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Clinical and echocardiographic parameters associated with low chronotropic index in non-elderly patients

Paulo Fernando Carvalho Secundo1, Bruno Fernandes de Oliveira Santos, José Alves Secundo Júnior

  • 1Universidade Federal de Sergipe, São Cristovão, Brazil.

Arquivos Brasileiros De Cardiologia
|April 7, 2012
PubMed

Insights

Chronotropic incompetence (CI) in non-elderly patients is linked to heart failure (HF) symptoms like dyspnea and chest pain, and increased left ventricular mass. CI does not predict myocardial ischemia.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Diagnostic Imaging

Background:

  • Chronotropic incompetence (CI) is underdiagnosed despite its association with increased morbidity and mortality.
  • Current cardiac evaluation protocols do not routinely incorporate CI as a defined diagnosis.
  • The clinical significance of CI remains underestimated in cardiovascular assessments.

Purpose of the Study:

  • To identify clinical and echocardiographic predictors of heart failure (HF) in non-elderly patients undergoing stress echocardiography (SE).
  • To investigate the association between chronotropic incompetence and heart failure in a cohort of younger adults.
  • To analyze the relationship between functional and structural cardiac parameters and HF in the context of chronotropic response during SE.

Main Methods:

  • Retrospective analysis of 1,798 non-elderly patients (mean age 48.4 ± 7.5 years) who underwent SE.
  • Patients were categorized as chronotropic incompetent (CI, chronotropic index < 0.8) or competent.
  • Multivariate logistic regression was used to identify independent predictors of HF.

Main Results:

  • 15% of patients (270) exhibited chronotropic incompetence (CI).
  • Independent predictors of HF included dyspnea (OR 4.27), prior chest pain (OR 1.51), higher left ventricular mass index (LVMI) (OR 1.16), lower metabolic equivalents (METs) (OR 0.70), ST depression (OR 0.58), and reduced systolic blood pressure increase (OR 0.87).
  • Myocardial ischemia was not significantly associated with HF in this cohort.

Conclusions:

  • Heart failure (HF) in non-elderly patients is associated with functional parameters like dyspnea, chest pain history, and reduced exercise capacity (METs).
  • Increased left ventricular mass is a key structural correlate of HF in this population.
  • Chronotropic incompetence (CI) itself does not appear to elevate the risk of myocardial ischemia in non-elderly individuals.
Abstract

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