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DOI: 10.1055/s-0032-1325922
Belastungsuntersuchungen und negative Chronotropie
Publikationsverlauf
Publikationsdatum:
20. Dezember 2012 (online)
![](https://www.thieme-connect.de/media/kardiologie-u2d/201204/lookinside/thumbnails/10.1055-s-0032-1325922-1.jpg)
Abstract
Chronotropic incompetence (CI) describes the inability of the heart to adequately increase its rate in response to increased activity or demand. Chronotropic incompetence is common in patients with cardiovascular disease, produces exercise intolerance, impairs quality of life, and is an independent predictor of major adverse cardiovascular events and overall mortality. The diagnosis of CI should take into account the confounding effects of aging, physical condition, and medications but can be achieved objectively with the use of widely available exercise testing methods and standardized definitions. The prognostic information of CI remains preserved in patients treated with β-Blockers. Therefore, the use of separate CI criteria for these patients does not appear necessary. The role of rate-adaptive pacing in patients with CI remains to be determined, although this technique showed promising results in small studies and individual patients. In addition, exercise training can reduce the extent of CI in patients with heart failure and thereby improve functional capacity and symptomatic state.
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Literatur
- 1 Balady GJ, Arena R, Sietsema K et al. Clinician’s guide to cardiopulmonary exercise testing in adults. A scientific statement from the American Heart Association. Circulation 2010; 122: 191-225
- 2 Löllgen H. Chronotrope Inkompetenz. Dt Ärztebl 1999; 96: A2089-A2092
- 3 Savonen KP, Kiviniemi V, Laukkanen JA et al. Chronotropic incompetence and mortality in middle-aged men with known or suspected coronary heart disease. Eur Heart J 2008; 29: 1896-1902
- 4 Brubaker PH, Kitzman DW. Chronotropic incompetence: causes, consequences, and management. Circulation 2011; 123: 1010-1020
- 5 Robergs RA, Landwehr R. The surprising history of the „HRmax=220-age“ equation. JEPonline 2002; 5: 1-10
- 6 Lauer MS, Okin PM, Larson MG et al. Impaired heart rate response to graded exercise. Prognostic implications of chronotropic incompetence in the Framingham Heart Study. Circulation 1996; 93: 1520-1526
- 7 Gulati M, Shaw LJ, Thisted RA et al. Heart rate response to exercise stress testing in asymptomatic women: the St. James women take heart project. Circulation 2010; 122: 130-137
- 8 Lauer MS, Francis GS, Okin PM et al. Impaired chronotropic response to exercise stress testing as a predictor of mortality. JAMA 1999; 281: 524-529
- 9 Dresing TJ, Blackstone EH, Pashkow FJ et al. Usefulness of impaired chronotropic response to exercise as a predictor of mortality, independent of the severity of coronary artery disease. Am J Cardiol 2000; 86: 602-609
- 10 Myers J, Tan SY, Abella J et al. Comparison of the chronotropic response to exercise and heart rate recovery in predicting cardiovascular mortality. Eur J Cardiovasc Prev Rehabil 2007; 14: 215-221
- 11 Khan MN, Pothier CE, Lauer MS. Chronotropic incompetence as a predictor of death among patients with normal electrograms taking beta blockers (metoprolol or atenolol). Am J Cardiol 2005; 96: 1328-1333
- 12 Hirsh BJ, Mignatti A, Garan AR et al. Effect of β-Blocker Cessation on Chronotropic Incompetence and Exercise Tolerance in Patients With Advanced Heart Failure. Circ Heart Fail 2012; 5: 560-565
- 13 Magrì D, Palermo P, Cauti FM et al. Chronotropic incompentence and functional capacity in chronic heart failure: no role of β-blockers and β-blocker dose. Cardiovasc Ther 2012; 30: 100-108
- 14 Phan TT, Shivu GN, Abozguia K et al. Impaired heart rate recovery and chronotropic incompetence in patients with heart failure with preserved ejection fraction. Circ Heart Fail 2010; 3: 29-34
- 15 Gwinn N, Leman R, Kratz J et al. Chronotropic incompetence: a common and progressive finding in pacemaker patients. Am Heart J 1992; 123: 1216-1219
- 16 Melzer C, Dreger H. Chronotropic incompetence: a never-ending story. Europace 2010; 12: 464-465
- 17 Armstrong HF, Gonzalez-Costello J, Jorde UP et al. The effect of lung volume reduction surgery on chronotropic incompetence. Respir Med 2012; 106: 1389-1395