Skip to main content
PMC home page
Clinical Cardiology logoLink to Clinical Cardiology
. 2006 Dec 5;28(1):25–29. doi: 10.1002/clc.4960280107

Heart rate response to graded exercise correlates with aerobic and ventilatory capacity in patients with heart failure

Alessandro Vallebona 1,✉, Guido Gigli 1, Sandro Orlandi 1, Giorgio Reggiardo 1
PMCID: PMC6654099  PMID: 15704528

Abstract

Background: Autonomic dysfunction and reduced exercise tolerance are typical features of patients with congestive heart failure (CHF). Baro‐chemoreflex balance and organ response may have a common role in conditioning exercise tolerance, ventilation, and chronotropic competence in patients with CHF.

Hypothesis: We tested the hypothesis that there is a relationship between functional capacity and chronotropic competence to exercise in CHF.

Methods: In all, 48 stable outpatients with CHF (age 65 ± 10 years, 41 men, NYHA class 2.1 ± 0, ejection fraction 31 ± 7%, peak VO2 16 ± 4 ml/kg/min) performed cardiopulmonary exercise testing (CPX). Heart rate (HR) response to exercise was assessed by the chronotropic index (CRI). The CRI was calculated by the following formula: CRI = peak HR ‐ rest HR/220 ‐ age ‐ rest HR × 100 (normal value > 80%). The relationship of CRI to peak oxygen consumption (VO2) and ventilation/carbon dioxide production (VE/VCO2) ratio was examined. A group of 33 healthy controls underwent CPX as well.

Results: The CRI correlated directly with peak VO2 (r = 0.638, p<0.001) and inversely with VE/VCO2 (r = −0.492, p < 0.001) in patients with CHF. A CRI< 78% identified patients with CHF and a peak VO2 < 20 ml/kg/min, area under the receiver operating curve (AUROC): 0.76,95% confidence interval (CI) 0.60–0.92. A CRI< 74% predicted exercise hyperventilation in CHF (AUROC: 0.71 for VE/VCO2 >30, 95% CI 0.53–0.88). The CRI was not significantly related either to peak VO2 or to VE/VCO2 in the control group.

Conclusions: In patients with mild to moderate CHF, CRI correlates with functional capacity. This relationship adds new data on pathophysiologic grounds and supports the routine incorporation of CRI into CPX interpretation.

Keywords: congestive heart failure, functional capacity, heart rate, chronotropic index

Full Text

The Full Text of this article is available as a PDF (37.7 KB).

References

  • 1. Packer M: The neurohormonal hypothesis: a theory to explain the mechanism of disease progression in heart failure. J Am Coll Cardiol 1992; 20: 248–254 [DOI] [PubMed] [Google Scholar]
  • 2. Notarius CF, Azevedo ER, Parker JD, Floras JS: Peak oxygen uptake is not determined by cardiac noradrenaline spillover in heart failure. Eur Heart J 2002; 23: 800–805 [DOI] [PubMed] [Google Scholar]
  • 3. Lang CC, Rayos GH, Chomsky DB, Wood AJJ, Wilson JR: Effect of sympathoinhibition on exercise performance in patients with heart failure. Circulation 1997; 96: 238–245 [DOI] [PubMed] [Google Scholar]
  • 4. Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH, Wilson JR: Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 1991; 83: 778–786 [DOI] [PubMed] [Google Scholar]
  • 5. Floras JS: Clinical aspects of sympathetic activation and parasympathetic withdrawal in heart failure. J Am Coll Cardiol 1993; 22: 72A–84A [DOI] [PubMed] [Google Scholar]
  • 6. Adamopoulos S, Piepoli M, McCance A: Comparison of different methods for assessing sympathovagal balance in chronic congestive heart failure secondary to coronary artery disease. Am J Cardiol 1992; 70: 1576–1582 [DOI] [PubMed] [Google Scholar]
  • 7. Guzzetti S, Cogliati C, Turiel M, Crema C, Lombardi F, Malliani A: Sympathetic predominance followed by functional denervation in the progression of chronic heart failure. Eur Heart J 1995; 16: 1100–1107 [DOI] [PubMed] [Google Scholar]
  • 8. Mortara A, La Rovere MT, Signorini MG: Can power spectral analysis of heart rate variability identify a high risk subgroup of congestive heart failure patients with excessive sympathetic activation? A pilot study before and after heart transplantation. Br Heart J 1994; 71: 422–430 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. Galinier M, Pathak A, Fourcade J, Androdias C, Curnier D, Varnous S, Boveda S, Massabuau P, Fauvel M, Senard JM, Bounhoure JP: Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failure. Eur Heart J 2000; 21: 475–482 [DOI] [PubMed] [Google Scholar]
  • 10. Colucci WS, Ribeiro JP, Rocco MB, Quigg RJ, Creager MA, Marsh JD, Gauthier DF, Hartley LH: Impaired chronotrophic response to exercise in patients with congestive heart failure. Circulation 1989; 80: 314–323 [DOI] [PubMed] [Google Scholar]
  • 11. Ponikowski P, Chua TP, Piepoli M, Ondusova D, Webb‐Peploe K, Harrington D, Anker SD, Volterrani M, Colombo R, Mazzuero G, Giordano A, Coats AJS: Augmented peripheral chemosensitivity as a potential input to baroreflex impairment and autonomic imbalance in chronic heart failure. Circulation 1997; 96: 2586–2594 [DOI] [PubMed] [Google Scholar]
  • 12. Narkiewicz K, Pesek CA, van de Borne PHJ, Kato M, Somers VK: Enhanced sympathetic and ventilatory response to central chemoreflex activation in heart failure. Circulation 1999; 100: 262–267 [DOI] [PubMed] [Google Scholar]
  • 13. Chua TP, Clark AL, Amadi AA, Coats AJS: Relation between chemosensitivity and the ventilatory response to exercise in chronic heart failure. J Am Coll Cardiol 1996; 27: 650–657 [DOI] [PubMed] [Google Scholar]
  • 14. Wang W, Chen JS, Zucher ICH: Carotid sinus baroreceptor sensitivity in experimental heart failure. Circulation 1990; 81: 1959–1966 [DOI] [PubMed] [Google Scholar]
  • 15. Ellenbogen KA, Mohanty PK, Szentpetery SS, Thames MD: Arterial baroreflex abnormalities in heart failure, reversal after orthotopic cardiac transplantation. Circulation 1989; 79: 51–58 [DOI] [PubMed] [Google Scholar]
  • 16. Piepoli M, Clark AL, Volterrani M, Adamopoulos S, Sleight P, Coats AJS: Contribution of muscle afferents to the hemodynamic, autonomic, and ventilatory responses to exercise in patients with chronic heart failure, effects of physical training. Circulation 1996; 93: 940–952 [DOI] [PubMed] [Google Scholar]
  • 17. Opasich C, Pinna GD, Bobbio M, Sisti M, Demichelis B, Febo O, Forni G, Riccardi R, Riccardi PG, Capomolla S, Corbelli F, Gavazzi L: Peak exercise oxygen consumption in chronic heart failure: Toward efficient use in the individual patient. J Am Coll Cardiol 1998; 31: 766–775 [DOI] [PubMed] [Google Scholar]
  • 18. Corrà U, Mezzani A, Bosimini E, Scapellato F, Imparato A, Giannuzzi P: Ventilatory response to exercise improves risk stratification in patients with chronic heart failure and intermediate functional capacity. Am Heart J 2002; 143: 418–426 [DOI] [PubMed] [Google Scholar]
  • 19. Wasserman K, Zhang YY, Gitt A, Belardinelli R, Koike A, Lubarsky L, Agostoni PG: Lung function and gas exchange in chronic heart failure. Circulation 1997; 96: 2221–2227 [DOI] [PubMed] [Google Scholar]
  • 20. Francis DP, Shamim W, Ceri Davies LC, Piepoli MF, Ponikowski P, Anker SD, Coats JS: Cardiopulmonary exercise testing for prognosis in chronic heart failure: Continuous and independent prognostic value from VE/VCO2 slope and peak VO2 . Eur Heart J 2000; 21: 154–161 [DOI] [PubMed] [Google Scholar]
  • 21. Fink LI, Wilson JR, Ferraro N: Exercise ventilation and pulmonary wedge pressure in chronic stable congestive heart failure. Am J Cardiol 1986; 57: 249–253 [DOI] [PubMed] [Google Scholar]
  • 22. Buller NP, Poole Wilson PA: Mechanism of the increased ventilatory response to exercise in patients with chronic cardiac failure. Br Heart J 1990; 63: 281–283 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23. American Society of Echocardiography Committee on standards, subcommittee on quantitation of two dimensional echocardiograms : Recommendations for quantitation of the left ventricle by two dimensional echocardiography. J Am Soc Echo 1989; 2: 358–367 [DOI] [PubMed] [Google Scholar]
  • 24. Weber KY, Janicki JS: Cardiopulmonary exercise testing for evaluation of chronic cardiac failure. Am J Cardiol 1985; 55: 22A–31A [DOI] [PubMed] [Google Scholar]
  • 25. Meyer K, Hajric R, West Brook S, Samek L, Lehmann M, Schwaibold M, Betz P, Roskamm H: Ventilatory and lactate threshold determinations in healthy normals and cardiac patients: Methodological problems. Eur J Appl Physiol 1996; 72: 387–393 [DOI] [PubMed] [Google Scholar]
  • 26. Robbins M, Francis G, Pashkow FJ, Snader CE, Hoercher K, Young JB, Lauer MS: Ventilatory and heart rate responses to exercise and better predictors of heart failure mortality than peak oxygen consumption. Circulation 1999; 100: 2411–2417 [DOI] [PubMed] [Google Scholar]
  • 27. Lauer MS, Okin PM, Larson MG, Evans JC, Levy D: Impaired heart rate response to graded exercise, prognostic implications of chronotropic incompetence in the Framingham heart study. Circulation 1996; 93: 1520–1526 [DOI] [PubMed] [Google Scholar]
  • 28. Litchfield RL, Kerber RE, Benge JW, Mark AL, Sopko J, Bhatnagar RK, Marcus ML: Normal exercise capacity in patients with severe left ventricular dysfunction: Compensatory mechanisms. Circulation 1982; 66: 129–134 [DOI] [PubMed] [Google Scholar]
  • 29. Dela F, Mohr T, Jensen CMR, Haahr HL, Secher NH, Sorensen FB, Kjaer M: Cardiovascular control during exercise, insights from spinal cord injured humans. Circulation 2003; 107: 2127–2133 [DOI] [PubMed] [Google Scholar]
  • 30. Metra M, Dei Cas L, Panina G, Visioli O: Exercise hyperventilation chronic congestive heart failure and its relation to functional capacity and hemodynamics. Am J Cardiol 1992; 70: 622–628 [DOI] [PubMed] [Google Scholar]
  • 31. Clark AL, Volterrani M, Swan JW, Coats AJR: The increased ventilatory response to exercise in chronic heart failure: Relation to pulmonary pathology. Heart 1997; 77: 138–146 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32. Wasserman K, Hansen JE, Sue DY, Whipp BJ, Casaburi R: Measurements during integrative cardiopulmonary exercise testing In Principles of Exercise Testing and Interpretation, p. 156 Philadelphia: Ed. Williams and Wilkins, 1999. [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES