Prevalence and functional impact of chronotropic incompetence in amyloid cardiomyopathy: a multicentre analysis
Damiano Magrì1,2, Nikita Ermolaev3, Robin Willixhofer3
1Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.
Insights
Chronotropic incompetence (CI) is common in amyloid cardiomyopathy and linked to reduced exercise capacity. A peak heart rate percentage (pHR%) of 75% or less may identify significant exercise impairment, even without cardiopulmonary exercise testing (CPET).
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Limited data exists on heart rate (HR) response during exercise and its link to functional capacity in amyloid cardiomyopathy.
- Amyloid cardiomyopathy can affect cardiac function and exercise tolerance.
Purpose of the Study:
- To determine the prevalence of chronotropic incompetence (CI) in patients with amyloid cardiomyopathy.
- To investigate the relationship between CI and cardiopulmonary exercise testing (CPET) variables.
Main Methods:
- Analysis of data from 172 outpatients with amyloid cardiomyopathy who underwent maximal CPET.
- Exclusion of patients with significant rhythm disorders.
Main Results:
- The prevalence of CI varied from 16% to 59% based on the age-predicted peak HR (pHR%) cut-off used.
- pHR% showed a non-linear correlation with peak oxygen uptake (pVO2) and an inverse correlation with ventilatory efficiency.
- A pHR% cut-off of ≤75% accurately identified moderate-to-severe exercise impairment (72% sensitivity, 73% specificity).
Conclusions:
- CI is prevalent in amyloid cardiomyopathy patients in sinus rhythm, with prevalence dependent on the pHR% cut-off.
- A blunted exercise-induced HR response correlates with poor exercise capacity in this population.
- A pHR% ≤75% may help identify significant exercise impairment in settings lacking CPET.
Background:
Little evidence is available about heart rate (HR) response to exercise as well as its relationship with functional capacity in amyloid cardiomyopathy. Then, in a multicentre cohort of patients with amyloid cardiomyopathy, we investigated the prevalence of chronotropic incompetence (CI) and its relationships with cardiopulmonary exercise testing (CPET) variables.
Methods:
Data from 172 outpatients with amyloid cardiomyopathy who performed a maximal CPET and who had no significant rhythm disorders were analysed.
Results:
The prevalence of CI differed depending on the age-predicted peak HR (pHR%) cut-off value adopted, ranging from 16% to 59%. pHR% correlated non-linearly with peak oxygen uptake (pVO2), either as expressed as a percentage of the maximum predicted or as mL/kg/min (p<0.001). Although to a lesser extent, pHR% correlated inversely with ventilatory efficiency (p<0.001). A pHR%≤75% resulted in the most accurate cut-off value in identifying a moderate-to-severe exercise impairment (sensitivity 72%; specificity 73%; area under the curve 77.2%).
Conclusions:
CI is prevalent in patients with amyloid cardiomyopathy in sinus rhythm, its percentage varying according to the pHR% cut-off value. A blunted exercise-induced HR response correlated with a poor exercise capacity even in this setting of patients, a pHR%≤75% cut-off value being possibly useful in centres without CPET availability to identify a significant exercise impairment.
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