Systolic Blood Pressure Response to Exercise as a Predictor of Mortality in Patients With Chronic Heart Failure

Abstract

SummaryIt is well known that peak oxygen consumption and heart rate (HR) recovery after exercise obtained from the cardiopulmonary exercise test are prognostic parameters in patients with chronic heart failure (CHF). However, it is unclear whether exercise-induced parameters obtained from the routine exercise stress test predict mortality in patients with CHF.We studied 136 patients (93 males/43 females) with CHF. All patients underwent symptom-limited exercise stress testing. Exercise parameters included exercise duration, exercise-induced HR and systolic blood pressure (SBP), and metabolic equivalents (METs).During the follow-up period (mean 6.2 years), 34 patients died. Survival rates at the 3rd and 5th years were 90% and 83%, respectively. Body mass index was significantly smaller in the nonsurvival group than in the survival group (P < 0.01). The incidence of patients with New York Heart Association III class was higher in the nonsurvival group than in the survival group (P < 0.05). In univariate analysis, predictors of mortality included peak HR and SBP, increases in HR and SBP during exercise, HR and SBP at the 1st minute after exercise, HR at the 3rd minute after exercise, and METs. The use of β-adrenergic blocking agents was not associated with prognosis. In Cox hazard model analysis, the increase in SBP (P < 0.002), HR at the 3rd minute after exercise (P < 0.05), and METs (P < 0.05) were independent predictors of mortality.SBP response to exercise, HR recovery after exercise, and METs obtained from the routine exercise test predicted mortality in patients with CHF irrespective of the use of β-adrenergic blocking agents. (Int Heart J 2010; 51: 111-115)

Relação entre imagem adrenérgica cardíaca e teste ergométrico na insuficiência cardíaca

“…During ET, in patients with altered washout rate (state of adrenergic hypertonia at rest), we found that SBP at peak exercise and the number of METs showed lower values when compared The variation in SBP during exercise is directly associatedwith cardiac output during exercise: a lower increase in intrastress SBP may result from inotropic deficit during the exercise, which is a common phenomenon in patients with ventricular dysfunction, and this finding is associated with a worse prognosis 2 . Fargard et al 22 in a sample of patients eligible for heart transplantation, demonstrated that an inadequate variation in SBP in response to submaximal exercise is a predictor of cardiac events.…”

“…Some of the parameters used in ET are the behavior of systolic blood pressure (SBP) intrastress and chronotropic reserve, which are recognized predictors of prognosis [2][3][4] . The adrenergic hyperactivity, a characteristic of HF, may lead to chronotropic incompetence, decrease in cardiac contractile response to catecholamines and decreased sympathetic reserve during exercise.…”

“…The adrenergic hyperactivity, a characteristic of HF, may lead to chronotropic incompetence, decrease in cardiac contractile response to catecholamines and decreased sympathetic reserve during exercise. An inadequate response in SBP and heart rate (HR) has been associated with a twofold risk of mortality and adverse cardiovascular events 2,[5][6][7] .…”

“…Both for the population 8 , and in the population with HF 2,9 , functional capacity is an important predictor of prognosis and is not related to measures of ventricular function at rest nor with left ventricular ejection fraction 10 .…”

Response to Fluid Boluses in the Fluid and Catheter Treatment Trial

“…As most of these patients received fl uids prior to study enrollment, we hypothesized that rates of fl uid responsiveness would be , 25% and that additional fl uid administration would not lead to durable improvements in hemodynamic parameters. Since the ability to increase cardiac output aft er a fl uid bolus might indicate a more adaptable cardiovascular system, and cardiovascular adaptability has been linked to improved outcomes in other conditions, [11][12][13] we also hypothesized that clinical outcomes would be better in patients who were fl uid responsive.…”