Heart rate dynamics during a treadmill cardiopulmonary exercise test in optimized beta-blocked heart failure patients

Authors

  • Vitor Oliveira Carvalho Universidade de São Paulo; Faculdade de Medicina; Instituto do Coração; Laboratório de Insuficiência Cardíaca e Transplante
  • Guilherme Veiga Guimarães Universidade de São Paulo; Faculdade de Medicina; Instituto do Coração; Laboratório de Insuficiência Cardíaca e Transplante
  • Emmanuel Gomes Ciolac Universidade de São Paulo; Faculdade de Medicina; Instituto do Coração; Laboratório de Insuficiência Cardíaca e Transplante
  • Edimar Alcides Bocchi Universidade de São Paulo; Faculdade de Medicina; Instituto do Coração; Laboratório de Insuficiência Cardíaca e Transplante

DOI:

https://doi.org/10.1590/S1807-59322008000400011

Keywords:

Heart failure, Heart rate, Carvedilol, Exercise, Optimization

Abstract

BACKGROUND: Calculating the maximum heart rate for age is one method to characterize the maximum effort of an individual. Although this method is commonly used, little is known about heart rate dynamics in optimized beta-blocked heart failure patients. AIM: The aim of this study was to evaluate heart rate dynamics (basal, peak and % heart rate increase) in optimized beta-blocked heart failure patients compared to sedentary, normal individuals (controls) during a treadmill cardiopulmonary exercise test. METHODS: Twenty-five heart failure patients (49±11 years, 76% male), with an average LVEF of 30±7%, and fourteen controls were included in the study. Patients with atrial fibrillation, a pacemaker or noncardiovascular functional limitations or whose drug therapy was not optimized were excluded. Optimization was considered to be 50 mg/day or more of carvedilol, with a basal heart rate between 50 to 60 bpm that was maintained for 3 months. RESULTS: Basal heart rate was lower in heart failure patients (57±3 bpm) compared to controls (89±14 bpm; p<0.0001). Similarly, the peak heart rate (% maximum predicted for age) was lower in HF patients (65.4±11.1%) compared to controls (98.6±2.2; p<0.0001). Maximum respiratory exchange ratio did not differ between the groups (1.2±0.5 for controls and 1.15±1 for heart failure patients; p=0.42). All controls reached the maximum heart rate for their age, while no patients in the heart failure group reached the maximum. Moreover, the % increase of heart rate from rest to peak exercise between heart failure (48±9%) and control (53±8%) was not different (p=0.157). CONCLUSION: No patient in the heart failure group reached the maximum heart rate for their age during a treadmill cardiopulmonary exercise test, despite the fact that the percentage increase of heart rate was similar to sedentary normal subjects. A heart rate increase in optimized beta-blocked heart failure patients during cardiopulmonary exercise test over 65% of the maximum age-adjusted value should be considered an effort near the maximum. This information may be useful in rehabilitation programs and ischemic tests, although further studies are required.

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Published

2008-01-01

Issue

Section

Clinical Sciences

How to Cite

Carvalho, V. O., Guimarães, G. V., Ciolac, E. G., & Bocchi, E. A. (2008). Heart rate dynamics during a treadmill cardiopulmonary exercise test in optimized beta-blocked heart failure patients . Clinics, 63(4), 479-482. https://doi.org/10.1590/S1807-59322008000400011