effect of donor alcohol abuse (AA) on cardiac allograft function and outcomes in heart transplant (HTx) recipients. Methods:Overall, 370 HTx recipients were divided into two groups: (a) the alcoholic donor group (AD, n = 58) and (b) the non-alcoholic donor group (NAD, n = 312). Results:Recipients in the AD group had a slower heart rate (86 ± 13 vs 93 ± 13, P = 0.004) and an increased incidence of early atrial fibrillation (AF) (30% vs 11%, P = 0.003). Echocardiographic left ventricular mass was higher among alcoholic donors (171.7 ± 66.7 vs 151.6 ± 54.7, P = 0.02). This difference remained present 1 year following HTx (185 ± 43 vs 166 ± 42, P = 0.007). E/E′ was higher in the AD group (9.5 ± 3.9 vs 8.4 ± 2.9, P = 0.04) and a larger number of AD recipients had a ventilatory equivalent for VCO 2 > 34 (50% vs 31%, P = 0.04) on cardiopulmonary exercise test. There was no significant difference in rejection, cardiac allograft vasculopathy (CAV), or survival between the groups. Conclusions:Our data suggest that donor AA does not impact rejection, CAV, or intermediate-term survival, but may cause increased incidence of post-HTx AF and impaired cardiac allograft diastolic function. K E Y W O R D Satrial fibrillation, diastolic dysfunction, donor characteristics, heart transplantation

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Section: Discussionmentioning

confidence: 58%

“…Resting heart rate (HR) was determined by ECGs performed during routine outpatient follow‐up at 1, 3, and 12 months following HTx. Based on the results of our previous study, a cutoff of ≥95 beats per minute (bpm) was selected as an elevated HR.…”

Section: Methodsmentioning

confidence: 99%

The effect of donor alcohol abuse on outcomes following heart transplantation

Newman

Liebo

Lowes

et al. 2019

Clinical Transplantation

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“…12 exercise capacity has not been well established. 13,14 Previous data 11 and our recent study 33 suggest that ST may be a primary contributor to post-HTx exercise intolerance and therefore slowing HR can improve exercise capacity and quality of life in HTx recipients.…”

Section: Discussionmentioning

confidence: 89%

“…Our previous studies 13, 33 and Vigneswaran et al 42 demonstrated that post-HTx sinus tachycardia can lead to shortening diastolic filling time resulting in decrease in SV 13,42 and CI. Similar to these findings, in the present study echocardiographic markers of cardiac allograft systolic function, LVEF, and SV, significantly raised compared to baseline in the diltiazem treated patients, and there was a trend toward its increase in the diltiazem group compared to controls at 1-year follow-up.…”

Section: T a B L E 3 (Continued)mentioning

confidence: 92%

Effect of diltiazem on exercise capacity after heart transplantation

Varnado

Peled-Potashnik

Huntsberry

et al. 2017

Clinical Transplantation

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“…Especially in the first year after HTx, patients suffer from chronic tachycardia, with resting heart rates (HRs) elevated to greater than 90 beats/min (bpm) and significantly reduced HR variability (HRV) (Awad et al, 2016;Kobashigawa and Olymbios, 2017). Furthermore, on top of raised HR recovery times, HTx recipients (HTxRs) show delayed and impeded exercise response (Awad et al, 2016;Kobashigawa and Olymbios, 2017), reaching peak HRs as low as only 133 bpm (McLaughlin et al, 1978;Crisafulli et al, 1985;Kavanagh et al, 1988;Labovitz et al, 1989;Wilson et al, 1991;Marzo et al, 1992;Rudas et al, 1993;Kao et al, 1994;Doering et al, 1996;Geny et al, 1996;Notarius et al, 1998;Hayman et al, 2010;Peled et al, 2017;Nygaard et al, 2019;Nytrøen et al, 2019). According to literature, elevated resting HRs are most certainly a result of the absence of vagal tone, rendering the heart to rely on intrinsic control only, whereas delayed and impeded exercise response is most likely due to lack of vagal withdrawal and missing sympathetic drive (Awad et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Changes in Resting and Exercise Hemodynamics Early After Heart Transplantation: A Simulation Perspective

2020

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Introduction: During heart transplantation (HTx), cardiac denervation is inevitable, thus typically resulting in chronic resting tachycardia and chronotropic incompetence with possible consequences in patient quality of life and clinical outcomes. To this date, knowledge of hemodynamic changes early after HTx is still incomplete. This study aims at providing a model-based description of the complex hemodynamic changes at rest and during exercise in HTx recipients (HTxRs). Materials and Methods: A numerical model of early HTxRs is developed that integrates intrinsic and autonomic heart rate (HR) control into a lumped-parameter cardiovascular system model. Intrinsic HR control is realized by a single-cell sinoatrial (SA) node model. Autonomic HR control is governed by aortic baroreflex and pulmonary stretch reflex and modulates SA node activity through neurotransmitter release. The model is tuned based on published clinical data of 15 studies. Simulations of rest and exercise are performed to study hemodynamic changes associated with HTxRs. Results: Simulations of HTxRs at rest predict a substantially increased HR [93.8 vs. 69.5 beats/min (bpm)] due to vagal denervation while maintaining normal cardiac output (CO) (5.2 vs. 5.6 L/min) through a reduction in stroke volume (SV) (55.4 vs. 82 mL). Simulations of exercise predict markedly reduced peak CO (13 vs. 19.8 L/min) primarily resulting from diminished peak HRs (133.9 vs. 169 bpm) and reduced ventricular contractility. Yet, the model results show that HTxRs can maintain normal CO for low-to medium-intensity exercise by increased SV augmentation through the Frank-Starling mechanism. Conclusion: Relevant hemodynamic changes occur after HTx. Simulations suggest that (1) increased resting HRs solely result from the absence of vagal tone; (2) chronotropic incompetence is the main limiting factor of exercise capacity whereby peripheral factors play a secondary role; and (3) despite the diminished exercise capacity, HTxRs can compensate chronotropic incompetence by a preload-mediated increase in SV augmentation and thus maintain normal CO in low-to mediumintensity exercise.

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Sinus tachycardia is associated with impaired exercise tolerance following heart transplantation

Abstract: HR≥95 at 3 months following HTx is associated with reduced exercise tolerance in stable HTx recipients. Medical HR reduction after HTx could improve exercise performance after HTx and merits further investigation.

Cited by 5 publications

References 61 publications

The effect of donor alcohol abuse on outcomes following heart transplantation

The effect of donor alcohol abuse on outcomes following heart transplantation

Effect of diltiazem on exercise capacity after heart transplantation

Changes in Resting and Exercise Hemodynamics Early After Heart Transplantation: A Simulation Perspective

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