Chronotropic Incompetence and Abnormal Heart Rate Recovery Early after Left Ventricular Assist Device Implantation

Autor:	Stavros Drakos, Stavros Dimopoulos, Lambros Katsaros, Anthi Mpouchla, Serafim Nanas, Athanasios Tasoulis, Christos Manetos, John Terrovitis, Nikolaos Diakos, Eleni Tseliou
Rok vydání:	2011
Předmět:	Chronotropic medicine.medical_specialty business.industry medicine.medical_treatment Chronotropic incompetence Prosthesis Implantation General Medicine Abnormal heart rate equipment and supplies medicine.disease Autonomic nervous system Ventricular assist device Internal medicine Heart failure Heart rate medicine Cardiology Cardiology and Cardiovascular Medicine business
Zdroj:	Pacing and Clinical Electrophysiology. 34:1607-1614
ISSN:	0147-8389
DOI:	10.1111/j.1540-8159.2011.03215.x
Popis:	Background: Chronotropic response to exercise and heart rate recovery immediately after exercise (HRR1) are valid prognostic markers in patients with chronic heart failure (CHF). The aim of this study was to evaluate heart rate profile during and after exercise in CHF patients early after left ventricular assist device (LVAD) implantation. Methods: We enrolled seven stable consecutive CHF patients (five males, mean age: 45 ± 16 years) after 1 month of LVAD (HeartMate II; Thoratec Corp, Pleasanton, CA, USA) implantation, seven healthy subjects, and 14 patients with advanced HF (HF control group) who performed an incremental symptom-limited cardiopulmonary exercise testing (CPET). CHF patients performed CPET at 1 and 3 months after LVAD. HRR1 was defined as the HR difference from peak to 1 minute after exercise and chronotropic response to exercise as the chronotropic reserve ([CR, %]=[peak HR-resting HR/220-age-resting HR]× 100). Results: LVAD patients 3 months after implantation had a significantly different HR profile during exercise compared to healthy controls, with significantly lower CR (57 ± 31 vs 90 ± 14, %, P < 0.001) and HRR1 (14 ± 6 vs 28 ± 8, bpm, P < 0.01). HR profile during exercise did not significantly change 1 and 3 months after LVAD implantation. There was no statistical difference compared to HF control group and LVAD group regarding cardiopulmonary parameters. Conclusions: LVAD patients present an impaired CR and an abnormal HRR1 after implantation, indicating significant cardiac autonomic abnormalities. These alterations seem to remain unaltered 3 months after LVAD implantation. (PACE 2011; 34:1607–1614)
Databáze:	OpenAIRE
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