Key result
Preoperative chronotropic incompetence was not significantly associated with myocardial injury within 3 days after noncardiac surgery (OR 1.05, 95% CI 0.74-1.50, p=0.78).
Why the study?
Heart rate increases during exercise are frequently blunted in heart failure, and it was unknown whether this chronotropic incompetence is associated with myocardial injury after noncardiac surgery.
Does chronotropic incompetence increase the risk of myocardial injury in patients undergoing noncardiac surgery?
Cohort (n=1,325)
Yes
Does chronotropic incompetence increase the risk of myocardial injury in patients undergoing noncardiac surgery?
Preoperative chronotropic incompetence is associated with subclinical heart failure but does not independently predict myocardial injury after noncardiac surgery.
Answers are grounded in this paper and cite their sources.
Does not support chronotropic incompetence for perioperative myocardial injury risk assessment; leaves open its link to longer-term mortality.
Background: Physiological measures of heart failure are common in surgical patients, despite the absence of a diagnosis. Heart rate (HR) increases during exercise are frequently blunted in heart failure (termed chronotropic incompetence), which primarily reflects beta-adrenoreceptor dysfunction. We examined whether chronotropic incompetence was associated with myocardial injury after noncardiac surgery. Methods: This was a predefined analysis of an international cohort study where participants aged !40 yr underwent symptom-limited cardiopulmonary exercise testing before noncardiac surgery. Chronotropic incompetence was defined as the ratio of increase in HR during exercise to age-predicted maximal increase in HR <0.6. The primary outcome was myocardial injury within 3 days after surgery, defined by high-sensitivity troponin assays >99th centile. Explanatory variables were biomarkers for heart failure (ventilatory efficiency slope [minute ventilation/carbon dioxide production] !34; peak oxygen consumption 14 ml kg 1 min 1 ; HR recovery 6 beats min 1 decrease 1 min post-exercise; preoperative N-terminal pro-B-type natriuretic peptide [NT pro-BNP] >300 pg ml 1 ). Myocardial injury was compared in the presence or absence of sympathetic (i.e. chronotropic incompetence) or parasympathetic (i.e. impaired HR recovery after exercise) thresholds indicative of dysfunction. Data are presented as odds ratios (ORs) (95% confidence intervals). Results: Chronotropic incompetence occurred in 396/1325 (29.9%) participants; only 16/1325 (1.2%) had a heart failure diagnosis. Myocardial injury was sustained by 162/1325 (12.2%) patients. Raised preoperative NT pro-BNP was more
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Abbott et al. (2019) conducted a cohort in Noncardiac surgery patients with perioperative risk factors (n=1,325). Chronotropic incompetence (chronotropic index <0.6) vs. No chronotropic incompetence (chronotropic index ≥0.6) was evaluated on Myocardial injury within 3 days after surgery (OR 1.05, 95% CI 0.74-1.50, p=0.78). Preoperative chronotropic incompetence was not significantly associated with myocardial injury within 3 days after noncardiac surgery (OR 1.05, 95% CI 0.74-1.50, p=0.78).
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