The heart failure (HF) syndrome is characterized by an autonomic unbalance with sympathetic hyperactivity, which contributes to increased myocardial oxygen demand, oxidative stress, peripheral vasoconstriction, afterload mismatch with a progressive desensitization, and down- regulation of cardiac beta 1-receptors. These changes, together with a few other structural and peripheral changes, lead to chronotropic incompetence (CI), such as the inability to increase heart rate (HR) consistently with activity or demand. Chronotropic incompetence, regardless of the method and cut-off adopted to define it, is associated with reduced exercise capacity and a worse prognosis. Furthermore, different pharmacological classes might interfere with the physiologic exercise-induced HR response, thus generating some confusion. In particular, the beta-blockers, albeit lowering peak HR, are known to improve prognosis and left ventricular inotropic reserve so that their withdrawal should be avoided at least in HF with reduced and mildly reduced ejection fraction. Similarly, a still debated strategy to counterbalance a blunted exercise-induced HR response is represented by rate-adapting pacing. The present review, besides supplying an overview on possible CI definitions, discusses the clinical impact of CI and potential pharmacological and non-pharmacological therapeutic strategies.

Chronotropic Incompetence across Heart Failure Categories / D. Magrì, M. Piepoli, G. Gallo, E. Fiori, M. Correale, A. Attanasio, M. Beltrami, A. Lauretti, A. Palazzuoli, P. Agostoni. - In: EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY. - ISSN 2047-4873. - (2024), pp. 1-10. [Epub ahead of print] [10.1093/eurjpc/zwae348]

Chronotropic Incompetence across Heart Failure Categories

M. Piepoli
Secondo
;
P. Agostoni
Ultimo
2024

Abstract

The heart failure (HF) syndrome is characterized by an autonomic unbalance with sympathetic hyperactivity, which contributes to increased myocardial oxygen demand, oxidative stress, peripheral vasoconstriction, afterload mismatch with a progressive desensitization, and down- regulation of cardiac beta 1-receptors. These changes, together with a few other structural and peripheral changes, lead to chronotropic incompetence (CI), such as the inability to increase heart rate (HR) consistently with activity or demand. Chronotropic incompetence, regardless of the method and cut-off adopted to define it, is associated with reduced exercise capacity and a worse prognosis. Furthermore, different pharmacological classes might interfere with the physiologic exercise-induced HR response, thus generating some confusion. In particular, the beta-blockers, albeit lowering peak HR, are known to improve prognosis and left ventricular inotropic reserve so that their withdrawal should be avoided at least in HF with reduced and mildly reduced ejection fraction. Similarly, a still debated strategy to counterbalance a blunted exercise-induced HR response is represented by rate-adapting pacing. The present review, besides supplying an overview on possible CI definitions, discusses the clinical impact of CI and potential pharmacological and non-pharmacological therapeutic strategies.
Heart failure; Chronotropic incompetence; Heart rate response
Settore MEDS-07/B - Malattie dell'apparato cardiovascolare
2024
13-nov-2024
Article (author)
File in questo prodotto:
File Dimensione Formato  
zwae348.pdf

accesso riservato

Tipologia: Publisher's version/PDF
Dimensione 776.65 kB
Formato Adobe PDF
776.65 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/1116568
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? 0
social impact