Chronotropic Incompetence and Cardiovascular Outcomes in Patients With Heart Failure With Preserved Ejection...

Area of Science:

• Cardiology
• Exercise Physiology

Background:

• Chronotropic incompetence is prevalent in older adults and a contributing factor to heart failure with preserved ejection fraction (HFpEF).
• This study aimed to clarify the relationship between chronotropic incompetence and cardiovascular outcomes in HFpEF patients.

Purpose of the Study:

• To investigate the impact of chronotropic incompetence on cardiovascular outcomes in patients diagnosed with HFpEF.
• To identify predictors of adverse cardiovascular events in this patient population.

Main Methods:

• A prospective study involving 113 HFpEF patients who underwent invasive cardiopulmonary exercise testing.
• Patients were followed for a median of 22.6 months, with outcomes including hospitalization for HF and cardiovascular death.
• Cox regression analysis was used to evaluate associations between exercise hemodynamics and outcomes.

Main Results:

• 75.2% of patients exhibited chronotropic incompetence, characterized by older age and higher female prevalence.
• Chronotropic incompetence was associated with impaired exercise hemodynamics, including lower cardiac output and peak oxygen consumption, and higher pulmonary capillary wedge pressure.
• Multivariate analysis identified chronotropic incompetence (HR, 1.725) and elevated pulmonary capillary wedge pressure/cardiac output slope (HR, 1.829) as significant predictors of adverse outcomes.

Conclusions:

• Chronotropic incompetence in HFpEF is linked to elevated filling pressures, reduced exercise capacity, and impaired ventilatory efficiency.
• The presence of chronotropic incompetence is associated with increased risk of HF hospitalization and cardiovascular death.
• Recognizing chronotropic incompetence is crucial for predicting poor prognosis in patients with HFpEF.