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Resting heart rate, peak heart rate and heart rate reserve in heart failure patients and heart transplant patients; HR-heart rate
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One way of defining an individual's heart effort is to calculate the maximum heart rate to be expected given their age, but the reinnervation seen in patients who have received heart transplants makes for different calculations from patients who have suffered heart failure. The purpose of this study is to evaluate heart rate dynamics (rest, peak an...
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Context 1
... subjects performed a satisfactory cardiopul- monary exercise test (respiratory exchange ratio 1.05 ± 0.06 in heart failure patients and 1.11 ± 0.1 in heart transplant patients; p = 0.08). The basal heart rate was lower in optimized beta-blocked heart failure patients (58 ± 5 bpm) compared to heart transplant patients (93 ± 11 bpm; p < 0.0001; Fig. 1), as also seen with peak heart rate (percenta- ge of maximum heart rate predicted for age; 60 ± ± 13% for heart failure and 80 ± 12 for heart trans- plantation; p < 0.0001; Fig. 2). No patients reached the maximum heart rate predicted for their age. Mo- reover, heart rate reserve was not different betwe- en the groups (p = 0.644; Fig. ...
Context 2
... subjects performed a satisfactory cardiopul- monary exercise test (respiratory exchange ratio 1.05 ± 0.06 in heart failure patients and 1.11 ± 0.1 in heart transplant patients; p = 0.08). The basal heart rate was lower in optimized beta-blocked heart failure patients (58 ± 5 bpm) compared to heart transplant patients (93 ± 11 bpm; p < 0.0001; Fig. 1), as also seen with peak heart rate (percenta- ge of maximum heart rate predicted for age; 60 ± ± 13% for heart failure and 80 ± 12 for heart trans- plantation; p < 0.0001; Fig. 2). No patients reached the maximum heart rate predicted for their age. Mo- reover, heart rate reserve was not different betwe- en the groups (p = 0.644; Fig. ...
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Citations
... The alterations could be related to an accidental change in the velocity of impulse spreading the excitations in the myocardium tissue with the regular rhythm issued by the sinoatrial node. The minor occurrence of sequences of accelerations or decelerations in the HTX patients may be a manifestation of the effect of slow acceleration and deceleration ability after the HTX, verified, for example, by tests measuring the exercise capacity (Carvalho et al., 2009(Carvalho et al., , 2013. Such a slow dynamics could be realized by patterns with "0, " namely patterns of a0a or d0d type are likely to be more common among the HTX patients than in the healthy group. ...
It is commonly believed that higher values of heart rate variability (HRV) indices account for better organization of the network of feedback reflexes driving an organism's response to actual bodily needs. In order to evaluate this organization in heart transplant (HTX) recipients, 58 nocturnal Holter signals of 14 HTX patients were analyzed. Their dynamical properties were evaluated by short-term HRV indices and measures grounded on entropy. Estimates grouped according to the patients' clinical progress: free of complications versus with complications, and arranged in order of the length of time since the HTX, lead us to the conclusion that higher HRV is associated with a worse outcome for HTX patients. Moreover, short-term HRV indices that are constant, rather than increasing over time, serve well in the prognosis of the future state of a HTX patient. These findings suggest that increases observed in HRV indices are related to erratic rhythms resulting from remodeling of the cardiac tissue (including heterogeneous innervation) in long-term HTX patients. Therefore, we hypothesize that dynamical landscape markers (entropy and fragmentation measures together with the short-term HRV indices) can serve as a tool in the exploration of the genesis of (non-respiratory sinus) arrhythmia.
... Contudo, Carvalho et al. [20] defenderam que é indispensável a prescrição de exercícios aeróbicos adequados, respeitando o limiar de VO 2 máximo, a fim de obter controle dos riscos relacionados ao exercício, bem como o aumento na capacidade do paciente em realizar o exercício. Os autores observaram que, após aplicar o protocolo conservador de reabilitação em 15 pacientes transplantados, houve uma redução da taxa do VO 2 pico em aproximadamente 80% do normal e na frequência cardíaca de reserva que se manteve em 50 batimentos por minuto. ...
Introdução: O frequente êxito do transplante cardíaco faz com que este se apresente como a primeira opção de tratamento na falência cardíaca. Objetivo: Investigar as hipóteses de condutas fisioterapêuticas que compõem a fase III de um programa de reabilitação cardíaca em pacientes submetidos ao transplante cardíaco. Métodos: Trata-se de um estudo de revisão bibliográfica, no qual foram utilizados artigos científicos em português e inglês de revistas indexadas nos bancos de dados Bireme, Pubmed e Comut, nas bases de dados Medline, Scielo e Lilacs, publicados entre os anos de 1998 a 2015. Discussão: Os protocolos ambulatoriais encontrados obtiveram uma diferença em função dos objetivos a curto, médio e longo prazo propostos para o paciente como, por exemplo, em relação í intensidade do treino aeróbico, que variou de 60 a 80%, a frequência das sessões que variaram de três a cinco vezes por semana, e a duração da sessão que variou de 45 a 65 minutos. Conclusão: A fase ambulatorial inclui exercícios de flexibilidade, exercícios aeróbicos e de fortalecimento muscular e exercícios respiratórios e os estudos relatam resultados positivos como melhora do consumo de oxigênio, diminuição da frequência cardíaca em repouso e melhora da capacidade funcional.Palavras-chave: transplante de coração, exercício, reabilitação, Fisioterapia.Â
... These findings are supported by a study from our center [21] , in which we documented a high degree of normalization of chronotropic responses within 6 mo after HTx. This occurred earlier and with a higher degree of normalization than demonstrated by others [2,24,62,[67][68][69] . The high degree of normalization during the first year after HTx [21] was confirmed in a different long-term HTx population in the previously discussed HIT-intervention study [18] . ...
While life expectancy is greatly improved after a heart transplant, survival is still limited, and compared to the general population, the exercise capacity and health-related quality of life of heart transplant recipients are reduced. Increased exercise capacity is associated with a better prognosis. However, although several studies have documented positive effects of exercise after heart transplantation (HTx), little is known about the type, frequency and intensity of exercise that provides the greatest health benefits. Moreover, the long-term effects of exercise on co-morbidities and survival are also unclear. Exercise restrictions apply to patients with a denervated heart, and for decades, it was believed that the transplanted heart remained denervated. This has since been largely disproved, but despite the new knowledge, the exercise restrictions have largely remained, and up-to-date guidelines on exercise prescription after HTx do not exist. High-intensity, interval based aerobic exercise has repeatedly been documented to have superior positive effects and health benefits compared to moderate exercise. This applies to both healthy subjects as well as in several patient groups, such as patients with metabolic syndrome, coronary artery disease or heart failure. However, whether the effects of this type of exercise are also applicable to heart transplant populations has not yet been fully established. The purpose of this article is to give an overview of the current knowledge about the exercise capacity and effect of exercise among heart transplant recipients and to discuss future exercise strategies.
... Taking into account that HR reserve [11] was higher in late recipients, what might refl ect the reinnervation process, and that HR reserve was not correlated to peak VO 2 in late heart transplant recipients, we hypothesized that peripheral components could be playing an important role in the low exercise capacity in late recipients. Cardiac reinnervation does not seem to be the only component involved in exercise capacity over the years following heart transplantation, once late recipients are also chronically taken immunosuppressive drugs that are related to impaired muscle function. ...
The aim of this study was to compare peak oxygen consumption (VO2), heart rate (HR) reserve and HR recovery in early and late heart transplant recipients. Moreover, we also aimed to correlate peak VO2 and HR reserve.
Fivteen heart transplant recipients (8 early and 7 late), 8 ± 3 and 161 ± 58 months after transplantation, respectively, performed a cardiopulmonary exercise test.
Early heart transplant recipients showed lower HR reserve compared to late heart transplant recipients, 39 ± 15 vs. 58 ± 19 bpm (p = 0.049), respectively. Peak VO2 (23.4 ± 4 vs. 21.8 ± 5 mL/kg/min, p = 0.56), VO2 respiratory compensation point (18.7 ± 2 vs. 18.5 ± 4 mL/ /kg/min, p = 0.48) and time of exercise testing (14 ± 3 vs. 13 ± 3 min, p = 0.95) %age- -predicted peakVO2 (65 ± 12 vs. 70 ± 10%, p = 0.24) were not different between the groups. Moreover, peak VO2 and %age-predicted peakVO2 correlated with HR reserve only in early heart transplant recipients (r = 0.89, p = 0.003 and r = 0.71, p = 0.04, respectively). Early heart transplant recipients increased HR (2.5 ± 2.0% at fi rst minute and 0.7 ± 2.3% at the second minute), while late recipients decreased HR (-6.0 ± 4.7 at fi rst minute and -15.5 ± 2.4 at the second minute) at the recovery period of cardiopulmonary exercise test.
Exercise capacity did not show difference between early and late heart transplant recipients. HR reserve was higher in late compared to early recipients. HR reserve only correlated with peak VO2 in early recipients. Moreover, only late heart transplant recipients showed decrease in HR during the recovery period of cardiopulmonary exercise test.
... In a study by our group, we tested the heart transplant recipient's chronotropic response during a cardiopulmonary exercise test, expressed by the percentage of age-predicted heart rate. We observed that those studied heart transplantation recipients had a chronotropic reserve by achieving 80% of the age-predicted heart rate [33]. This finding may reflect the process of partial reinnervation that occurred along the 5.4 years of the heart transplant recipients. ...
Heart transplantation is a gold-standard treatment for selected patients in the terminal stages of heart failure and it can improve patients' quality of life, exercise capacity, and survival. Despite of the exercise performance in heart transplant recipients increases with respect to pre-transplantation, it still remains subnormal when compared with healthy subjects. Exercise training is an important nonpharmacological tool in heart transplant recipients to improve the exercise capacity, muscle strength, quality of life, and the chronotropic response. Despite this there is no consensus about what methods of aerobic exercise prescription are more adequate.
The purpose of this review is to provide an up-to-date summary of the direct and indirect methods of prescription of aerobic exercise training in heart transplant recipients.
The indirect methods of aerobic exercise prescription seem to be very frail and they do not seem to be reliable in heart transplant recipients.
... It is well known that the lower resting heart rate could predict the exercise capacity status [8]. Despite this, healthy subjects reach the maximum age-predicted heart rate during the exercise test [9][10][11], what suggests that this sympathetic blockade induced by exercise training does not affect the peak heart rate, as carvedilol seems to do in heart failure patients. ...
... Minute ventilation, oxygen uptake, carbon dioxide output and other cardiopulmonary variables were acquired breath-by-breath by a comput-erized system (Vmax 229 model, SensorMedics, Yorba Linda, CA, USA). Resting oxygen consumption and heart rate were computed as the mean of the final 30 seconds of the resting period (standing position) [7,[9][10][11], while peak effort (peak of oxygen consumption) and peak heart rate were the mean values of the final 30 seconds of effort before exhaustion. The respiratory exchange ratios were recorded as the averaged samples obtained during each stage of the protocol used (modified Naughton protocol to heart failure patients, Balke 4.0 to healthy sedentary subjects and Ellestad to athletes). ...
In recent years, beta-blocker therapy has become a primary pharmacologic intervention in patients with heart failure by blocking the sympathetic activity. To compare the exercise training's sympathetic blockade in healthy subjects (athletes) and the carvedilol's sympathetic blockade in sedentary heart failure patients by the evaluation of the heart rate dynamic during an exercise test. A total of 26 optimized and 49 nonoptimized heart failure patients in a stable condition (for, at least, 3 months), 15 healthy athletes and 17 sedentary healthy subjects were recruited to perform a cardiopulmonary exercise test. The heart rate dynamic (rest, reserve, peak and the peak heart rate in relation to the maximum predicted for age) was analyzed and compared between the four groups. The heart rate reserve was the same between optimized (48 +/- 15) and nonoptimized (49 +/- 18) heart failure patients (P < 0.0001). The athletes (188 +/- 9) showed a larger heart rate reserve compared to sedentary healthy subjects (92 +/- 10, P < 0.0001). Athletes and healthy sedentary reached the maximum age-predicted heart ratefor their age, but none of the heart failure patients did. The carvedilol's sympathetic blockade occurred during the rest and during the peak effort in the same proportion, but the exercise training's sympathetic blockade in healthy subjects occurred mainly in the rest.
... Heart failure is considered to be the last stage of heart disease and is a cause of worldwide mortality and morbidity [5, 6]. It is characterized by a persistent activation of the neurohormonal system [7], endothelial dysfunction [8, 9] , exercise intoler- ance101112, high mortality [13] and a poor quality of life [14]. The recommended treatment for heart failure (HF) patients is divided into non-drug and drug therapy. ...
Physical activity (PA) has proven benefits in the primary prevention of heart diseases such as heart failure (HF). Although it is well known, HF PA habits and physicians' advice have been poorly described. The aim of this study was to investigate if physicians were advising HF patients to exercise and to quantify patients' exercise profiles in a complex cardiology hospital.
All 131 HF patients (80 male, average age 53 +/- 10 years, NYHA class I-V, left ventricular ejection fraction 35 +/- 11%, 35 ischemic, 35 idiopatic, 32 hypertensive and 29 with Chagas disease) went to the hospital for a HF routine check-up. On this occasion, after seeing the physician , we asked the patients if the physician had advised them about PA. Then, we asked them to fill in the international physical activity questionnaire (IPQA) Short Form to classify their PA level.
Our data showed a significant difference between patients who had received any kind of PA advice from physicians (36%) and those who had not (64%, p<0.0001). Using the IPAQ criteria, of the 36% of patients who had received advice, 12.4% were classified as low and 23.6% as moderate. Of the 64% of patients who did not receive advice, 26.8% were classified as low and 37.2% as moderate. Etiology (except Chagas), functional class, ejection fraction, sex and age did not influence the PA profile.
Physicians at a tertiary cardiology hospital were not giving patients satisfactory advice as to PA. Our data supports the need to strengthen exercise encouragement by physicians and for complementary studies on this area.
While life expectancy is greatly improved after a heart transplant, survival is still limited, and compared to the general population, the exercise capacity and health-related quality of life of heart transplant recipients are reduced. Increased exercise capacity is associated with a better prognosis. However, although several studies have documented positive effects of exercise after heart transplantation (HTx), little is known about the type, frequency and intensity of exercise that provides the greatest health benefits. Moreover, the long-term effects of exercise on co-morbidities and survival are also unclear. Exercise restrictions apply to patients with a denervated heart, and for decades, it was believed that the transplanted heart remained denervated. This has since been largely disproved, but despite the new knowledge, the exercise restrictions have largely remained, and up-to-date guidelines on exercise prescription after HTx do not exist. High-intensity, interval based aerobic exercise has repeatedly been documented to have superior positive effects and health benefits compared to moderate exercise. This applies to both healthy subjects as well as in several patient groups, such as patients with metabolic syndrome, coronary artery disease or heart failure. However, whether the effects of this type of exercise are also applicable to heart transplant populations has not yet been fully established. The purpose of this article is to give an overview of the current knowledge about the exercise capacity and effect of exercise among heart transplant recipients and to discuss future exercise strategies.
Partial normalization of the heart rate (HR) response can take place some time after heart transplantation (HTx), but the extent to which this occurs, its time course, and functional significance remain unclear.
Seventy-seven heart transplantation patients underwent an exercise test at approximately 1, 6, and 12 mos after heart transplantation, consisting of a resting period, a submaximal exercise test, and a maximal exercise test with stair climbing, followed by a recovery period. An HR monitor was used for continuous surveillance of HR.
During the follow-up, HR at rest did not change, whereas all other HR parameters obtained during and after exercise improved, demonstrating a more rapid increase, a higher peak, and a more rapid decline in HR after stopping exercise. Age-predicted maximum HR at baseline was 73% ± 9%, improving to 83% ± 10% at 6 mos (P < 0.001) and to 90% ± 10% at 12 mos (P < 0.001), whereas the Chronotropic Response Index at baseline was 0.49 ± 0.15, improving to 0.67 ± 0.17 at 6 mos (P < 0.001) and to 0.81 ± 0.23 at 12 mos (P < 0.001).
Partial normalization of HR was achieved by 71% of heart transplantation patients at 12 mos, with significant changes occurring within 6 mos in most subjects. These findings should contribute to reducing the exercise restrictions that apply to the denervated heart.
We sought to evaluate the neurohormonal activity in heart transplant recipients and compare it with that in heart failure patients and healthy subjects during rest and just after a 6-minute walking test.
Despite the improvements in quality of life and survival provided by heart transplantation, the neurohormonal profile is poorly described.
Twenty heart transplantation (18 men, 49+/-11 years and 8.5+/-3.3 years after transplantation), 11 heart failure (8 men, 43+/-10 years), and 7 healthy subjects (5 men 39+/-8 years) were included in this study. Blood samples were collected immediately before and during the last minute of the exercise.
During rest, patients' norepinephrine plasma level (659+/-225 pg/mL) was higher in heart transplant recipients (463+/-167 pg/mL) and healthy subjects (512+/-132), p<0.05. Heart transplant recipient's norepinephrine plasma level was not different than that of healthy subjects. Just after the 6-minute walking test, the heart transplant recipient's norepinephrine plasma level (1248+/-692 pg/mL) was not different from that of heart failure patients (1174+/-653 pg/mL). Both these groups had a higher level than healthy subjects had (545+/-95 pg/mL), p<0.05.
Neurohormonal activity remains increased after the 6-minute walking test after heart transplantation.
