Resting heart rate and heart rate reserve in advanced heart failure have distinct pathophysiologic correlates and prognostic impact

A prospective pilot study

Jan Benes, Martin Kotrc, Barry A Borlaug, Katerina Lefflerova, Petr Jarolim, Bela Bendlova, Antonin Jabor, Josef Kautzner, Vojtech Melenovsky

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objectives: The purpose of this study was to compare the prognostic impact of clinical and biomarker correlates of resting heart rate (HR) and chronotropic incompetence in heart failure (HF) patients. Background: The mechanisms and underlying pathophysiological influences of HR abnormalities in HF are incompletely understood. Methods: In a prospective pilot study, 81 patients with advanced systolic HF (97% were receiving beta-blockers) and 25 age-, sex-, and body-size matched healthy controls underwent maximal cardiopulmonary exercise testing with sampling of neurohormones and biomarkers. Results: Two-thirds of HF patients met criteria for chronotropic incompetence. Resting HR and HR reserve (HRR, a measure of chronotropic response) were not correlated with each other and were associated with distinct biomarker profiles. Resting HR correlated with increased myocardial stress (B-type natriuretic peptide [BNP]: r = 0.26; pro-A-type natriuretic peptide: r = 0.24; N-terminal-proBNP: r = 0.32) and inflammation (leukocyte count: r = 0.28; high-sensitivity C-reactive protein assay: r = 0.25). In contrast, HRR correlated with the neurohumoral response to HF (copeptin: r = -0.33; norepinephrine: r = -0.29) but not with myocyte stress or injury reflected by natriuretic peptides or hs-troponin I. Patients in the lowest chronotropic incompetence quartile (HRR ≤0.38) displayed more advanced HF, reduced exercise capacity, ventilatory inefficiency, and poorer quality of life. Over a median follow-up of 17 months, the combined endpoint of death or urgent transplant/assist device implantation occurred more frequently in patients with higher resting HR (>67 beats/min) or lower HRR, with both markers providing additive prognostic information. Conclusions: Increased resting HR and chronotropic incompetence may reflect different pathophysiological processes, provide incremental prognostic information, and represent distinct therapeutic targets.

Original languageEnglish (US)
Pages (from-to)259-266
Number of pages8
JournalJACC: Heart Failure
Volume1
Issue number3
DOIs
StatePublished - Jun 2013

Fingerprint

Heart Failure
Heart Rate
Prospective Studies
Natriuretic Peptides
Biomarkers
Exercise
Systolic Heart Failure
Troponin I
Congenital Heart Defects
Brain Natriuretic Peptide
Body Size
Leukocyte Count
C-Reactive Protein
Muscle Cells
Neurotransmitter Agents
Norepinephrine
Quality of Life
Inflammation
Transplants
Equipment and Supplies

Keywords

  • Biomarkers
  • Chronotropic incompetence
  • CI
  • Exercise
  • Heart failure
  • Heart rate
  • HF
  • HR
  • HRR
  • LV
  • MLHFQ
  • NYHA
  • RV
  • VCo
  • VE
  • Vo

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Resting heart rate and heart rate reserve in advanced heart failure have distinct pathophysiologic correlates and prognostic impact : A prospective pilot study. / Benes, Jan; Kotrc, Martin; Borlaug, Barry A; Lefflerova, Katerina; Jarolim, Petr; Bendlova, Bela; Jabor, Antonin; Kautzner, Josef; Melenovsky, Vojtech.

In: JACC: Heart Failure, Vol. 1, No. 3, 06.2013, p. 259-266.

Research output: Contribution to journalArticle

Benes, Jan ; Kotrc, Martin ; Borlaug, Barry A ; Lefflerova, Katerina ; Jarolim, Petr ; Bendlova, Bela ; Jabor, Antonin ; Kautzner, Josef ; Melenovsky, Vojtech. / Resting heart rate and heart rate reserve in advanced heart failure have distinct pathophysiologic correlates and prognostic impact : A prospective pilot study. In: JACC: Heart Failure. 2013 ; Vol. 1, No. 3. pp. 259-266.
@article{9f882e4682b44e88b6044b8c2c49ee53,
title = "Resting heart rate and heart rate reserve in advanced heart failure have distinct pathophysiologic correlates and prognostic impact: A prospective pilot study",
abstract = "Objectives: The purpose of this study was to compare the prognostic impact of clinical and biomarker correlates of resting heart rate (HR) and chronotropic incompetence in heart failure (HF) patients. Background: The mechanisms and underlying pathophysiological influences of HR abnormalities in HF are incompletely understood. Methods: In a prospective pilot study, 81 patients with advanced systolic HF (97{\%} were receiving beta-blockers) and 25 age-, sex-, and body-size matched healthy controls underwent maximal cardiopulmonary exercise testing with sampling of neurohormones and biomarkers. Results: Two-thirds of HF patients met criteria for chronotropic incompetence. Resting HR and HR reserve (HRR, a measure of chronotropic response) were not correlated with each other and were associated with distinct biomarker profiles. Resting HR correlated with increased myocardial stress (B-type natriuretic peptide [BNP]: r = 0.26; pro-A-type natriuretic peptide: r = 0.24; N-terminal-proBNP: r = 0.32) and inflammation (leukocyte count: r = 0.28; high-sensitivity C-reactive protein assay: r = 0.25). In contrast, HRR correlated with the neurohumoral response to HF (copeptin: r = -0.33; norepinephrine: r = -0.29) but not with myocyte stress or injury reflected by natriuretic peptides or hs-troponin I. Patients in the lowest chronotropic incompetence quartile (HRR ≤0.38) displayed more advanced HF, reduced exercise capacity, ventilatory inefficiency, and poorer quality of life. Over a median follow-up of 17 months, the combined endpoint of death or urgent transplant/assist device implantation occurred more frequently in patients with higher resting HR (>67 beats/min) or lower HRR, with both markers providing additive prognostic information. Conclusions: Increased resting HR and chronotropic incompetence may reflect different pathophysiological processes, provide incremental prognostic information, and represent distinct therapeutic targets.",
keywords = "Biomarkers, Chronotropic incompetence, CI, Exercise, Heart failure, Heart rate, HF, HR, HRR, LV, MLHFQ, NYHA, RV, VCo, VE, Vo",
author = "Jan Benes and Martin Kotrc and Borlaug, {Barry A} and Katerina Lefflerova and Petr Jarolim and Bela Bendlova and Antonin Jabor and Josef Kautzner and Vojtech Melenovsky",
year = "2013",
month = "6",
doi = "10.1016/j.jchf.2013.03.008",
language = "English (US)",
volume = "1",
pages = "259--266",
journal = "JACC: Heart Failure",
issn = "2213-1779",
publisher = "Elsevier BV",
number = "3",

}

TY - JOUR

T1 - Resting heart rate and heart rate reserve in advanced heart failure have distinct pathophysiologic correlates and prognostic impact

T2 - A prospective pilot study

AU - Benes, Jan

AU - Kotrc, Martin

AU - Borlaug, Barry A

AU - Lefflerova, Katerina

AU - Jarolim, Petr

AU - Bendlova, Bela

AU - Jabor, Antonin

AU - Kautzner, Josef

AU - Melenovsky, Vojtech

PY - 2013/6

Y1 - 2013/6

N2 - Objectives: The purpose of this study was to compare the prognostic impact of clinical and biomarker correlates of resting heart rate (HR) and chronotropic incompetence in heart failure (HF) patients. Background: The mechanisms and underlying pathophysiological influences of HR abnormalities in HF are incompletely understood. Methods: In a prospective pilot study, 81 patients with advanced systolic HF (97% were receiving beta-blockers) and 25 age-, sex-, and body-size matched healthy controls underwent maximal cardiopulmonary exercise testing with sampling of neurohormones and biomarkers. Results: Two-thirds of HF patients met criteria for chronotropic incompetence. Resting HR and HR reserve (HRR, a measure of chronotropic response) were not correlated with each other and were associated with distinct biomarker profiles. Resting HR correlated with increased myocardial stress (B-type natriuretic peptide [BNP]: r = 0.26; pro-A-type natriuretic peptide: r = 0.24; N-terminal-proBNP: r = 0.32) and inflammation (leukocyte count: r = 0.28; high-sensitivity C-reactive protein assay: r = 0.25). In contrast, HRR correlated with the neurohumoral response to HF (copeptin: r = -0.33; norepinephrine: r = -0.29) but not with myocyte stress or injury reflected by natriuretic peptides or hs-troponin I. Patients in the lowest chronotropic incompetence quartile (HRR ≤0.38) displayed more advanced HF, reduced exercise capacity, ventilatory inefficiency, and poorer quality of life. Over a median follow-up of 17 months, the combined endpoint of death or urgent transplant/assist device implantation occurred more frequently in patients with higher resting HR (>67 beats/min) or lower HRR, with both markers providing additive prognostic information. Conclusions: Increased resting HR and chronotropic incompetence may reflect different pathophysiological processes, provide incremental prognostic information, and represent distinct therapeutic targets.

AB - Objectives: The purpose of this study was to compare the prognostic impact of clinical and biomarker correlates of resting heart rate (HR) and chronotropic incompetence in heart failure (HF) patients. Background: The mechanisms and underlying pathophysiological influences of HR abnormalities in HF are incompletely understood. Methods: In a prospective pilot study, 81 patients with advanced systolic HF (97% were receiving beta-blockers) and 25 age-, sex-, and body-size matched healthy controls underwent maximal cardiopulmonary exercise testing with sampling of neurohormones and biomarkers. Results: Two-thirds of HF patients met criteria for chronotropic incompetence. Resting HR and HR reserve (HRR, a measure of chronotropic response) were not correlated with each other and were associated with distinct biomarker profiles. Resting HR correlated with increased myocardial stress (B-type natriuretic peptide [BNP]: r = 0.26; pro-A-type natriuretic peptide: r = 0.24; N-terminal-proBNP: r = 0.32) and inflammation (leukocyte count: r = 0.28; high-sensitivity C-reactive protein assay: r = 0.25). In contrast, HRR correlated with the neurohumoral response to HF (copeptin: r = -0.33; norepinephrine: r = -0.29) but not with myocyte stress or injury reflected by natriuretic peptides or hs-troponin I. Patients in the lowest chronotropic incompetence quartile (HRR ≤0.38) displayed more advanced HF, reduced exercise capacity, ventilatory inefficiency, and poorer quality of life. Over a median follow-up of 17 months, the combined endpoint of death or urgent transplant/assist device implantation occurred more frequently in patients with higher resting HR (>67 beats/min) or lower HRR, with both markers providing additive prognostic information. Conclusions: Increased resting HR and chronotropic incompetence may reflect different pathophysiological processes, provide incremental prognostic information, and represent distinct therapeutic targets.

KW - Biomarkers

KW - Chronotropic incompetence

KW - CI

KW - Exercise

KW - Heart failure

KW - Heart rate

KW - HF

KW - HR

KW - HRR

KW - LV

KW - MLHFQ

KW - NYHA

KW - RV

KW - VCo

KW - VE

KW - Vo

UR - http://www.scopus.com/inward/record.url?scp=84878643747&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878643747&partnerID=8YFLogxK

U2 - 10.1016/j.jchf.2013.03.008

DO - 10.1016/j.jchf.2013.03.008

M3 - Article

VL - 1

SP - 259

EP - 266

JO - JACC: Heart Failure

JF - JACC: Heart Failure

SN - 2213-1779

IS - 3

ER -