Abstract
Objective: Heart rate increase early after the initiation of exercise has not been characterized nor related to exercise capacity, heart rate recovery, and gas exchange analyses in patients with advanced heart failure. One hundred and forty-one patients including 121 patients randomized in the GREATER-EARTH trial were investigated. Methods: Exercise capacity was assessed using a treadmill ramp exercise protocol with gas exchange analyses, a fix-load endurance exercise protocol, and a 6-minute walk test. Heart rate increase was computed at 1-, 2- minutes, and 1/3 of exercise time while heart rate recovery was measured at 1- and 2-minutes following maximal exercise. Results: Heart rate increase early after the initiation of exercise test was not related to exercise capacity. In contrast, heart rate recovery was significantly related to maximal and submaximal exercise capacity. Among gas exchange responses, only the VE/VCO2 slope and PetCO2 at peak exercise were significantly associated with maximal but not submaximal exercise capacity. Conclusions: Heart rate increase early after the initiation of exercise yields no relationship with maximal and submaximal exercise capacity in patients with advanced heart failure. Among gas exchange parameters, only some markers of ventilatory inefficiency have significant associations with maximal exercise capacity in patients with heart failure.
Highlights
Heart rate increase at the onset of exercise testing has been associated with adverse outcomes in patients with or without documented coronary artery disease (CAD) [1,2]
Leeper et al [1] reported that a rapid initial heart rate increase was associated with an improved survival in a large cohort of subjects referred for clinical exercise testing while Falcone et al [2] reported that a rapid increase in heart rate at 1-minute following the initiation of exercise testing was associated with adverse outcomes in patients with documented CAD
Heart rates increase at 1-minute and at 1/3 of exercise times were lower when compared with report from Leeper et al Peak heart rate achieved during the submaximal exercise test was 101 bpm, equivalent to 87% of peak heart rate measured at peak exercise during the ramp exercise test
Summary
Heart rate increase at the onset of exercise testing has been associated with adverse outcomes in patients with or without documented coronary artery disease (CAD) [1,2]. The characterization of heart rate increase at the onset of exercise testing and its association with exercise capacity assessed concomitantly with gas exchange analyses and submaximal exercise duration have not been reported in a large cohort of patients with symptomatic heart failure. The relationships between heart rate increase, heart rate recovery, and functional capacity assessed both by maximal and submaximal exercise tests have not been investigated in a large cohort of patients with advanced heart failure with a wide QRS complex referred to CRT (cardiac resynchronization therapy) [14]. The secondary objective was to assess the relationship between maximal and submaximal exercise capacity and parameters with both heart rate increase and recovery in this study population
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