Skip Navigation

European Heart Journal 2002 23(16):1301-1308; doi:10.1053/euhj.2001.3078
Copyright © 2002 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (8)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Kindermann, M.
Right arrow Articles by Fröhlig, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kindermann, M.
Right arrow Articles by Fröhlig, G.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Defining the optimum upper heart rate limit during exercise. A study in pacemaker patients with heart failure

M. Kindermanna,f1, B. Schwaabb, N. Finklera, S. Schallera, M. Böhma and G. Fröhliga

a Department of Internal Medicine, Division of Cardiology and Angiology, Universitätskliniken des Saarlandes, Homburg/Saar, Germany
b Curschmann-Clinic for Cardiovascular Diseases, Timmendorfer Strand, Germany

revised October 30, 2001; accepted November 7, 2001

Abstract

Aims There is no non-invasive method to determine the individual optimum of maximum exercise heart rate. Knowledge of this value is of particular interest in patients with structural heart disease who are prone to tachycardia intolerance. The purpose of this study was to define the optimal maximum heart rate using cardiopulmonary exercise testing and exercise Doppler echocardiography and to compare the results of both approaches.

Methods and Results In 49 pacemaker patients with chronotropic incompetence, the optimum upper heart rate limit was determined using cardiopulmonary exercise testing and exercise Doppler echocardiography. The optimum upper rate limit was given by the highest pacing rate which still produced an increase in oxygen consumption, or by that pacing rate which was linked to the lowest value for the Doppler-derived myocardial performance index. In patients with normal left ventricular ejection fraction (≥55%) the optimum upper rate limit was 86% of age-predicted maximum heart rate, in patients with left ventriuclar dysfunction (ejection fraction ≤45%) it was 75% of the age-predicted maximum rate (P=0·004). The optimum upper rate limit, as defined by cardiopulmonary exercise testing and exercise Doppler echocardiography, were closely correlated (P<0·0001) with a mean deviation of 6±6beats.min–1.

Conclusion Cardiopulmonary exercise testing and exercise Doppler echocardiography are valuable tools which help to determine the optimum upper rate limit in order to avoid excess heart rates in heart failure patients. The application of these methods is not limited to pacemaker patients but may be helpful in therapeutic interventions with chronotropic drugs. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.

Key Words: Heart rate, exercise, heart failure, cardiac pacing

f1 Correspondence: Michael Kindermann, MD, Innere Medizin III (Kardiologie/Angiologie), Universitätskliniken des Saarlandes, Kirrberger Straße, D 66421 Homburg/Saar, Germany.

References

  1. Higginbotham MB, Morris KG, Williams RS, McHale PA, Coleman RE, Cobb FR. Regulation of stroke volume during submaximal and maximal upright exercise in normal man. Circ Res. 1986;58:281–291[Abstract/Free Full Text]
  2. Alt EU, Schlegl MJ, Matula MM. Intrinsic heart rate response as a predictor of rate-adaptive pacing benefit. Chest. 1995;107:925–930[Abstract/Free Full Text]
  3. Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001;37:153–156[Abstract/Free Full Text]
  4. Brutsaert DL, Sys SU, Gillebert TC. Diastolic failure: pathophysiology and therapeutic implications. J Am Coll Cardiol. 1993;22:318–325[Abstract]
  5. Böhm M, La Rosée K, Schmidt U, Schulz C, Schwinger RHG, Erdmann E. Force-frequency relationship and inotropic stimulation in the nonfailing and failing human myocardium: implications for the medical treatment of heart failure. Clin Investig. 1992;70:421–425[ISI][Medline]
  6. Pieske B, Kretschmann B, Meyer M. Alterations in intracellular calcium handling associated with the inverse force-frequency relation in human dilated cardiomyopathy. Circulation. 1995;92:1169–1178[Abstract/Free Full Text]
  7. Alpert NR, Leavitt BJ, Ittleman FP, Hasenfuss G, Pieske B, Mulieri LA. A mechanistic analysis of the force-frequency relation in non-failing and progressively failing human myocardium. Basic Res Cardiol. 1998;93:23–32[CrossRef][ISI][Medline]
  8. Kjekshus J, Gullestad L. Heart rate as a therapeutic target in heart failure. Eur Heart J. 1999;1:64–69
  9. McElroy PA, Janicki JS, Weber KT. Physiologic correlates of the heart rate response to upright isotonic exercise: relevance to rate-responsive pacemakers. J Am Coll Cardiol. 1988;11:94–99[Abstract]
  10. Treese N, MacCarter D, Akbulut O. Ventilation and heart rate response during exercise in normals: relevance for rate variable pacing. PACE. 1993;16:1693–1700
  11. Kindermann M, Fröhlig G, Doerr T, Schieffer H. Optimizing the AV delay in DDD pacemaker patients with high degree AV block: mitral valve Doppler versus impedance cardiography. PACE. 1997;20:2453–2462
  12. Mehta D, Gilmour S, Ward DE, Camm AJ. Optimal atrioventricular delay at rest and during exercise in patients with dual chamber pacemakers: a non-invasive assessment by continuous wave Doppler. Br Heart J. 1989;61:161–166[Abstract/Free Full Text]
  13. Beaver WL, Wasserman K, Whipp BJ. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol. 1986;60:2020–2027[Abstract/Free Full Text]
  14. McElroy PA, Janicki JS, Weber KT. Cardiopulmonary exercise testing in congestive heart failure. Am J Cardiol. 1988;62:35A–40A[CrossRef][Medline]
  15. Ekelund LG, Holmgren A. Central hemodynamics during exercise. Circ Res. 1967;20/21:33–43
  16. Hansen JE, Sue DY, Wasserman K. Predicted values for clinical exercise testing. Am Rev Respir Dis. 1984;129:S49–S55[ISI][Medline]
  17. Tei C, Ling LH, Hodge DO. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function—a study in normals and dilated cardiomyopathy. J Cardiol. 1995;26:357–366[Medline]
  18. Zhou Q, Henein M, Coats A, Gibson D. Different effects of abnormal activation and myocardial disease on left ventricular ejection and filling times. Heart. 2000;84:272–276[Abstract/Free Full Text]
  19. Tei C, Nishimura RA, Seward JB, Tajik AJ. Noninvasive Doppler-derived myocardial performance index : correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr. 1997;10:169–178[CrossRef][ISI][Medline]
  20. Sowton E. Haemodynamic studies in patients with artificial pacemakers. Br Heart J. 1963;26:737–746
  21. Haltern G, Kempa L, Ochs JG, Hanrath P, Sigmund M. Chronic frequency-adaptive pacemaker therapy in patients with heart failure. Z Kardiol. 1995;84:834–843[ISI][Medline]
  22. Krüger S, Stellbrink C, Frielingsdorf J, Hermanns E, Sigmund M, Hanrath P. Value of spiro-ergometry and stress echocardiography on optimized programming of the upper frequency limit of dual chamber cardiac pacemakers. Z Kardiol. 1998;87:817–825[CrossRef][ISI][Medline]
  23. Feldman MD, Alderman JD, Aroesty JM. Depression of systolic and diastolic myocardial reserve during atrial pacing tachycardia in patients with dilated cardiomyopathy. J Clin Invest. 1988;82:1661–1669[ISI][Medline]
  24. Ng KS, Gibson DG. Impairment of diastolic function by shortened diastolic filling period in severe left ventricular disease. Br Heart J. 1989;62:246–252[Abstract/Free Full Text]
  25. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med. 1999;341:1351–1357[Abstract/Free Full Text]
  26. Owen CH, Esposito DJ, Davis JW, Glower DD. The effects of ventricular pacing on left ventricular geometry, function, myocardial oxygen consumption, and efficiency of contraction in conscious dogs. PACE. 1998;21:1417–1429

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 EuropaceHome page
C. Melzer, J. Witte, R. Reibis, H.J. Bondke, W. Combs, K. Stangl, G. Baumann, and H. Theres
Predictors of chronotropic incompetence in the pacemaker patient population.
Europace, January 1, 2006; 8(1): 70 - 75.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
H.-F. Tse, C.-W. Siu, K. L.F. Lee, K. Fan, H.-W. Chan, M.-O. Tang, V. Tsang, S. W.L. Lee, and C.-P. Lau
The Incremental Benefit of Rate-Adaptive Pacing on Exercise Performance During Cardiac Resynchronization Therapy
J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2292 - 2297.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (8)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Kindermann, M.
Right arrow Articles by Fröhlig, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kindermann, M.
Right arrow Articles by Fröhlig, G.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?