What about chronotropic incompetence in heart failure with mildly reduced ejection fraction? Clinical and prognostic implications from the Metabolic Exercise combined with Cardiac and Kidney Indexes score dataset
Key result
Lower peak exercise heart rate percentage linked to ~3% higher CV death risk in HFmrEF.
- HR 0.97
- 95% CI 0.95-0.99
- P<0.05
- n=864
Why the study?
Chronotropic incompetence is a strong predictor of outcome in HFrEF, but no data on its clinical and prognostic impacts in HFmrEF were available.
Does chronotropic incompetence predict cardiovascular death in stable outpatients with heart failure with mildly reduced ejection fraction?
Population
864 stable HFmrEF outpatients who performed a maximal CPET without significant rhythm disorders or comorbidities
Comparison
Patients with chronotropic incompetence vs without chronotropic incompetence
Design
Multicentre cohort study from the MECKI database
Authors
Discussion
Loading...
Member takes
Implication
Chronotropic incompetence, measured during cardiopulmonary exercise testing, is a significant predictor of cardiovascular death in patients with heart failure with mildly reduced ejection fraction.
Key Points
- To assess the prevalence of chronotropic incompetence and determine its prognostic impact on cardiovascular death in patients with heart failure with mildly reduced ejection fraction.
- Analyzed data from N=864 stable outpatients with heart failure with mildly reduced ejection fraction from the multicenter MECKI database who underwent maximal cardiopulmonary exercise testing on a cycle ergometer.
- Evaluated chronotropic incompetence using peak heart rate percentage (pHR%) and peak heart rate reserve percentage (pHRR%) against the primary endpoint of cardiovascular death.
- Chronotropic incompetence prevalence ranged from 11% to 62% across the cohort depending on the definition and cutoff criteria applied.
- Over follow-up, 84 cardiovascular deaths (9.7%) occurred (39 within 5 years), with both pHR% (HR 0.97, 95% CI 0.95–0.99, P < 0.05) and pHRR% (HR 0.977, 95% CI 0.961–0.993, P < 0.01) independently predicting risk at optimal cutoffs of ≤75% and ≤50%, respectively.
Study Design
Type
Cohort (n=864)
Multicenter
Yes
Structured PICO
Does chronotropic incompetence predict cardiovascular death in stable outpatients with heart failure with mildly reduced ejection fraction?
P
Population
864 stable outpatients with heart failure with mildly reduced ejection fraction (HFmrEF) who performed a maximal cardiopulmonary exercise testing (CPET) at the cycle ergometer, excluding those with significant rhythm disorders or comorbidities.
I
Intervention
Chronotropic incompetence (assessed via peak heart rate percentage or peak heart rate reserve percentage during CPET)
C
Comparator
Normal chronotropic response (absence of chronotropic incompetence)
O
Outcome
Cardiovascular (CV) deathhard clinical
Main Result
Effect estimate: HR 0.97 (95% CI 0.95-0.99)
p-value: p=<0.05
Chronotropic incompetence, measured during cardiopulmonary exercise testing, is a significant predictor of cardiovascular death in patients with heart failure with mildly reduced ejection fraction.
Limitations
- Needs to be addressed in larger prospective studies
Cite This Study
Magrì et al. (2023) conducted a cohort in Heart failure with mildly reduced ejection fraction (HFmrEF) (n=864). Chronotropic incompetence (assessed by peak heart rate percentage and reserve) was evaluated on Cardiovascular (CV) death (HR 0.97, 95% CI 0.95-0.99, p=<0.05). Lower peak heart rate percentage during exercise was significantly associated with an increased risk of cardiovascular death in patients with HFmrEF (HR 0.97; 95% CI 0.95-0.99; P<0.05).